[Infected myxoma as a cause of acute infective endocarditis]. / Infikovaný myxom jako prícina akutni infekcní endokarditidy.

Myxoma is the most frequent primary cardiac tumor. In the typical clinical picture mostly dominate signs of intracardial obstruction, embolisation or general signs of neoplastic process. The myxoma can mimic the course of acute endocarditis. Genuine proof of infection is rare. We report on a patient with familiar form of infected myxoma, who was treated succesfully with antiobiotic therapy and surgical extirpation of the tumor.

Quantitative evaluation of body surface potential mapping of heart electrical field in ischaemic heart disease.

New possibilities of quantitative evaluation of body surface potential mapping were studied in 78 patients with ischaemic heart disease. Integral maps of the Q wave, QRS and ST-T intervals were plotted and isochronous maps of ventricular activation time and maps of asynchronous potential minima of the Q wave were determined. Minimum and maximum potential values and their time relations were evaluated in the maps. Left ventricular contraction abnormality detected by left ventricular angiography was determined by a point score and expressed as an index of asynergy. The number of coronary artery branches with significant narrowing was assessed and the extent of coronary artery damage was evaluated by an arbitrary defined index. Using quantitative parameters from the maps, multiple stepwise linear regression was performed. The relationship between map parameters and index of asynergy corresponded to multiple correlation coefficient r = 0.69 (p = 0.01) in the whole group of patients. In the group of patients with left ventricular contraction abnormality the relationship between these parameters was found to be r = 0.87 (p = 0.01). The relationship between map parameters and the number of coronary artery branches with significant stenosis was r = 0.60 (p = 0.01) in the group of patients with positive coronary angiography. In the same group of patients the relationship between map parameters and the index evaluating coronary artery damage was equal to r = 0.63 (p = 0.01). The data obtained from body surface integral maps enable to quantify cardiac ischaemic damage.

[Incidence and changes in mitral regurgitation in balloon valvotomy of the mitral valve. A color Doppler study]. / Výskyt a zmeny mitrální regurgitace u balónkové valvulotomie mitrální chlopne. Barevne dopplerovská studie.

The objective of the work was a detailed examination of the incidence and changes of mitral regurgitation (MR) in conjunction with percutaneous transluminal valvotomy of the mitral valve (VMCH). Using coloured Doppler mapping, the authors examined a total of 40 patients before and in the course of one week after VMCH. They assessed the number of regurgitation jets the site of their development, the timing and haemodynamic impact of MR. Knowing the site of development of MR, the authors were able to assess whether the regurgitation after VMCH persisted, developed de novo or disappeared. The total number of mitral regurgitation increased after VMCH from 38 to 51 (increase by 34%, p < 0.05) with a significant rise of the number of double regurgitation jets (4 before as compared with 12 after VMCH, p < 0.05). Before VMCH the authors recorded a holocystic MR in 53%, after VMCH in 86% of the patients (p < 0.01). While before VMCH almost half the regurgitation jets originated in the central portion of the valve, after VMCH MR originated mainly from the area of commissures (48% regurgitation jets before, 79% after VMCH, p < 0.01). Only in 33% of MR after VMCH persisting regurgitation was involved, almost half (47%) of 38 regurgitation jets present before VMCH, disappeared after valvulotomy. MR displays a considerable variability. This may be one of the reasons why prediction of the development and severity of MR after PTMV is difficult.

[Noninvasive quantification of the severity of aortic defects using the Doppler method]. / Neinvazívní kvantifikace závaznosti aortálních vad Dopplerovou metodou.

Using Doppler method (HPRF and CW regime), the authors assessed the peak velocity of flow in an aortal spurt in 41 patients with aortal stenosis. For calculation of the transaortal pressure gradient they used a modified Bernoulli equation. The values of the calculated gradients were compared with those obtained by direct manometric assessment during catheterization of the heart after an interval of several hours to five days. Combination of two Doppler techniques correlated closely with direct assessment (r = 0.811; p less than 0.001). By application of the continuity equation in the best records of spectral analysis of velocity curves the authors calculated in 8 patients the area of the reduced aortal orifice which was very close to the area calculated by means of Hakki's formula from direct haemodynamic indicators (r = 0.948; p less than 0.001). In 33 patients the authors quantified by Doppler method the severity of aortal regurgitation from the ratio of forward and backward flow in the descending portion of the aortal arch (expressed as the % regurgitation fraction--RF). The RF values correlated well with the angiographic semiquantitative scale of severity of aortal insufficiency (r = 0.805; p less than 0.001), although they enabled the authors only to make a partial differentiation of haemodynamically severe regurgitations and mild or insignificant ones. The authors conclude that the Doppler approach makes it possible to evaluate sufficiently accurately the severity of aortic valve disease (in insufficiencies the authors recommend a more comprehensive approach), which when correctly applied and interpreted, can make non-invasive clinical diagnosis more accurate and thus permits also more accurate indication of surgical treatment of these patients.

