[Causes of occurrence of wave V of pulmonary wedge pressure in patients with acquired heart valve diseases]. / Przyczyny pojawiania sie fali V cisnienia kapilarnego plucnego u chorych z nabytymi zastawkowymi wadami serca.

It is believed that a significant V wave in pulmonary capillary wedge pressure (PWP) is a sign of mitral regurgitation. Of 358 patients with acquired valvular heart disease in 24-cases a significant V wave (15 mm Hg of PWP) was recorded during right heart catheterization. All patients underwent right heart catheterization with a flow- directed, balloon-tipped, thermodilution catheters (Edwards Labs). Mean pulmonary, capillary wedge, and right atrial pressures were monitored and recorded. Cardiac output was determined by thermodilution technique using iced 5% dextrose. After measurements of flow, pulmonary and systemic resistance morphology of V wave from PWP recordings was assessed. We measured dp/dt of the ascending limb of V wave and Libanoff and Rodbard V wave index (dp/dt:CI). Nine patients with significant V wave had no signs of mitral regurgitation and had mainly significant mitral stenosis (group III). Group II (6 patients) consisted of patients with different combinations of acquired left heart valve disease and mitral regurgitation. Group I (9 pts) consisted of patients with isolated mitral regurgitation. There were no differences in right atrial, pulmonary, and capillary wedge pressures, cardiac index, pulmonary and systemic valvular resistance among groups I, II and III. There were significant differences as far as dp/dt V wave was concerned (gr I--136 +/- 31.4, gr II--112.2 +/- 30.7, gr III--72.7 +/- 31.2 mm Hg/s). Libanoff's index of V wave was also significantly different in all three groups--gr I--12.7 +/- 6.2; gr II--8.0 +/- 2.3; gr III--4.8 +/- 1.7 mm Hg/s). It seems that V wave in PWP recordings is not only a sign of mitral regurgitation, but also could be a sign of decreased pulmonary veins compliance.

[Effect of intravenous administration of nitroglycerin and regitine on hemodynamics in mitral valve insufficiency]. / Wplyw dozylnego podania nitrogliceryny i regityny na hemodynamike w niedomykalnosci mitralnej.

During exercise in subjects with congestive heart failure and mitral regurgitation the rise in systemic arterial pressure is usually accompanied by increase in systemic vascular resistance. That could cause decrease of cardiac output not only because of a lack of myocardial reserve, but also because of an increase of mitral regurgitant volume. In such situation decrease in left ventricular preload could further increase the regurgitant volume and cardiac output. Whether changes in pre-or afterload can cause significant changes in mitral regurgitation, nitroglycerin and phentolamine was assessed in that group of patients. 22 patients with significant mitral regurgitation (3+,4+) was randomly divided into two groups. The first one received short intravenous infusion of nitroglycerin at a rate of 170 micrograms/min. The second one received phentolamine intravenously 1-1,5 mg/min. Patients underwent right heart catheterization with Swan-Ganz thermodilution catheter. Mean pulmonary, pulmonary capillary wedge, and right atrial pressure were monitored and recorded. Cardiac output was determined by thermodilution technique using iced 5% dextrose. If there were no contraindications (PWP greater than 30 mm Hg) an effort test was performed (cycloergometer, supine position). The same protocol was repeated during administration of nitroglycerin and phentolamine. Nitroglycerin significantly decreased right atrial and capillary wedge pressure (from 22.9 to 15.6 mm Hg). There were no significant differences in cardiac output, pulmonary and systemic vascular resistance. Pulmonary artery pressure decreased after nitroglycerin but the difference was not significant. All above effects of nitroglycerin persisted during effort. Phentolamine decreased significantly right atrial, pulmonary and capillary wedge pressure with simultaneous increase of cardiac output (30%) and decrease of pulmonary and systemic vascular resistance. In summary, nitroglycerin decreases only symptoms and theoretically could worsen forward flow in patients with mitral regurgitation and heart failure, especially in subjects with a significant increase of systemic vascular resistance during effort.

[Pulmonary venous compliance. Indirect evaluation based on pulmonary capillary pressure registration]. / Podatnosc zylnego lozyska plucnego. Ocena posrednia w oparciu o rejestracje kapilarnego cisnienia plucnego.

