[Prevalence of dangerous arrhythmia during pharmacological stress echocardiography]. / Czestosc wystepowania groznych zaburzen rytmu podczas farmakologicznej echokardiografii obciazeniowej.

UNLABELLED: Pharmacological stress echocardiography (SE) has become a routine diagnostic and prognostic method in patients with ischemic heart disease. However, all stress tests can provoke undesirable adverse effects including dangerous arrhythmia. The aim of the study was to access the prevalence and types of arrhythmia that can appear during SE. MATERIALS AND METHODS: A retrospective study included the cohort of patients studied using SE in our Department of Cardiology between 1995 and 2002. We followed the data of 836 patients (pts) (615 men, aged 52 +/- 5 yrs). Dobutamine SE was performed in 695 pts (83.2%) and dipyridamole SE in a group of 141 pts (16.8%). Additionally, atropine was administrated to achieve submaximal heart rate in a group of 694 pts (83%). 519 pts (62%) underwent SE was performed according to high dose protocol and in 317 pts (35%)--low dose protocol. RESULTS: During SE the following arrhythmia events were observed: one persistent ventricular tachycardia (0.12%) and two paroxysmal atrial fibrillation (0.24%) in dobutamine test. The set of unsustained ventricular tachycardia in six patients (0.72%) 5 patients from dobutamine group and 1 from dipyridamole group). Complex forms of ventricular extrasystoles (as bigeminy and trigeminy) in 46 pts (5.5%) 43 in dobutamine SE and 3 in dipyridamole SE. All arrhythmias were mild and withdrew spontaneously or after beta-blockers administration. CONCLUSIONS: The risk of dangerous arrhythmia during either dobutamine SE or dipyridamole SE is small and similar in both groups. Dobutamine SE tends to provoke of mild arrhythmia (p = 0.075) more often.

Arterial dysfunction in syndrome X: results of arterial reactivity and pulse wave propagation tests.

OBJECTIVE: To assess arterial distensibility using pulse wave velocity (PWV) measurements and its relation with endothelium dependent vasodilatation (EDV) in patients with cardiological syndrome X. METHODS: The study group consisted of 92 patients: 52 with syndrome X (34 women, 18 men, mean (SD) age 45 (3) years) and 40 healthy volunteer controls (27 women, 13 men, mean (SD) age 41 (2) years) without risk factors of atherosclerosis and with negative ECG exercise test and normal proximal coronaries on transoesophageal echocardiography. Patients with arterial hypertension, diabetes mellitus, valvar disease, or cardiomyopathy were excluded. PWV measured by a Complior Colson device was calculated for each patient. EDV was assessed from two dimensional Doppler measurement using an Acuson Sequoia with 8 MHz linear transducer at rest, during postischaemic reactive hyperaemia, and after an oral dose of 400 micro g of glyceryl trinitrate. RESULTS: PWV was significantly higher in patients with syndrome X than in healthy subjects (9.3 (0.7) m/s v 8.2 (0.9) m/s, respectively, p < 0.001). Baseline brachial artery diameter was similar in the syndrome X and control groups (4.0 (0.6) mm v 4.08 (0.64) mm, NS). EDV was impaired in patients with syndrome X compared with controls (6.6 (3.0)% v 11.1 (3.9)%, p < 0.001). Endothelium independent vasodilatation was similar in both groups. In patients with syndrome X there was a positive correlation between PWV and the degree of EDV (r = 0.864, p < 0.001). The cut off value for PWV was 8.5 m/s, with a sensitivity of 62% and a specificity of 91%. CONCLUSIONS: EDV but not glyceryl trinitrate induced vasodilatation is decreased in patients with syndrome X. There is a strong correlation between PWV and the degree of endothelial dysfunction of peripheral arteries in patients with syndrome X. PWV assessment may be useful to identify abnormal vascular physiology in these patients.

Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study.

