[Left cerebral ischemia in mitral valve aneurysm]. / Linkszerebrale Ischämie bei Mitralklappenaneurysma.

An anterior mitral leaflet aneurysm was detected by two-dimensional echocardiography using the transesophageal approach in a 53-year-old patient with cerebral ischemic event. The transesophageal examination allowed a clear description of the aneurysm which was confirmed during surgery. This case demonstrates that transesophageal echocardiography is the method of choice in evaluation of distinct valvular lesions. The importance of TEE examination in patients with a neurological history is evident.

Myocardial echinococcosis with perforation into the pericardium.

Though rare, cardiac echinococcosis should be included in the differential diagnosis of cardiac tumors, particularly in patients originating from endemic areas or with manifestation of hydatid disease in other organs. Diagnosis and localisation of the cysts is best accomplished with non-invasive methods such as 2-D transthoracic and transesophageal echocardiography, computed tomography and NMR. Excision of the cardiac cyst from the interventricular septum in a 21 year old patient with polyvisceral echinococcosis was performed with cardiopulmonary bypass. Adjunctive medical therapy with mebendazol is being continued for 24 months postoperatively. Twelve months after surgery the patient is asymptomatic without echocardiographic signs of recurrence.

Effects of the calcium antagonist, isradipine, and nifedipine on resting and exercise haemodynamics and the neurohumoral system in patients with stable chronic angina.

In a randomized double-blind study, the haemodynamic and anti-ischaemic effects of the new dihydropyridine calcium channel blocker isradipine (5 mg and 10 mg thrice daily (t.i.d.) were investigated over 1 week in nine patients with coronary artery disease and chronic effort angina and compared with nifedipine (20 mg t.i.d.) and placebo. In standardized exercise stress tests and exercise radionuclide ventriculography, haemodynamics improved under medication compared with placebo: resting end-diastolic and end-systolic volume index decreased on isradipine 5 mg, 10 mg and on nifedipine, and ejection fraction at rest increased with all medications. Resting mean arterial pressure was reduced compared with placebo accompanied by a decrease in systemic vascular resistance (P less than 0.05) and systolic wall tension (P less than 0.05). Cumulative ST-segment depression was significantly reduced by all three medications (-48%, -23%, -36%), while the increase in work capacity was insignificant. No significant change was found for either heart rate, double product, cardiac index, or stroke work index. Resting plasma levels of noradrenaline, adrenaline and renin activity increased with all three medications (except adrenaline at isradipine 5 mg). Isradipine has favourable effects comparable with those of nifedipine in patients with chronic stable angina and can be safely administered in these patients.

[Papillary fibroelastoma of the aortic valve: primary echocardiography diagnosis in an asymptomatic patient]. / Papilläres Fibroelastom der Aortenklappe: Primär echokardiographische Diagnose bei asymptomatischer Patientin.

A rare case of a cardiac tumor located between the right coronary ostium and cusp of the aortic valve is reported. Diagnosis was confirmed by two-dimensional echocardiography. Histologic evaluation revealed a papillary fibroelastoma.

Baroreceptor and chemoreceptor reflexes in postganglionic neurones supplying skeletal muscle and hairy skin.

Postganglionic neurons supplying skeletal muscle and hairy skin of the cat's hindlimb were investigated for their reactions to stimulation of carotid baroreceptors and chemoreceptors in chloralose-anaesthetized, immobilized and artificially ventilated animals. The baroreceptors were stimulated by the pulsatile blood pressure and by pressure increases applied to an isolated carotid sinus (carotid blind sac) leaving only one intact buffer nerve. Chemoreceptors were stimulated by systemic hypoxia and by intracarotid bolus injections of CO2-saturated saline. The cardiac rhythmicity of activity in the postganglionic neurones (evaluated from the post-R-wave histograms) and the neurone reactions to intracarotid pressure increases were fairly well correlated, with a coefficient of r = 0.84. The time course and magnitude of inhibitory responses to intracarotid pressure increases were identical in some of the cutaneous postganglionic neurones and postganglionic neurones supplying skeletal muscle. The majority of the postganglionic neurones supplying skin, however, exhibited a weaker inhibitory response and a different time course in their activity during and after the sinus pressure increases. Muscle postganglionic neurones were excited and the majority of the cutaneous postganglionic neurones were inhibited by stimulations of arterial chemoreceptors produced by systemic hypoxia and by intracarotid injection of CO2-saturated saline. Small fractions of the post-ganglionic neurones supplying skin were excited by stimulation of arterial chemoreceptors. The activity of these cutaneous postganglionic neurones showed a strong cardiac rhythmicity. It is proposed that those postganglionic neurones supplying skin which are affected by stimulation of baro- and chemoreceptors in the same manner as are the postganglionic neurones supplying skeletal muscle may innervate cutaneous resistance (nutritional) vessels. It is likewise suggested that those cutaneous postganglionic neurones inhibited by stimulation of arterial chemoreceptors and under weak control by the arterial baroreceptors may innervate cutaneous capacitance and shunt vessels.