Right to left shunt, with severe hypoxemia, at the atrial level in a patient with hemodynamically important right ventricular infarction.

This report describes a patient with a massive right ventricular infarction, complicated by severe hypoxemia. Contrast echocardiography demonstrated a right to left shunt through a previously asymptomatic atrial septal defect. This phenomenon should be considered as a possible cause of hypoxemia in the presence of right ventricular infarction.

Hemodynamic effects of pimobendan given orally in congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

Pimobendan (UD-CG 115 BS) was administered orally to 23 patients with congestive heart failure (functional class IV) caused by coronary artery disease (11 patients) or idiopathic dilated cardiomyopathy (12). All patients received maintenance doses of digoxin, furosemide and warfarin. Baseline data, collected during 15 hours, stayed within a 10% range. A 10-mg oral dose of pimobendan increased the heart rate from 95 +/- 20 to 109 +/- 24 beats/min (p less than 0.003). The pulmonary artery wedge pressure decreased from 23.0 +/- 5.9 to 10.1 +/- 5.2 mm Hg (p less than 0.0001), the cardiac index increased from 1.9 +/- 0.4 to 3.3 +/- 0.7 liters/min/m2 (p less than 0.0001) and the left ventricular stroke work index increased from 2,005 +/- 927 to 3,065 +/- 1,161 ml/mm Hg/m2 (p less than 0.0001). Statistically significant improvements in hemodynamic variables were still present 10 hours after the administration of pimobendan. Most patients felt better and reported no angina or other side effect, the incidence of ventricular arrhythmias was unchanged and no electrocardiographic changes suggesting ischemia were observed. Patients with severe congestive heart failure experienced a prolonged improvement of their cardiovascular condition after a single dose of pimobendan.

Effectiveness of intraaortic balloon pumping without cardiac surgery for patients with severe heart failure secondary to a recent myocardial infarction.

Twenty-five patients with class III or class IV left ventricular failure (Myocardial Infarction Research Unit criteria) after a recent myocardial infarction were treated with intraaortic balloon pumping between December 1, 1972 and December 1, 1976. Three patients had no improvement and died during pumping. Two patients with improvement died during at attempt at weaning from circulatory assistance. Of 20 patients successfully weaned, 6 died within 3 months, 5 of these within 10 days after the weaning procedure. Of 14 patients who survived for more than 3 months, 13 were alive on February 15, 1977. Twelve of these 13 were in functional class II and 6 had resumed professional activities. Intraaortic balloon pumping proved an effective method for treating severe left ventricular failure after an acute myocardial infarction. Even withour surgery, 14 of 25 patients survived 3 or more months after an acute infarction complicated by serious pump failure.

Prevalence of retrograde conduction in heart block after DDD pacemaker implantation.

Electrophysiologic studies were performed before DDD pacemaker implantation in 50 patients with symptomatic heart block. The patients were separated into 2 groups. Group I consisted of patients with intact retrograde conduction and group II consisted of patients with blocked retrograde conduction. After pacemaker implantation, postventricular atrial refractory periods in patients in group I were programmed at 50 to 100 ms, in excess of the retrograde conduction times measured during electrophysiologic studies. In group II patients, postventricular atrial refractory periods were routinely programmed at 300 ms. During follow-up, patients visited the outpatient clinic at 3-month intervals for noninvasive assessment of the prevalence of retrograde conduction, and to test the inducibility of pacemaker-mediated tachycardias. The mean follow-up of group I (15 patients) was 27 +/- 10 months, whereas the mean follow-up of group II (35 patients) was 19 +/- 9 months. The mean number of noninvasive tests performed during follow-up was 8 +/- 3 per patient for group I and 5 +/- 3 per patient for group II. In group I, retrograde conduction remained intact in 12 patients (p less than 0.01). In 29 of 31 patients in group II, retrograde conduction remained absent (p less than 0.01). In 4 patients in group II, chronic atrial fibrillation occurred during follow-up. Chronic atrial fibrillation did not occur in any patient in group I. During serial electrophysiologic testing, no pacemaker-mediated tachycardias could be induced in any patient in group I or II.(ABSTRACT TRUNCATED AT 250 WORDS)

Progressive development of a left ventricular thrombus.

In a patient with ischemic heart disease and terminal left ventricular failure, echocardiographic techniques (single-crystal M-mode echocardiograms and bidimensional, linear, dynamically focussed multiscan recordings) allowed the detection and follow-up of a left ventricular thrombus, later documented at autopsy.

Growth rate of left atrial myxoma. Development of a symptomatic left atrial myxoma less than two years after coronary artery bypass grafting.

In April 1984, a left atrial myxoma almost filling the left ventricle was discovered in a patient who had no evidence of myxoma at the time of aortocoronary bypass grafting in September 1982. We conclude that the growth rate of a primary cardiac myxoma may be much faster than expected from previous observations.

Suicide with aprindine and digoxin.

