Biventricular pacing as alternative therapy for dilated cardiomyopathy associated with congenital heart disease.

Biventricular, alternative, and multisite pacing are currently being explored to improve cardiac function among patients with medically refractory, end-stage dilated cardiomyopathies. Although, due to inherent myocardial abnormalities, patients with repaired congenital heart defects may be at a greater risk than others to develop heart failure, often requiring cardiac transplantation. The efficacy of biventricular pacing among these patients is unknown. This report presents a patient with successfully repaired congenital heart disease in infancy who developed a symptomatic dilated cardiomyopathy at 22 years of age. Following biventricular pacing, systemic ventricular function showed a 14% improvement in ventricular dP/dt. One month later, subjective symptoms improved and cardiac ultrasound illustrated a 125% increase in fractional area of change. Exercise stress testing showed a 17% improvement in aerobic work capacity.

A study of the electron paramagnetic resonance properties of single monoclinic crystals of bovine superoxide dismutase.

Monoclinic crystals of native bovine superoxide dismutase and its monocyano derivative were studied by means of electron paramagnetic resonance spectroscopy. Through computer simulation of the spectra, the directions of the principal axes of the magnetic tensors (g and A) have been found with respect to the crystal principal axes and with respect to the positions of atoms bear the Cu(II) as previously determined by x-ray crystallography (Richardson, J. S., Thomas, K. A., and Richardson, D. C. (1975) Biochem. Biophys. Res. Commun. 63, 986-992; Tainer, J. A., Getzoff, E. D., Richardson, J. S., and Richardson, D. C. (1980) in 2SOD: Cu, Zn-Superoxide Dismutase Complete Atomic Coordinates (Richardson, D. C., and Richardson, J. S., eds) Brookhaven Protein Structure Data Bank). In the native protein, the direction of the gz axis of Cu(II) was found to lie perpendicular to the rough plane formed by the four imidazole nitrogen atoms coordinated to the Cu(II). The direction of gy is approximately along the His 44N-Cu-His 46N direction, and gx is in the direction of the Cu-His 61-Cu-N bond. The A is coaxial with g within 15 degrees C. A substantial shift occurs in the direction of gz when CN- binds to the Cu(II), suggesting a change in the coordination configuration of the metal.

The relationship between sodium excretion and renin secretion by the perfused kidney.

The effect of altered tubular sodium reabsorption on renin secretion (RSR) was examined under conditions in which other factors influencing renin release could be controlled or excluded. To do this, isolated canine kidneys were perfused at constant pressure with blood circulating from donor animals. Volume expansion or hemorrhage of the donor dogs produced large changes in the animal's blood pressure, renal function, sodium excretion (UNaV), and RSR, but were without effect on renal hemodynamics, UNaV, or RSR in the perfused kidney. Hemodilution without volume expansion, resulted in hypotension, decreased UNaV and increased RSR in the donor dogs, and increased UNaV and suppressed RSR in the perfused kidney. These effects of hemodilution in the perfused kidney were partially reversed when plasma protein concentration was restored to control levels with hyperoncotic albumin, and, overall, there was a significant inverse relationship between electrolyte excretion and RSR. These results provide new evidence for the hypothesis that the rate at which sodium is delivered to the macula densa is an important determinant of the rate of renin secretion.