Direct operations for the management of life-threatening ischemic ventricular tachycardia.

UNLABELLED: Between June 1978 and 1986, 93 consecutive patients underwent electrophysiologically guided operations for life-threatening recurrent sustained ventricular tachycardia mostly associated with other surgical procedures, such as left ventricular resection (aneurysmectomy) and coronary artery bypass grafting. DATA: Eighty-seven percent of the surviving patients were free of spontaneous ventricular tachycardia return or sudden death 1 year after the operation and 77% at 5 years. The instantaneous risk of ventricular tachycardia return was highest immediately after operation, declined rapidly, and by 2 weeks postoperatively had merged with the constant hazard phase, which persisted as long as the patients were observed. Endocardial resection, rather than encircling endocardial myotomy, increased the risk of spontaneous ventricular tachycardia return/sudden death. Survival rates, including hospital deaths, were 95% at 30 days, 89% at 1 year, and 70% at 5 years after operation. The most prevalent mode of death was heart failure. The absence of anterolateral left ventricular aneurysms and the use of more extended encircling incisional techniques for ventricular tachycardia ablation increased the risk of early and late death. Survival was particularly poor in that subset of patients in whom recurrent sustained ventricular tachycardia returned after operation; the most prevalent mode of death in this group was also progressive left ventricular failure. Inferences: (1) Complete and partial encircling endocardial myotomy incisions are the most effective surgical techniques for malignant ventricular tachycardia ablation. (2) Because of their adverse effects on left ventricular structure and function, the arrhythmogenic tissues have to be localized as precisely as possible, and the encompassing incisions should be kept as limited as possible. (3) The late return of ventricular tachycardia may be more related to a progressive ischemic left ventricular cardiomyopathy than to an inadequate operation.

[Effect of molsidomine on hemodynamics in patients with dilated cardiomyopathy]. / Der Effekt von Molsidomin auf die Hämodynamik bei Patienten mit dilatativer Kardiomyopathie.

The effect of 4 mg Molsidomine iv. followed by a continuous infusion of 3 mg per hour for 3 hours on arterial blood pressure, pulmonary artery pressure, cardiac index, peripheral and pulmonary vascular resistance and heart rate was evaluated in eleven patients suffering from chronic heart failure caused by non-ischaemic dilatative cardiomyopathy (NYHA II-III). A significant decrease in systemic blood pressure, systolic and mean pulmonary artery pressure and pulmonary wedge pressure was observed and also a marked decrease in total peripheral and pulmonary vascular resistance. There was a slight, but not significant increase in cardiac index. The heart rate did not change significantly. Treatment had to be stopped in one patient because of side effects (hypotension, nausea).