Echocardiographic assessment of the different left ventricular geometric patterns in hypertensive patients.

OBJECTIVE: To identify left ventricular geometric patterns in hypertensive patients on echocardiography, and to correlate those patterns with casual blood pressure measurements and with the parameters obtained on a 24-hour ambulatory blood pressure monitoring. METHODS: We studied sixty hypertensive patients, grouped according to the Joint National Committee stages of hypertension. Using the single- and two-dimensional Doppler Echocardiography, we analyzed the left ventricular mass and the geometric patterns through the correlation of left ventricular mass index and relative wall thickness. On ambulatory blood pressure monitoring we assessed the means and pressure loads in the different geometric patterns detected on echocardiography RESULTS: We identified three left ventricular geometric patterns: 1) concentric hypertrophy, in 25% of the patients; 2) concentric remodeling, in 25%; and 3) normal geometry, in 50%. Casual systolic blood pressure was higher in the group with concentric hypertrophy than in the other groups (p=0.001). Mean systolic pressure in the 24h, daytime and nighttime periods was also higher in patients with concentric hypertrophy, as compared to the other groups (p=0.003, p=0.004 and p=0.007). Daytime systolic load and nighttime diastolic load were higher in patients with concentric hypertrophy ( p=0.004 and p=0.01, respectively). CONCLUSIONS: Left ventricular geometric patterns show significant correlation with casual systolic blood pressure, and with means and pressure loads on ambulatory blood pressure monitoring.

Myocardial perfusion by contrast echocardiography. Establishment of normal pattern of intracoronary injection and safety in humans.

OBJECTIVE: To establish the normal pattern and safety of echocardiographic contrast in patients with no significant obstruction of epicardial coronary arteries. METHODS: 67 patients with normal coronary arteries or obstructions < 50% were selected from 277 patients who underwent coronary angiography (CA). Mean age was 56 +/- 11 years and 36 were males. At the end CA, echocardiographic contrast was selectively injected into each coronary artery. The parasternal short axis of the left ventricle (LV) was divided into six segments: anterior (A), antero-lateral (AL), postero-lateral (PL), posterior (P), infero-septal (IS) and antero-septal (AS). Anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were also considered. The pattern and intensity of the appearance of the myocardial contrast was visually analyzed. RESULTS: The right coronary artery (RCA) was dominant in 60 patients. Contrast appearance was sudden and simultaneous in the 3 muscle layers. All segments could be contrasted after the injection in both coronary arteries. 100% of the AS, A and AL segments, 97% of the PL and 98% of the ALPM were perfused by the left coronary artery (LCA). P and IS segments were perfused by the RCA in 85% and 82%, respectively, and by a dominant LCA in 71% of the cases. The PMPM was perfused by a dominant RCA in 77% and by a dominant LCA in 86%. There were no symptoms. CONCLUSION: Intracoronary injection of the sonicated solution is a safe procedure that allows for an excellent opacification of the myocardium and can potentially be used during routine CA.

Quantificaçäo ecodopplercardiográfica do débito cardíaco / Ecodopplercardiographic determination of cardiac output

A determinaçäo do débito cardíaco pela ecodopplercardiografia, correlaciona-se bem com as técnicas invasivas de medidas. Levando-se sempre em conta as dificuldades discutidas e limitaçöes, o cálculo do fluxo volumétrico pelo doppler permanece últil na prática clínica, especialmente quando determinaçöes seriadas do débito cardíaco säo requeridas

Prognosis of 1000 young women studied by coronary angiography.

One thousand women younger than age 50 years suspected of having coronary disease were followed for at least 5 years (average 8.4 years) to determine their course after coronary arteriography. Three patients were lost to follow-up; all had normal arteriograms. The survival rate was 96.9% at 5 years for 761 patients who had less than 50% narrowing of any artery. One patient who had coronary ectasia died within 5 years, and one woman who had minimal lesions suffered sudden death. Seven of 727 women who had normal arteries or less than 30% narrowing of any artery had coronary events (death, myocardial infarction, bypass operation for progressive disease), and six of 34 women who had 30 to almost 50% obstruction of at least one artery had coronary events. Calculations of survival for 236 women who had severe coronary lesions were affected by withdrawal for operation. Five-year survival was 74%.

Rotura de cordoalha tendinosa de valva mitral. Relato de sete casos e revisao da literatura. / Rupture of the chordae tendineae of the mitral valve. Report of 7 cases and review of the literature

Em 210 casos de rotura de cordoalha tendinosa de valva mitral revistos desde 1958 (7 acompanhados pelos autores), houve predominio do sexo masculino na proporcao de 1,8:1, sendo mais jovens as mulheres acometidas. Os pacientes foram divididos de acordo com a duracao da doenca, se inferior ou superior a 12 meses, em 2 subgrupos (I e II, respectivamente), predominando o ultimo (69,4%). Em ambos grupos, foi mais frequente a forma idiopatica, seguida pela endocardite infecciosa. O sopro sistolico irradiava para axila em 49,4% e para axila e base em 44,6%; a 1a. bulha estava aumentada de intensidade em 30,9% e 4a.bulha estava presente em 63,5% dos casos. No ECG, verificaram-se ritmo sinusal em 67%; fibrilacao atrial em 33% e HVD em 15%. O RX mostrou aumento de area em 85,5%, sendo frequente o crescimento atrial esquerdo (59,3%).A pressao de arteria pulmonar media foi maior no subgrupo I (p<0,05). O principal achado ecocardiografico foi o movimento aleatorio do folheto atingido. Nos pacientes operados a partir de 1966, 80,3% receberam protese e 19,7% tiveram reconstrucao valvar. Nossos sete pacientes foram operados com sucesso