A 48 year old man with severe coronary artery disease died approximately 33 hours after swallowing unknown amounts of aprindine, digoxin, furosemide, acenocoumarol, flurazepam, nitrazepam and lorazepam. Blood analysis carried out 40 min. before death showed no hydric or ionic imbalance; blood gases were normal. Serum digoxin concentration was 3.9 ng/ml; plasma concentration of aprindine was 2.5 mug/ml and plasma concentration of desethylaprindine was 386 ng/ml. Patient was profoundly comatose, hypotensive, and the electrocardiogram showed broad and bizarre QRS complexes; patient ultimately died in irreversible secondary ventricular fibrillation and asystole. Aprindine probably played a decisive role in the fatal outcome of this complex drug intoxication.

Echocardiological contrast studies with dynamically focussed multiscan.

Bidimensional contrast echocardiological examinations were carried out in 120 patients with the use of dynamically focussed multiscan. Ultrasonic contrast was produced by a push injection of 10 ml of isotonic saline or of 5% glucose in water injected into an antecubital vein through an 18 gauge needle. Contrast studies were observed on a television monitor and recorded on videotape for detailed off-line analysis. All the echocardiological diagnoses presented here were confirmed during catheterization. A few typical clinical examples are illustrated, including a patient with Ebstein's anomaly, a case of tricuspid regurgitation, atrial and ventricular septal defects, and a left ventricular ultrasound angiocardiogram. Bidimesional contrast opens a new field for the assessment of remediable cardiac lesions.

[Contrast echocardiology in two dimensions and in real time. 1. Ultrasonic techniques]. / Echocardiologie de contraste en deux dimensions et en temps réel. 1. Techniques ultrasoniques.

An aqueous solution (5% glucose) injected rapidly into a peripheral vein modifies the acoustic homogeneity of the blood not only at the periphery, but also within the cavities of the heart. This ultrasonic contrast technique has taken a new lease of life thanks of two-dimensional echocardiology in real time, which allows the blood to be visualised as it moves. A description is given of the current two-dimensional real time transducers, and the dynamically focal multiscan which has been developed in our laboratories. An analysis is made of the chosen ultrasonic contrast medium (glucose water), of the site and mode of injection, of the recording technique and of the various echocardiological views. Finally, a discussion highlights the limitations of single crystal echocardiography, and the advantages of the two-dimensional technique in real time.

[Contrast echocardiography in two dimensions and in real time. 2. Clinical applications]. / Echocardiologie de contraste en deux dimensions et en temps réel. 2. applications cliniques.

The anatomical and functional abnormalities which are the basis of septal defects and valvular incompetence can be visualised directly by two-dimensional contrast echocardiology. Although right-left shunts at atrial or ventricular level can easily be discovered and visualised after injection peripherally, the same is not true of left-right ventricular shunts; these are not detectable. As for left-right shunts (as demonstrated by oxymetry) at the atrial level, these are in a separate category; the passage of ultrasonic contrast medium from right to left is inconstant. This technique also allows the study of abnormal blood flow: tricuspid incompetence, turbulence caused by prosthetic valves, etc.

[Bidimensional and direct visualization of the heart by multiple element echocardiography]. / Visualisation bidimensionnelle et directe du coeur par échocardiographie à éléments multiples

Multiple element echography permits a direct visualization of heart sections. In congenital heart diseases, an accurate anatomical diagnosis is often possible. In valvular heart diseases, visualization of the valvular movements and measurement of haemodynamic repercussions over the other cardiac structures makes it possible to assess the severity of the lesion. The overall function of the heart may also be assessed as well on the basis of measurement of the size of the heart, and above all through analysis of valvular movements and the left ventricular wall kinaetics, an information analogous to that obtained by cineangiocardiography. A quantitative study of the left ventricular function by measurement of the systolic and diastolic volumes is still in the experimental stage. A different method of recording and the use of a large single cristal allow a better resolution of the picture of conventional echography, but technical progress might be foreseen in multiple element echography.

[Hemodynamic effects of intravenous perfusion of amrinone in increasing doses in 12 patients with severe heart decompensation]. / Effets hémodynamiques d'une perfusion intraveineuse d'amrinone à doses croissantes chez douze patients en décompensation cardiaque sévère.

Twelve patients with severe heart failure were given amrinone by intravenous infusion in doses rising from 1 to 2, 3 and 4 mg X min-1, the interval between each dose being 30 min. The total cumulative dose was 300 mg over 120 min. Haemodynamic measurements were started the day before treatment to take into account nycthemeral fluctuations in haemodynamics and the possible effects of maintenance treatments and meals, all factors which might influence the baseline values. When given at a rate of more than 2 mg X min-1, amrinone significantly improved cardiac function (p less than 0.001). The mean pulmonary capillary pressure fell from 24.1 +/- 5.3 to 13.7 +/- 8.6 mmHg, and the cardiac index rose from 1.75 +/- 0.40 to 2.51 +/- 0.32 1 X min-1 X m-2. Heart rate and blood pressure were not significantly modified. No adverse reaction was observed during the infusion and the following 24 hours. Thus, intravenous amrinone proved effective in patients with severe heart failure, with maximal effects being obtained in doses of 3 mg X min-1.