Atypical clinical presentation of bileaflet cardiac prosthetic valve dysfunction. Preliminary report.

Single-leaflet disc immobilisation in 3 patients with St Jude Medical prostheses and 1 patient with a Carbo Medics valve prosthesis resulted in mild mitral regurgitation without acute pulmonary oedema. Three patients presented with slowly worsening pulmonary congestion while 1 patient had neurological symptoms. Clinicians need to be aware of the possibility of single-leaflet failure in a bileaflet cardiac valve prosthesis, because haemodynamic deterioration occurs insidiously in these patients, resulting in atypical symptoms and signs.

Quantitative analysis of nitroglycerin-induced coronary artery vasodilation in transplanted hearts.

Quantitative serial coronary angiograms performed annually over a 3-year period after transplantation in 26 orthotopic heart transplant recipients showed persistently normal nitroglycerin-induced vasodilation. The vasodilator response to nitroglycerin did not predict development of graft arteriopathy; the presence of graft arteriopathy did not prevent a substantial vasodilator response to nitroglycerin.

Serial quantitative coronary angiography in the assessment of coronary disease in the transplanted heart.

Quantitative angiographic studies with use of cine-videodensitometry after maximal coronary vasodilation with nitroglycerin in 18 "angiographically normal" heart transplant recipients demonstrated significant loss of lumen diameter between years 1 and 3. When sensitive angiographic techniques are used, graft arteriopathy appears to be ubiquitous in heart transplant recipients.

Videodensitometry versus digital calipers for quantitative coronary angiography.

Single-plane left coronary angiograms in 18 patients were prospectively analyzed using videodensitometry (XR-70 system) and handheld digital calipers to compare arterial dimensions, stenosis dimensions, intraobserver variability and interobserver variability for the methods. A total of 648 arterial segments were measured, yielding a highly significant correlation between videodensitometry and caliper-determined cross-sectional area (r = 0.96, p = 0.0001). Similarly, a highly significant linear relation was observed between videodensitometry and caliper-determined diameter (r = 0.95, p = 0.0001). When data subsets for small, medium and large arterial segments were examined, higher variability in the correlation between videodensitometry and caliper-determined area was observed in the large segments (greater than 10 mm2). In addition, caliper-estimated areas tended to be slightly smaller than videodensitometry-estimated areas in these segments. For diameter estimations, correlations between caliper and videodensitometry data were similar for the entire range of arterial segment sizes. Intra- and interobserver variability was low for both caliper and videodensitometry determination of diameter or area. Thus, over a wide range of arterial dimensions, results obtained with caliper estimates of luminal area and diameter are comparable to those obtained with videodensitometry using the XR-70 system.

A comparison of the clinical relevance of thallium-201 and technetium-99m-methoxyisobutyl-isonitrile for the evaluation of myocardial blood flow.

Thallium-201 is at present the radiotracer of choice for the clinical evaluation of myocardial blood flow. Although different technetium-99m-isonitrile agents have been synthesised recently, only 99mTc-methoxyisobutyl-isonitrile (99mTc-MIBI) has proved to hold promise for clinical implementation. The myocardial distribution of 201Tl and 99mTc-MIBI was compared in a group of 20 patients, who underwent both 201Tl single photon emission computed tomography and 99mTc-MIBI study as well as coronary angiography. The sensitivity for predicting a lesion ranged from 25% to 88% in different areas of the heart and was comparable for the two radiopharmaceuticals. The specificity was greater than 80% for all regions except the inferior region where a specificity of 58% obtained by 99mTc-MIBI was better than the low specificity of 17% obtained with 201Tl (P less than 0.008).

Intracoronary thrombolysis and coronary angioplasty for evolving myocardial infarction.

At present experience in South Africa with coronary reperfusion during the acute phase of myocardial infarction is limited. Acute reperfusion of an infarct-related coronary artery was attempted in 55 patients using intracoronary thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA). Intracoronary streptokinase infusion had reopened 25 to 40 totally occluded lesions but usually a residual severe stenosis remained. PTCA was subsequently attempted in 36 severely stenotic coronary arteries and 19 totally occluded coronary arteries. PTCA was successful in 48 of the 55 cases (87%). After 1 week vessel patency was present in 36 of the 39 patients who had early coronary artery re-assessment. Late restenosis occurred in 4 out of 14 cases. There were no procedure-related deaths. Normal global as well as regional left ventricular function was present in 15 cases after 1 week. Emergency PTCA alone or in combination with intracoronary thrombolytic therapy is efficacious in achieving coronary reperfusion. On follow-up, left ventricular function appeared to be well preserved in 27% of patients with patent infarct-related arteries.