The compliance of pulmonary venous system (PV comp) is one of the most important factors influencing left ventricular filling pressure. The decrease of PV comp could be also one of the most important factors promoting secondary pulmonary hypertension. The aim of the study was to assess diagnostic value of PV comp based on some haemodynamic data in patients (pts) with isolated mitral stenosis (MS). PV comp was estimated according to Hirakawa equation (dV/dP = 0.4 * k2 x SV/(v - d), where k2 = 0.075 * PWP + 0.9) in 78 pts with MS, during preoperative right heart catheterisation with Vygon 5155-180 thermodilution catheters. The mean PV comp for the entire group of pts was 4.5 +/- 2.4 ml/mmHg. In pts with atrial fibrillation PV comp was significantly lower as compared with pts on sinus rhythm (3.7 +/- 1.9 vs 6.4 +/- 2.3, p < 0.0001. There was also a significant difference between NYHA I/II vs III/IV class as far as PV comp was concerned (5.1 +/- 2.3 vs 3.9 +/- 2.3, (p < 0.05). In the group with low PV comp less than 4 ml/mmHg pulmonary vascular resistance, RA, PA and amplitude of V-wave of PWP were significantly higher and stroke volume index of RV was lower than in the group with PV comp above 4 ml/mmHg. PWP did not differentiate the analysed groups. A decrease of PV comp is a sign of advanced mitral stenosis.

[Consequences of late diagnosis and long-term conservative treatment of patients with congenital heart defects]. / Konsekwencje póznych rozpoznan oraz wieloletniego zachowawczego leczenia chorych z wrodzonymi wadami serca.

Of adult patients of the Cardiac Defects Clinic, National Institute of Cardiology (in Warsaw) we can distinguish several groups of patients with congenital heart defects among which those who were diagnosed after the age of 18 or those who despite of early and correct diagnosis, not underwent surgery on the childhood due to many reasons. In this paper we analyzed the group of 218 patients treated in our clinic between 1981-1987; 103 women aged 13-64 (mean-32 years) and 115 men aged 15-58 (mean-28 years). We classified congenital heart defects into 6 group: ASD, VSD, Tetralogy of Fallot, Persistent Ductus Arteriosus, Coarctation of Aorta and others (19.2%). We classified the range of health care before admission to our Department into the following categories: cardiosurgery (palliative or total correction); no therapy after congenital heart defects diagnosis; medical treatment after diagnosis; admission to our clinic immediately after the diagnosis of a heart defect. We compared that range of health care with qualifications of our Institute-(1. qualification for operation, 2. contraindication for operation, 3. operation unnecessary as the defect is not significant). We conclude basing on our results that, late diagnosis of a congenital heart defect does not finally effect on cardiosurgery possibilities. the majority of patients with C.H.D. have been waiting for many years for a specialist diagnosis and optimal therapeutic decision. long term conservative therapy of the patients with C.H.D. significantly reduces the changes of surgical correction.

[Factors influencing survival in patients with coronary disease. I. Characteristics of examined patients and survival curves]. / Czynniki wplywajace na przezywalnosc chorych z choroba wiencowa--Czesc I. Charakterystyka badanych chorych i krzywe przezycia.

The group of 683 patients with the significant narrowing (> 70%) of at least one coronary vessel diagnosed by coronarography performed between 1976-1988 in the Institute of Cardiology in Warsaw was followed during one to seven years. The number of patients with a poor left ventricular function was high in the group treated surgically and non surgically. Ejection fraction < 50% was found in 27% and 43% respectively, LVEDP > 12 mmHg (66% and 69%), EDVI > 100 ml/m2 (58% and 70%). Survival curves were calculated in the two different subsets of patients treated surgically and non surgically. Despite some favorite trend toward a better outcome for patients treated surgically the differences were not statistically significant for a whole group. However we showed a significantly higher probability of survival in the subgroup of the three vessel disease treated surgically compared to other treatment. There were no significant differences in survival in patients with one, two, or three vessel disease treated surgically (survival probability of 0.82; 0.78; 0.84 respectively after 7 years). In patients treated non surgically the growing number of diseased vessels worsened the prognosis (survival probability of 0.84; 0.78; 056 respectively). In our observation the differences for better outcome in patients with poor left ventricular function treated surgically did not reach a statistical significance.

[Factors influencing survival in patients with coronary heart disease. II. Multivariate logistic function analysis]. / Czynniki wplywajace na przezywalnosc chorych z choroba wiencowa--Czesc II--Analiza metoda funkcji logistycznej wielu zmiennych.

A group of 683 patients with the significant narrowing (> 70%) of at least one coronary vessel diagnosed by coronarography performed between 1976-1988 in the Institute of Cardiology in Warsaw was followed during one to seven years. Two hundred ninety of them were treated surgically, 393 non surgically. A multivariate logistic function (MLF) analysis of 10 variables is presented obtained from anamnesis and hemodynamic data and their significance upon survival after 2, 4 and 6 years. In the group treated non surgically the number of narrowed vessels was a factor independently significant after 2, 4 and 6 years. After 4 and 6 years the ejection fraction and the left ventricle end diastolic volume index were also significant. In the group treated surgically none of those were significant after 2 years. After 4 and 6 years anamnesis of arterial hypertonia was significant after 6 years also left ventricle end diastolic volume index. Coefficients calculated from multivariate logistic function analysis allow the calculation of probability of survival for an individual patient.