Contrast Doppler echocardiography.

First clinical experiences with contrast Doppler echocardiography -- a new technique of cardiac ultrasound examination are described. The presence of contrast material within the right heart cavities following the peripheral vein injection is easily recognized by characteristic Doppler signal changes. This knowledge was used to detect a small amount of contrast passing through atrial (ASD) or ventricular septal defect (VSD) towards the left heart cavities despite the dominant left-to-right shunting. The high sensitivity of this technique in those conditions was attested to by correct diagnosis of 10 ASD and 3 VSD. Besides that, this technique is indicated also in selected cases of tricuspid regurgitation. The combination of both pulsed Doppler and contrast echo-investigation seems to be advantageous in the diagnosis of the mentioned diseases. However, further study of this very specialized method is required.

Unloading effects of prazosin in patients with chronic aortic regurgitation.

Seventeen patients with chronic aortic regurgitation (AR) were examined by echocardiography and left and right heart catheterization. Cardiac output and regurgitation volume were measured by the dye dilution method. Administration of single and four repeated doses of prazosin (PZ) led to reductions of left ventricular (LV) end-diastolic, end-systolic, and left atrial end-systolic diameters, and decrease of left ventricular filling pressure. Regurgitation fraction, regurgitation flow, and volume indexes decreased significantly (p less than 0.01). Total left ventricular output decreased (p less than 0.001) as did derived parameters of left ventricular work and performance. Fractional shortening, ejection fraction, and mean circumferential fiber shortening velocity increased as did LV dP/dt and dP/dt/P. Changes in heart rate and cardiac and stroke indexes after PZ were not significant. Preload reduction (dilation of the venous bed and reduction of regurgitation) seems to be the most important effect of PZ in AR. We found PZ to be a suitable and effective drug for oral treatment of chronic AR.

Quantitative evaluation of valvular regurgitation by 133Xenon infusion.

Mitral and aortic regurgitation was evaluated by X-ray, dye dilution bolus, and 133Xenon infusion methods in 24 patients with mitral, aortic or both valve lesions. Good reproducibility was found using the 133Xenon infusion method. The regurgitant fraction estimated by 133Xenon constant infusion method correlates well with the results of the dye dilution method in mitral regurgitation as well as in aortic regurgitation. The 133Xenon infusion method is well-suited for quantitative evaluation of mitral and aortic regurgitation. For its simplicity, it is therefore recommended for further clinical evaluation in pharmacodynamic and preoperative studies.

[Assessment of regional ventilation using the inhalation of a radioactive and an aerosol of a 113mIn-labelled colloid solution]. / Otsenka regionarnoi ventiliatsii pri pomoshchi ingalatsii radioaktivnogo gaza i aérozolia kolloidnogo rastvora, mechennogo 113mIn.

Two methods of assessing regional ventilation distribution-dynamic scintigraphy with 133Xe-labelled gas inhalation, and pulmonary scanning following the inhalation of 113mIn-labelled colloid aerosol-were subjected to critical review. A total of 10 normal controls, 5 cardiac patients and 12 patients with pulmonary diseases were examined using both techniques. The subjective imaged of the lungs converged only in 24% of the cases. A considerable discrepancy in the results of the two investigation procedures was noted in 76%, primarily due to the sedimentation of inhaled colloid along the air passages. It is suggested that radio-aerosol scanning cannot visualize actual distribution of ventilation throughout the lungs; however, the method can be useful in the diagnosis of minor bronchial patency disorders before dynamic investigation using 133Xe can detect any changes, or where gamma-counter and analyzer facility is not available. To provide an accurate assessment of regional ventilation, the gas inhalation method should be combined with the dynamic analysis using a gamma-counter and analyzer facility, and perhaps a computer.