AIMS: To establish whether the addition of enoxaparin (a low-molecular-weight heparin) to streptokinase therapy improves early and sustained coronary patency and clinical outcome in patients with evolving myocardial infarction. METHODS AND RESULTS: A total of 496 patients with acute myocardial infarction treated with streptokinase were randomized to an intravenous bolus (30 mg) and subcutaneous injections (1mg x kg(-1), twice daily) of enoxaparin (n=253), or placebo (n=243) for 3-8 days. The median duration of treatment in both groups was 5 days. ST-segment resolution at 90 min and 180 min measured by electrocardiogram was improved in patients receiving enoxaparin. Complete, partial and no ST-segment resolution at 180 min was observed in 36%, 44% and 19% in the enoxaparin group vs 25%, 44% and 31% in the placebo group, respectively (P=0.004). Assessment of the primary end-point revealed improved TIMI-3 flow with enoxaparin vs placebo (70% vs 58%, P=0.01). Combined TIMI-2 and -3 flow was also improved (88% vs 72%, P=0.001), as was TIMI frame count (P=0.003). The triple clinical end-point of death, reinfarction and recurrent angina at 30 days was reduced with enoxaparin (13% vs 21%, P=0.03). CONCLUSION: Streptokinase in combination with enoxaparin is associated with better ST-segment resolution and better angiographic patency at days 5-10, suggesting more effective reperfusion. This was associated with a significant reduction in clinical events, indicating less reocclusion.

Efficacy and safety of dofetilide in the prevention of symptomatic episodes of paroxysmal supraventricular tachycardia: a 6-month double-blind comparison with propafenone and placebo.

BACKGROUND: Existing drug therapies for paroxysmal supraventricular tachycardia (PSVT) have potentially serious adverse effects. Dofetilide, a pure class III antiarrhythmic agent, may offer an effective and safe alternative for treating PSVT. This study compared the efficacy and safety of dofetilide with that of propafenone and placebo in the prevention of PSVT. METHODS: This multicenter, randomized, placebo-controlled, parallel-group study compared the effectiveness of oral dofetilide 500 microg given twice daily with that of propafenone 150 mg given 3 times a day and placebo in preventing the recurrence of PSVT in 122 symptomatic patients. Episodes of PSVT were documented by symptom diaries and Hertcard (Hertford Medical, Hertfordshire, UK) event recorders. RESULTS: After 6 months of treatment, patients taking dofetilide, propafenone, and placebo had a 50%, 54%, and 6% probability, respectively, of remaining free of episodes of PSVT (P <.001 for both dofetilide and propafenone vs placebo). Both dofetilide and propafenone also decreased the frequency of episodes of PSVT; the median numbers of episodes in the dofetilide- and propafenone-treated groups were 1 and 0.5, respectively, compared with 5 in the placebo-treated group. Dofetilide was well tolerated; no proarrhythmia occurred. Three patients taking propafenone had serious treatment-related adverse effects that required drug discontinuation. CONCLUSIONS: Dofetilide and propafenone were equally effective in preventing the recurrence of or decreasing the frequency of PSVT.

Symptomatic atrial pacemaker lead thrombosis: detection by echocardiography and successful surgical treatment.

Formation of thrombi on a permanent pacemaker lead is a rare complication of pacing. However, because of its serious outcome it should be suspected in a patient who reveals right-sided heart failure, dyspnea, or syncope. An early decision to perform an echocardiographic examination, followed by surgical or thrombolytic treatment can solve this clinical problem. In a 69-year-old woman with increasing signs of congestive heart failure, echocardiography revealed a mobile mass in the right atrium attached to the pacemaker lead. Because of threatened symptoms and large dimensions of the mass, urgent surgical removal of the endocardial lead was successfully performed.

Definition of flow parameters in proximal nonstenotic coronary arteries using transesophageal Doppler echocardiography.

