Ruptured aneurysms of the sinus of Valsalva.

From 1969 to 1989, 15 patients with an aneurysm of the sinus of Valsalva underwent operative correction. This represents 0.23% of 6515 cardiac operations with cardiopulmonary bypass during that time. There were 8 males and 7 females ranging in age from 15 to 54 years (mean 35.8 years). Symptoms of congestive heart failure, fatigue and palpitation were common. All patients underwent cardiac catheterization including aortography. Associated lesions included aortic valve regurgitation in 6 patients and a ventricular septal defect in 3 patients. The following connections occurred: right coronary sinus to right ventricle (8 patients), right coronary sinus to both right atrium and right ventricle (1 patient), and noncoronary sinus to right atrium (6 patients). The aneurysm was repaired via aortotomy or through the chamber into which it emptied. The aortic valve was replaced in 2 patients. There were no early or late postoperative deaths. Fourteen patients were in NYHA functional class I at late follow-up (range 0.5 to 20.5 years, mean 8.7 years). There have been no recurrences. Our experience supports the concept that early surgical intervention in patients with ruptured aneurysms of the sinus of Valsalva is justified.

[Using the radial artery in myocardial revascularization]. / Az arteria radialis alkalmazása a szívizom revascularisatiójában.

Between March 1996 and April 1998, 10 patients underwent myocardial revascularization using radial artery grafts. The age ranged between 59-81 (mean 67.7) years. The mean left ventricular ejection fraction was found to be 0.53 (range 0.45-0.62). A mean of 3.2 distal anastomoses per patient were performed. There was no operative mortality and no perioperative myocardial infraction was observed. No ischaemia of the hand was noticed. At a mean follow-up of 16.6 months (range 3-27) all patients are alive and free of symptoms. Only one patient had angina at bicycle ergometer test. The precise and atraumatic harvesting of radial artery and use of calcium antagonists prevent vasospasm and early graft occlusion on the short term. To assess the late results longer follow-up is necessary.

[Ergometry-induced silent ischemia--clinical and angiographic features]. / Az ergometriás terheléssel provokált silent ischaemia--klinikai és angiográfiás jellemzök.

This study was planned to clarify the clinical and angiographic attributes of patients with exercise induced silent myocardial ischaemia. The study sample consisted of 102 patients who had ischaemic exercise electrograms (greater than = 1 mm ST segment depression) and significant angiographic stenosis (greater than = 50% diameter stenosis), in at least one of the major coronary arteries. In 61 patients (60%) painful ischaemia was observed during exercise (group A) while in 41 patients (40%) only SD depression (silent ischaemia) occurred (group B). The groups were similar with respect to age, sex, history of diabetes and all angiographic parameters including the Gensini coronary score. A history of prior myocardial infarctions was observed more frequently (p less than 0.01) in patients with silent ischaemia (group B). Prior myocardial infarction may be a factor causing silent myocardial ischaemia.

[Symptomless (silent) myocardial ischemia and its prognostic significance]. / A panaszmentes ("silent") szívizom ischaemia és prognosztikus jelentösége.

The authors studied the prognostic significance of Silent myocardial ischemia. To study the correlation between the silent ischemia before the operation of coronary revascularization and the perioperative complications (infarction, mortality) Holter-monitoring (HM) was performed with 26 patients. The average time of HM was 43 +/- 3.1 h. During the observation period total 138 silent ischemic episodes were registered with 7 patients. The average heart rate observed during the ischemic event did not differ from that observed in other periods. Three myocardial infarctions occurred in the perioperative period one of them was of lethal outcome. Silent ischemia was detected in 2 of 3 patients before operation. The patient who displayed the gravest ischemic alteration died of perioperative myocardial infarction. On the basis of their observations the authors attribute prognostic significance to the preoperative silent myocardial ischemia.

Effects of lidocaine on myocardial function and on isoprenaline-induced circulatory changes in man.

14 non-cardiac patients aged 42 to 71 years (mean 49 years) were studied. Part I 1 mg/kg or 2 mg/kg of lidocaine were administered i.v. on two consecutive days and systolic time intervals (STI) were obtained at one minute intervals for 30 minutes. No change in STI was observed after lidocaine injection. In Part II, a bolus of 5 mug of isoprenaline was given i.v. before and after an injection of 2 mg/kg of lidocaine. Isoprenaline caused a highly significant increase in the heart rate, shortening of the total electromechanical systole, pre-ejection period, electromechanical delay, isovolumic contraction time as well as PEP/LVET and ICT/QS1, indices (in all cases p less than 0.001). 2 mg/kg lidocaine had no blocking or potentiating action on the catecholamine-induced circulatory changes. In Part III, after the isoprenaline challenge, a dose of 2 mg/kg of lidocaine was administered and the bolus injection was followed by an infusion of 30 mug/kg/min. Lidocaine per se caused no change in STI in the course of the infusion over 90 minutes, and there was no difference between isoprenaline-induced changes in STI before and during lidocaine infusion. These results suggest that lidocaine has no negative inotropic effect in the therapeutic dose range in man. Lidocaine caused no change in the systolic time intervals, it had no blocking or potentiating action on the isoprenaline-induced circulatory changes, and it had no negative inotropic effect in therapeutic doses in man.

Painful and silent myocardial ischaemia during exercise testing.

The study was designed to clarify the clinical and angiographic attributes of patients with exercise induced silent myocardial ischaemia. The sample consisted of 102 patients who had ischaemic exercise electrograms (greater than or equal to 1 mm ST segment depression) and had a significant angiographic stenosis (greater than 50% diameter stenosis), in at least one of the major coronary arteries. In 61 patients (60%) painful ischaemia was observed during exercise (group A) while in 41 patients (40%) only ST depression (silent ischaemia) occurred (group B). The groups were similar with respect to age, sex, history of diabetes and all angiographic parameters including the Gensini coronary score. A history of prior myocardial infarctions was observed more frequently (p less than 0.01) in patients with silent ischaemia (group B). Prior myocardial infarction may be a factor causing silent myocardial ischaemia.

Preoperative silent myocardial ischemia. Has it prognostic significance?

We studied the prognostic significance of preoperative silent myocardial ischemia in patients undergoing coronary artery bypass grafting (CABG). Nonfatal and fatal perioperative myocardial infarction were regarded as prognostically important endpoints. Ninety-five patients (9 women) with stable-effort angina pectoris were studied during their hospital stay in the surgery ward before CABG. Silent ischemia was detected using Holter monitoring; all patients had Holter monitoring 76 +/- 9 h before surgery using Marguette Laser Holter and Cardiodata Prodigy systems. Two-channel electrocardiographic recordings were used which included CM5 and a modified inferior lead. Effort was taken to avoid leads with pathological Q waves and resting ST segment abnormalities. The mean duration of the monitoring was 27.9 +/- 11.3 h. Three patients (3.2%) had angina pectoris during these observations, 1 of them with significant ST depression. Silent ST depression was found in 12 patients (12.6%). Twelve patients (12.6%) had perioperative myocardial infarction. Perioperative myocardial infarction was more common in patients with silent ischemia: 4/12 vs. 8/83; chi 2 = 4.48955, p = 0.0341. Our results suggest that Holter monitoring identifies a group of patients with a higher probability of perioperative myocardial infarction. In the future, it may be possible to study different methods to prevent this surgical complication.