[Non-invasive assessment of the efficacy of long-term vasodilator therapy of cardiac decompensation in patients with dilated cardiomyopathy]. / Neinvazívne sledovanie úcinnosti dlhodobej vazodilatacnej liecby srdcovej dekompenzácie u pacientov s dilatacnými kardiomyopatiami.

In 18 patients (14 men, 4 women, in the age of 37-52 years, mean = 43 years) with dilated cardiomyopathy allocated into NYHA functional classification groups III-IV, the efficacy of ambulatory long term (mean = 6 years) vasodilator therapy by means of non-invasive methods was evaluated. NITRO-MACK retard (venodilator) in the dosage of 20 mg per day and DIHYDRALAZIN (arteriodilator) in the dosage of 100-200 mg per day were combined simultaneously with continuous administration of cardiotonics and diuretics. Vasodilator therapy had a favourable effect on systolic and diastolic function of the left ventricle with the mostly marked effect at the beginning of treatment. Amidst non-invasive parameters, the diastolic amplitude time index and left ventricular hypertrophy-dilatation index had the greatest prognostic value regarding the treatment efficacy and survival of patients. This objective evidence of the efficacy of vasodilator therapy in patients with dilated cardiomyopathy coincided with the improvement of clinical status, subjective relief, moderation of decompensation, and thus with the improvement of life quality. (Fig. 1, Tab. 4, Ref. 24.).

[Indications for cardiac surgery on the basis of noninvasive examination methods with major emphasis on echocardiography]. / Indikácie kardiochirurgického výkonu na základe neinvazívnych vysetrovacích metód s hlavným zretel'om na echokardiografiu.

Over the years 1983-1988 cardiosurgical procedures with extracorporeal circulation without catheterization of the heart were indicated in 191 patients, representing 19.8% of all the patients operated on at extracorporeal circulation (n--962). Indications for surgery were made on the basis of the clinical state of the patient and of the results of noninvasive methods, with main emphasis on echocardiographic findings. The close relationship between the methodological level of ultrasound diagnosis and the increasing number of patients operated on without preceding hemodynamic examination is documented (13% in 1983, 35% in 1988). With a few exceptions, noninvasive techniques provide a sufficient amount of relevant information definitely deciding on the indication for operation without catheterization in heart tumors and infective endocarditis, in about one half of the patients with dissecting aneurysm of the aorta and with deranged function of valvular prostheses, in one third of the patients with mitral defects, and in about one third of the patients with atrial septal defects. On the basis of their own results, the authors present the criteria for indicating cardiosurgical procedures without catheterization of the heart in the diagnoses studied. The diagnostic conclusion was confirmed by the operative finding in 99.5%. The obtained results are comparable with those reported by authors from abroad and demonstrate the significant medical and economic contribution.

[Valvular defects in advanced age]. / Problematika chlopnových chýb vo vyssom veku.

Based on many years experience with the diagnosis and treatment of valvular defects in advanced age the authors present a review of the problem with emphasis on non-rheumatic degenerative damage of the cardiac valves and valvular apparatus. They draw attention to the reliability of non-invasive examination methods and prefer their routine use in cardiological geriatric practice. As regards therapeutic procedures, they draw attention to more progressive methods of treatment of valvular defects in old age such as percutaneous, transluminal balloon valvuloplasty of the aortic valve, open valvuloplasty of the mitral valve and replacement of damaged valves by prostheses, in particular biological ones. Finally the authors stress the importance of investigations of the pathology and clinical aspects of valvular diseases in old age as one of the ways of careful preparation for better health care of old people in future.

The first heart sound abnormalities accompanied with alteration of systolic time intervals in incipient heart failure.

A phonocardiological analysis of the first heart sound was made and systolic time intervals were measured in 40 patients (ischaemic heart disease, hypertensive heart disease, cardiomyopathies) with incipient cardiac failure (functional groups I--II according to the NYHA) with auscultatory changes of the first heart sound and in controls of randomly selected healthy persons or patients in whom cardiopulmonary disease was excluded. The patients in all diagnostic groups differed significantly (P less than 0.05--0.001) in practically all the phonocardiographic indicators from the controls. The most constant abnormal finding was a pathological split of the first heart sound which may be divided into three phonocardiographic forms. Simultaneously, systolic time intervals alterations (P less than 0.02--0.001) were also found in these patients and indicated a lowered performance of the left ventricle. The results suggest that 1) a certain relation exists between systolic time intervals and the phonocardiographic pattern of the first heart sound in patients with cardiovascular diseases and those without it; 2) the modified (pathologically splitted and prolonged) first heart sound could be a sign of incipient cardiac failure.