Transesophageal echocardiography (TEE) enables the visualization of proximal coronary arteries. We investigated the feasibility of coronary flow evaluation using TEE, as well as to define flow parameters found in normal proximal coronary arteries. The subgroups of patients with normal proximal segments of coronary arteries were selected from the cohort of 210 patients undergoing routine coronary angiography. The left main coronary artery (LMCA), proximal segment of left anterior descending coronary artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA) were analyzed separately in 147, 64, 53, and 70 patients, respectively. Proximal coronary arteries were evaluated in the transverse plane using a 5-MHz TEE probe, and the flow in normal arteries was registered using pulsed-wave Doppler. The registration of flow with pulsed-wave Doppler was feasible in 88% of studies for the LMCA, 85% for the LAD, 58% for the LCx, and 65% for the RCA. Normal flow was laminar with distinct phasic character (diastolic predominance). Mean +/- SD values of peak coronary flow velocity were (systole/diastole) for the LMCA, 36 +/- 11/71 +/- 19 cm/sec; the LAD, 31 +/- 9/67 +/- 19 cm/sec; the LCx, 36 +/- 13/75 +/- 24 cm/sec; and the RCA, 25 +/- 8/39 +/- 12 cm/sec. Peak diastolic coronary flow velocity was most significantly correlated with heart rate. Doppler evaluation of proximal coronary flow is feasible using TEE in the majority of patients. The knowledge of normal flow values, which is different for the left and the right coronary artery, provides the background for proper interpretation of flow in diseased coronary arteries.

[Use of harmonic echocardiographic contrast imaging and intravenous bolus of Levovist for evaluation of the left ventricle]. / Zastosowanie harmonicznej echokardiografii kontrastowej z dozylnym podaniem Levovistu do oceny lewej komory serca.

Harmonic imaging is a new imaging modality using nonlinear acoustic response, which is particularly sensitive for the particles of contrast agents. Our study was designed to compare the potential of harmonic echocardiographic imaging of the left ventricle using a contrast agent, Levovist to improve the detection of endocardium in patients with suboptimal image quality. 40 patients were studied using standard transthoracic apical views of the left ventricle patients using fundamental frequency and second harmonic frequency after and intravenous injection of 2.5 g Levovist. The quality of endocardial delineation in 16 standard segments was scored from 0 to 2. Endocardial visualization index was calculated as a mean of the scores to express overall diagnostic quality. Harmonic imaging with contrast significantly improved left ventricular endocardial border detection (endocardial visualization index at baseline 1.24 +/- 0.41, with contrast 1.63 +/- 0.38; p < 0.001). The improvement was qualitatively observed in all parts of the left ventricle: in apex (2.4 +/- 0.8), in the middle part (2.5 +/- 0.9) and slightly less in the basal part (2.1 +/- 1.1) as scored on a 0-3 scale. The number of invisible segments decreased from 124 (fundamental) to 50 in contrast harmonic mode. The persistence of the contrast enhancement, prolonged in harmonic as compared to fundamental imaging (284 +/- 136s vs 117 +/- 87s; p < 0.001) enabled convenient recording of all necessary views. Harmonic imaging after an intravenous injection of Levovist significantly improves the visualization of left ventricular endocardial border. Prolonged contrast effect after a single bolus enhances the pertinence of the method in clinical practice.

[Which medical treatment can minimize late complications after pharmacologic treatment of unstable angina?]. / Jakie leczenie farmakologiczne minimalizuje odlegle powiklania po zachowawczym leczeniu niestabilnej choroby wiencowej?

