Magnetic resonance studies in management of adult cases with Bland-White-Garland syndrome.

Bland-White-Garland syndrome (BWG) is a rare congenital anomaly that is predominantly discovered in infancy. BWG is characterized by an anomalous origin of the left coronary trunk from the pulmonary artery that produces a coronary steal phenomenon, left-to-right shunt, and thus an abnormal left ventricular perfusion. The latter may induce myocardial necrosis, left ventricular dysfunction and commonly associated with mitral regurgitation. Despite its high mortality without surgical repair in infancy, several cases were reported to reach adulthood. In some patients, however, BWG was revealed only in older age, and may cause mild symptoms. Recent developments in cardiovascular MRI enable the determination of heart function, viability and perfusion with high resolution. We present three middle-aged female BWG cases indicating that MRI studies may give further insight into the therapeutic decision making in this age-group.

[Experiences in the invasive treatment of acute coronary syndrome]. / Tapasztalataink az akut coronaria-szindróma invazív kezelésével.

INTRODUCTION: Primer percutaneous coronary intervention is a very powerful tool in the treatment of acute coronary syndrome. The aim of the authors was to work out and analyse the methods of making the upto-date percutaneous coronary intervention available for patients living far from the Heart Institute. PATIENT AND INTERVENTIONS: Between 1st January 2000 and 31st October 2002, 221 patients with acute coronary syndrome were sent to intensive treatment from Kaposvár to the Heart Institute in Pécs partly by helicopter. The average age of patients was 54 years. 103 of them with acute myocardial infarction and 118 others with unstable angina were catheterised. Revascularization was achieved in 133 cases, and coronary operation in 63 cases. Primary intensive therapy was applied on 34 patients with infarction. RESULTS: No lethal complications arose during transport or operation. Mortality rate coming from cardial complications was only 4% during the first two years. These results are based on well organised cooperation between the Department of Internal Medicine Kaposvár and Heart Institute Pécs. CONCLUSION: Given suitable logistic background and adequate indication the risk of transporting patients can be taken. The percutaneous coronary intervention proved to be successful.

[New methods for the diagnosis of acute pulmonary embolism]. / Az akut pulmonalis embolia diagnosztikájának újabb lehetöségei.

INTRODUCTION: Pulmonary embolism is a high mortality cardiovascular disease, which is difficult to diagnose even today. AIM AND METHOD: In this study the symptoms and the results of diagnostic methods were analysed in 81 patients with acute pulmonary embolism, admitted during a one-year period to Kaposi Mór County Hospital. The patient records were examined with special emphasis on the diagnostic value of novel methods such as D-dimer assay and chest computed tomography scanning along with the routine techniques used in the management of pulmonary embolism. RESULTS: In all patients ECG, in 88% of the cases chest X-ray, in 57% blood gas analysis and in 53% D-dimer assay results were evaluated. 14.8% of the patients died during hospitalisation. The following diagnostic imaging procedures were undertaken: in 80.2% of the cases lung scan, in 59.3% echocardiography and in 8.7% of the cases spiral computed tomography scan were prepared. In 12.3% of all cases thrombolysis proved necessary. The results were compared with data from International Cooperative Pulmonary Embolism Registry Study, which analyses 2454 patient cases. CONCLUSION: It is foreseen that the increasing use of echocardiography, lower limb ultrasound and highly informative spiral computed tomography scanning as an additional means in pulmonary embolism diagnostics may in some cases spare the use of pulmonary scintigraphy.