Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair.

BACKGROUND: In patients with mild to moderate functional tricuspid regurgitation (TR) and absence of right ventricular dysfunction or tricuspid annulus (TA) dilatation, there is currently no indication for concomitant tricuspid valve (TV) repair during elective mitral valve (MV) surgery. However, long-term results are conflicting. Here, we sought to determine the clinical outcome of this cohort, the rate of TR progression after MV surgery and the role of MV aetiology. METHODS: Patients for elective MV surgery without concomitant TV repair were retrospectively analysed with longitudinal echocardiographic and clinical follow-up, focusing on TR progression and MV aetiology. Linear regression analysis was performed for change in TR at follow-up, using pre-determined variables and confounders. RESULTS: In total 204 patients without TV repair were analysed. Development of more than moderate TR after a median of 3.1 [1.6-4.6] years was rarely seen: only in 2 out of 161 patients (1.2%) with known TR grade at follow-up. Overall, median preoperative and late postoperative TR grade were equal (p = 0.116). Subanalysis showed no significant difference in MV aetiology subgroups. Preoperative TR grade and male gender were inversely correlated to change in TR. Mortality was not influenced by the 1­year postoperative TR severity. CONCLUSION: Our data showed that in a study population of patients with mild to moderate TR undergoing MV surgery without concomitant TV repair, significant late TR was rarely seen. Based on our study, it is safe to waive concomitant TV repair in this specific patient cohort.

[Use of sumatriptan (Imigran) in a female patient with coronary spasm]. / Gebruik van sumatriptan (Imigran) bij een patiënte met coronaire spasmus.

Sumatriptan (Imigran), an effective drug against symptoms of migraine may cause a sensation of thoracic oppression. In some patients, this is accompanied by ECG alterations. In such cases, the underlying mechanism is probably coronary spasm, although this has never been demonstrated angiographically. The case is described of a young woman who was hospitalized after resuscitation because of ventricular fibrillation. One week previously, after subcutaneous administration of sumatriptan, she had had chest pains for half an hour. A spasm provocation test during coronary angiography gave a positive result. The patient was treated with a calcium antagonist following which she remained free of symptoms. In patients with chest pain after administration of sumatriptan, it is necessary to use this drug cautiously; spasm of the coronary arteries as a cause should be excluded.

P wave recognition and atrial stimulation with fractally iridium coated VDD single pass leads.

UNLABELLED: The bottleneck of VDD systems is the reliable detection of the small atrial signals by a floating atrial electrode. Fractally iridium coated electrodes offer excellent sensing and pacing performance. In this study, the performance of such a floating atrial lead in P wave sensing and synchronous ventricular stimulation was examined. Atrial pacing was also used as a test of atrial wall contact. PATIENTS AND METHODS: A fractally iridium coated VDD lead was implanted in 18 patients. In 15 patients it was interfaced with a VDD pacemaker and in 3 patients with a DDD system depending on the P wave amplitude measured acutely (> or = 2 mV). Simultaneous recordings of the surface ECG and pacemaker telemetry were used to analyze P wave amplitudes and AV synchrony in different body positions, and during normal and deep breathing. Additionally, exercise tests based on daily life activities and 24-hour ECG monitoring were performed to test the pacemaker function. RESULTS: During implantation P wave amplitudes were 1.86 mV +/- 1.08 mV (range 0.5-4.9 mV) and during follow-up (6.6 +/- 5.6 weeks) 0.18-3.8 mV. Holter recordings revealed reliable P wave sensing at a sensitivity setting of 0.5 mV (95.5%). P wave sensing was further improved by a higher atrial sensitivity. AV synchronous pacing > or = 99.9% was achieved in all patients. In 7 patients the atrial electrode could be positioned close to the atrial wall enabling atrial stimulation thresholds at an average of 4.3 volts. CONCLUSION: This fractally iridium coated VVD lead allowed consistent and reliable P wave sensing at an atrial sensitivity as low as 0.5 mV in selected patients.