UNLABELLED: Current pharmacological treatment of unstable coronary diseases has significantly reduced the rate of early and late complications. Aim of this study was to investigate the impact of in-hospital and ambulatory treatment on the occurrence of late complications in patients with unstable angina treated conservatively. The study group consisted of consecutive 79 patients hospitalized in our Department on the turn of years 1998-1999 (48 men--age 62 +/- 11 years), followed up by at least 1 year. We analyzed the administered agents on the first day of hospitalization: acetylsalicylic acid, heparin, nitroglycerin, beta-adrenergic agents, calcium channels blockers, statins and ACE inhibitors, as well these drugs prescribed for ambulatory management. At least one complication (recurrent hospitalization due to coronary artery disease, unstable angina pectoris, myocardial infarction, need for revascularization or death) occurred in 57 patients (72%) in a follow-up of 16 +/- 3 months. The following drugs significantly reduced rate of late complications (OR--odds ratio, CI--confidence interval, p--significance level):--intravenous heparin during hospitalization: OR = 0.22; CI = 0.12-0.42; p = 0.007;--acetylsalicylic acid administration during hospitalization: OR = 0.42; CI = 0.22-0.77; p = 0.03;--acetylsalicylic acid prescribed for ambulatory treatment: OR = 0.24; CI = 0.13-0.46; p = 0.05. CONCLUSIONS: Heparin and acetylsalicylic acid treatment seems to reduce the number of late complications in patients treated conservatively for the episode of unstable angina.

[Atrial fibrillation in mitral valve disease--risk factors]. / Migotanie przedsionków w wadach zastawki dwudzielnej--czynniki ryzyka.

UNLABELLED: Atrial fibrillation is frequently found in association with rheumatic mitral valve disease. However, the risk factors of atrial fibrillation have not been well established. The aim of this study was to assess risk factors of atrial fibrillation in patients with mitral valve disease. METHODS: The study group consisted of 141 patients (pts) with isolated mitral valve disease. Pts were divided into 3 groups (45 pts--mitral stenosis, 29 pts--mitral regurgitation, 67 pts--combined mitral valve disease). Mean age--52.5 years. Atrial fibrillation before operation was in 102 pts (72.3%). The clinical history of each patient was taken to obtain the patient's age, likely etiology of the valve lesion time of onset of atrial fibrillation. Echocardiografic and electrocardiografic records were performed in each patient. RESULTS: In all three groups of patients age and left atrial size were the most important factors of atrial fibrillation (atrial fibrillation was rare when left atrial dimension was below 40 mm). CONCLUSIONS: Atrial fibrillation was strongly associated with mitral stenosis and combined mitral disease. The most important factors of atrial fibrillation was age, left atrial dimension and hemodynamic class.

[A comparison of titers of immunoglobulins A and G reacting with Helicobacter pylori antigens in patients with unstable angina and symptomless blood donors]. / Porównanie mian immunoglobulin klasy IgG oraz IgA reagujacych z antygenami Helicobacter pylori w grupie pacjentów z niestabilna choroba wiencowa i w grupie zdrowych krwiodawców.

The aim of the study was to estimate the prevelance and distribution of titers of immunoglobulins IgA and IgG reacting with glycine extract of Helicobacter pylori antigens in the group of patients with unstable angina and in the group of symptomless blood donors. The sera of 30 patients and 33 healthy individuals (blood donors) were assessed using ELISA test. Comparing the results from these two groups we observed that distributions of IgG antibodies were not concordant: the higher titers were more typical for the group ++of patients with unstable angina then for blood donors. This suggests that intensive humoral response on H. pylori antigens may play a role in aggravation of symptoms of coronary artery atherosclerosis.

Coronary anomalies diagnosed with transesophageal echocardiography: complementary clinical value in adults.

INTRODUCTION: Coronary arteriography remains a gold standard for the evaluation of coronary anatomy. In the case of anatomical anomalies, understanding of vessel course based upon a coronary angiogram may be difficult. Transesophageal echocardiography is a noninvasive method allowing tomographic visualization of proximal coronary arteries. Experience concerning its usefulness for the assessment of anomalous coronary arteries is limited. MATERIAL: Eleven patients with confirmed coronary anomalies studied between 1993-96 were identified in the cohort of those undergoing transesophageal echocardiography. RESULTS: Transesophageal echocardiography revealed potentially serious anomalies (origin of left or right coronary artery from contralateral aortic sinus) in 3 patients and benign in 8. Coronary ostia and proximal course could be delineated in all patients. Anatomical information was consistent between methods, except for a separate origin of the left anterior descending and circumflex artery, where the angiogram missed a very short common left main coronary artery in 2 patients. The relationship between the coronary arteries, aorta and pulmonary trunk was better defined by the echocardiogram. Doppler flow analysis allowed us to exclude anomaly-related flow disturbances. CONCLUSIONS: Transesophageal echocardiography can be considered as a noninvasive technique with the potential for anatomical and functional evaluation of anomalous proximal coronary arteries and deserves a routine use whenever such a condition is suspected. This approach may simplify invasive procedures in this patient group.