Myocardial bridging as a cause of myocardial infarction. A case report.

There is controversy over the clinical significance of myocardial bridging. A case of symptomatic bridging of the left anterior descending coronary artery resulting in myocardial infarction is reported.

Successful coronary reperfusion with intracoronary streptokinase in a patient with coronary ectasia.

A case in which successful coronary artery reperfusion was achieved during an acute inferior wall myocardial infarction by means of infusion of streptokinase (Kabikinase; Adcock Ingram) into an ectatic right coronary artery is described. The pathogenic mechanisms resulting in occlusion of ectatic coronary arteries and the incidence of the condition are discussed and the importance of anticoagulation therapy in these patients is stressed.

Autonomic neuropathy and atypical myocardial infarction in a diabetic clinic population.

The incidence of autonomic neuropathy in 52 insulin-dependent and 87 non-insulin-dependent diabetic subjects was studied as well as the relationship between the type and duration of diabetes, metabolic control and the association of atypical infarctions with autonomic neuropathy. No statistically significant relationship was found between any parameter and the presence of autonomic neuropathy. Atypical infarctions were not confined to subjects with autonomic neuropathy, but the incidence was considerably higher than that in the general population. Position of the infarction did not determine whether it was silent or not. It is suggested that physicians should be alert to the occurrence of silent infarctions in all diabetics and not only those with clinical evidence of autonomic neuropathy.

Vitamin B6 and coronary artery disease. Epidemiological observations and case studies.

The finding of low plasma pyridoxal-5'-phosphate levels in patients suffering from myocardial infarction has been construed as possible evidence for the pathogenetic role that vitamin B6 deficiency may play in causing premature ischaemic heart disease. However, the presence of normal plasma pyridoxal-5'-phosphate levels in patients with angiographic evidence of coronary artery narrowing but with no previous infarctions prompted the investigation of possible short-term alterations in plasma pyridoxal-5'-phosphate levels during the acute phase of myocardial infarction. In the follow-up of 30 patients with acute myocardial infarction, all of them showed a continuous decrease of approximately 45% in plasma pyridoxal-5'-phosphate levels during the acute phase. These levels subsequently returned back to normal before discharge from hospital. A large number of volunteers from an ethnic group known to have a very low incidence of ischaemic heart disease were found to have both significantly lower total cholesterol and plasma pyridoxal-5'-phosphate levels than a Caucasian group in the same geographic area which is known to have a high incidence of ischaemic heart disease. These findings therefore do not support the contention that vitamin B6 deficiency may be a risk index for ischaemic heart disease.

Traumatic aorta-vena cava fistula detected with radionuclide angiocardiography. A case report.

Diagnosis of a traumatic aorta-superior vena cava fistula in a 54-year-old man is reported, and the value of radionuclide angiocardiography in detecting and localizing the lesion is described.

Systemic nodular panniculitis (Weber-Christian disease) in a black woman. A case report.

There are many causes of panniculitis and systemic nodular fat necrosis; Weber-Christian disease is one of the rarer forms. A 47-year-old black woman with Weber-Christian disease is described and the aetiology, pathology and clinical manifestations of the disease are discussed.

Anaesthesia in myositis ossificans progressiva. A case report and clinical review.

An 18-year-old black youth with myositis ossificans progressiva recently underwent eye surgery. The clinical, laboratory and radiological findings are described. The problems associated with anaesthesia are presented and their management is discussed. The condition is briefly reviewed.

Phantom tumour of the lung secondary to left heart failure. A case report.

Considerable variation in nomenclature and of interpretation exists with regard to the term 'pseudotumour of the lung'. Interlobar encysted effusions, plasma cell tumours fibrous histiocytomas, xanthogranulomas, pseudolymphomas and recently round atelectasis of the lung have all been called 'pseudotumours'. A young man was investigated twice for an encysted interlobar effusion secondary to left heart failure. Treatment of the cardiac condition after the diagnosis of a probable 'phantom tumour' had been made led to rapid clearing of the lung fields. The literature on phantom tumour and some recently accepted ideas concerning nomenclature are reviewed.