Early and long-term outcome of aortic valve replacement with homograft versus mechanical prosthesis--8-year follow-up study.

BACKGROUND: Aortic valve disease is an important and frequent clinical problem with a mortality rate as high as 50-80% in a 5-year natural history of patients with severe aortic valve disease. Biological or mechanical prosthesis implantation is the only way to improve prognosis. HYPOTHESIS: The aim of our study was to assess the clinical outcome of aortic valve replacement according to the underlying valve pathology and the type of replacement device, that is, aortic homografts versus mechanical prostheses. METHODS: The study group consisted of 143 patients with a mean follow-up period of 4.1 +/- 2.7 years. All patients had annual clinical and Doppler echocardiographic evaluation. RESULTS: Total 8-year mortality was 4.9% (7/143) including early mortality of 1.4%. Eight-year survival probability was not significantly higher in the homograft than in the mechanical prosthesis recipients. No differences were found among subgroups with aortic stenosis, insufficiency, and combined disease. Overall early and late complication rate (13.3 and 24.8%, respectively) was similar in homograft and mechanical valve recipients. The most common late complications were ventricular arrhythmia (10%) (Lown class I-III), predominantly in the homograft recipients (17.7 vs. 3.7%), and heart failure (9.2%), more frequent in mechanical valve recipients (14.8 vs. 1.6%). Thromboembolic events occurred in 6.3%, infective endocarditis in 4.2% (more common in mechanical valve recipients), serious bleeding in 3.7% (only in mechanical valve recipients). There was no significant difference in early and late complication rate among subgroups (aortic stenosis, insufficiency, and combined disease). Of the patients studied, 91.6% improved in functional status after surgery, with significantly better outcome in homograft recipients. The type of preexisting valve disease did not influence clinical improvement. CONCLUSION: Early and late mortality as well as estimated probability of survival and hemodynamic improvement at 8-year follow-up after aortic valve replacement are independent of the type of implanted valve. Complication rate does not depend upon the type of preexisting valve pathology, but severe late complications are more common after mechanical valve implantation than after homograft implantation.

Regression of left ventricular dilatation and hypertrophy after aortic valve replacement.

The aim of the study was to assess the influence of aortic valve replacement on left ventricular size and muscle hypertrophy according to the type of preexisting valve disease (aortic stenosis, insufficiency or combined disease). The study group consisted of 143 consecutive patients (pts) after aortic valve replacement (109 men, 34 women, mean age 48.1 +/- 10.9 years). Reason for the operation was aortic stenosis in 35 pts, aortic insufficiency in 64 pts and combined disease in 44 pts. Echocardiography was performed before surgery, 1 month and 1 year after operation, and yearly during 5-year follow-up. Transvalvular aortic pressure gradients decreased significantly after valve replacement in all subsets without further changes during follow-up (Pmax (mmHg): from 54.2 +/- 20.7 to 17.9 +/- 9.6 in combined disease pts, from 72.3 +/- 19.9 to 21.6 +/- 14.6 in aortic stenosis and from 34.5 +/- 24.2 to 15.6 +/- 11.3 in aortic insufficiency pts, respectively, P < 0.0005). One year after surgery the diastolic dimension of the left ventricle decreased significantly in all subjects, whereas the systolic dimension only in aortic insufficiency and combined disease pts (from 44 +/- 11.8 to 31.6 +/- 5.4 mm, P < 0.001 and from 41.9 +/- 11.5 to 33 +/- 6.7 mm, P < 0.05, respectively). Further decrease of both diastolic and systolic dimensions was observed only in the aortic insufficiency group. Ejection fraction of left ventricle increased only in combined disease pts (from 51.6 +/- 10% to 56.8 +/- 8.2%, P < 0.05). Wall thickness of the left ventricle decreased 1 year after valve replacement only in the aortic stenosis group and in further follow-up in the aortic stenosis and combined disease group. Normalization of left ventricular size is observed in more than 90% of patients during 5-year follow-up as opposed to left ventricular muscle hypertrophy, regressed only in less than a half of the study population. In patients with aortic valve disease the greatest hemodynamic improvement is observed 1 year after valve replacement. This is expressed by marked reduction of the left ventricular dimensions and wall thickness, without significant improvement of the ejection fraction. Further regression of left ventricle dimensions occurs in patients operated on due to predominant valve insufficiency, whereas regression of left ventricular hypertrophy is observed in patients with preexisting valvular stenosis.

Ischaemic episodes detected by early exercise test and Holter monitoring after myocardial infarction: which are of most prognostic value?

BACKGROUND: The aim of this study was to assess the significance of ST-segment depressions (ST-SD) detected during exercise test or Holter monitoring and to determine which parameters of ST-SD are the most important prognostic factors in patients after myocardial infarction. METHODS: The study group consisted of 164 patients (126 men and 38 women) who survived their first uncomplicated myocardial infarction. Twenty-four-hour Holter monitoring on day 10 (+/- 2) after infarction and a treadmill exercise test 1 or 2 days later were performed. The following parameters of ST-SD were taken into consideration: amplitude, localization according to the area of infarction and presence or absence of concomitant angina. Patients were observed for 24 months to assess the occurrence of new cardiac events. RESULTS: In 78 patients (group I) ST-SD were detected in both Holter monitoring and the exercise test, and in 32 patients (group II) in the exercise test only. Fifty-four patients (group III) were without ST-SD. During follow-up there were 83 cardiac events in group I, 24 in group II and 16 in group III (P < 0.01, group I versus II; P < 0.0001, group I versus III; P < 0.05, group II versus III). In multivariate analysis the presence of ST-SD during Holter monitoring or the exercise test, or both, appeared to be of most prognostic significance (P < 0.0001). The number of new cardiac events was significantly higher in patients with painful ST-SD greater than 3 mm, detected outside the area of infarction (distant ischaemia). CONCLUSIONS: This study shows a significant prognostic value of early post-infarction ischaemia detected by Holter monitoring and an exercise test. Distant, painful ST-SD greater than 3 mm were more powerful determinants of poor prognosis than others. Electrode placement during Holter monitoring appears to be very important, particularly in post-infarction patients.

Right ventricular outflow tract obstruction by cardiac metastasis as the first manifestation of follicular thyroid carcinoma.

A 40-year-old man was sent to the echocardiographic laboratory because of a heart murmur. An intracardiac mass, causing obstruction of flow within right ventricle, was diagnosed and the patient was referred to surgery. Histologic examination classified the mass as a metastasis of highly differentiated follicular carcinoma of the thyroid gland. Thyroidectomy was performed and radioiodine treatment instituted. Thus echocardiographic identification of right ventricular outflow obstructing mass was the initial presentation of follicular carcinoma of the thyroid gland. Early detection of this moderately disseminated malignancy allowed for surgical excision and systemic radioactive iodine treatment.

[Analysis of risk factors for coronary disease in women with their first acute myocardial infarction]. / Analiza czynników zagrozenia choroba niedokrwienna serca u kobiet z pierwszym zawalem miesnia sercowego.

Based on the analysis of the results of the investigation performed in 92 women hospitalized between 1989 and 1992 with the first acute myocardial infarction (AMI), frequency of coronary artery disease (CAD) risk factors was assessed with attention to the patient's age. It was proved that in women under 44 yrs the most common factors are: cigarette smoking, family history of CAD or myocardial infarction (MI), decreased levels of HDL-cholesterol and hypertriglyceridemia. In older age there are: hypercholesterolemia, decreased levels of HDL-cholesterol, hypertriglyceridemia, arterial hypertension, obesity and diabetes mellitus. Furthermore, some differences in the frequency of CAD risk factors between the both sexes were noted. In women under 44 yrs cigarette smoking, significant family history, decreased levels of HDL-cholesterol and hypertriglyceridemia occurred more often than in men. In women above 56 yrs we found significantly higher levels of total cholesterol and triglycerides, lower levels of HDL-cholesterol, higher frequency of hypertension, diabetes and obesity, compared to men.

[Comparison of the effectiveness of olicard 40 retard and cardonit 40 prolongatum preparations in treatment of stable coronary heart disease]. / Porównanie skutecznosci preparatów Olicard 40 retard i Cardonit 40 prolongatum w leczeniu stabilnej choroby wiencowej.

The purpose of the work was a comparison of the effectiveness of representatives of two subgroups of nitrates: Olicard 40 (isosorbide mononitrate) and Cardonit 40 (isosorbide dinitrate) in the treatment of ischaemic heart disease. The studied group consisted of 52 patients with stable coronary heart disease who were given for 30 days according to "blind trial" rules either Cardonit 40 or Olicard 40 in single daily dose. The effects of the treatment were monitored, assessing the parameters during three exercise tests and two 24-hour records by the Holter method. The advantage of Olicard 40 was demonstrated, expressed by higher effectiveness in the treatment of coronary heart disease (especially its "silent" form) without development of tachyphylaxis and with lower per cent of adverse reactions.

[Heart rupture in the course of acute transmural myocardial infarction]. / Pekniecie serca w przebiegu ostrego, pelnosciennego zawalu serca.

The purpose of the work was an assessment of the incidence of heart rupture as the complication of acute transmural myocardial infarction, and establishing of risk factors. In a retrospective study, among 150 patients hospitalized in the department in the years 1982-1992 and dying in the course of acute transmural myocardial infarction, in whom postmortem examination was done, 19 cases complicated with heart rupture were found. The analysis was carried out on the basis of autopsy results and clinical documentation. The studied group included 12 women (63.2%) and 7 men (36.8%). Most frequently encountered were ruptures of the free wall of the left ventricle (n = 12). The risk factors are: age over 60 years, female sex, arterial hypertension, left ventricular hypertrophy and the first myocardial infarction without earlier coronary complaints.

[Transesophageal echocardiograph in the evaluation of proximal segments of coronary arteries]. / Echokardiografia przezprzelykowa w ocenie proksymalnych odcinków naczyn wiencowych.

The study was undertaken to assess the usefulness of TEE for evaluation of morphology and flow in coronary arteries. TEE (2D, spectral and color Doppler imaging) and coronary angiography were performed in 75 patients (pts)-41 with valvular heart disease and 34 with ischemic heart disease. Proximal coronary artery stenosis was detected by coronarography in 11 pts (9--left main coronary artery, 2--right coronary artery). TEE visualization of proximal coronary arteries was possible in all pts. Echocardiographic features of artery stenosis were: the narrowing of the vessel in 2D image (9 pts), high flow velocity spectral Doppler (4 pts, mean 135 cm/s vs 55 cm/s in normal arteries) and mosaic, turbulent flow in color Doppler (10 pts). Sensitivity and specificity of TEE for coronary artery stenosis detection was respectively 81%/98% for 2D imaging and 90%/100% for color Doppler. TEE is a new, noninvasive and safe method for the evaluation of proximal coronary arteries. Detection of LMCA stenosis prior to catheterization may enhance the safety of coronary angiography.