[The importance of electrocardiographic changes at rest during exercise in deciding to perform immediate ("ad hoc") percutaneous transluminal coronary angioplasty]. / Význam elektrokardiografických zmien v pokoji a pri zát'azi pre rozhodnutie o bezprostredne vykonanej ("ad hoc") perkutánnej transluminálnej koronárnej angioplastike.

In 100 patients (75 men and 25 women, mean age 53 years) who had "ad hoc" percutaneous transluminal coronary angioplasty (PTCA) on one or two vessels retrospectively the ECG records were evaluated (signs of necrosis or ischaemia) at rest and/or after exercise and compared with the finding of major obstruction (complete occlusion, stenosis > 50%) on coronarography. In obstruction of the ramus interventricularis anterior the positive ECG finding was consistent with the area of the impaired blood supply in 87%, in case of obstruction of the right coronary artery in 79%, in obstruction of the ramus circumflexus in 90%. In concurrent obstruction of two coronaries despite a 100% positive ECG no close topical correlation was found between coronarography and ECG. On the whole no reliable consistency was found between ECG and kinetic disorders detected by echocardiography. The results indicate that topical analysis of ECG ischaemic findings in patients with coronary arterial disease before planned coronarography contributes to the decision to make "ad hoc" PTCA in affections of one artery. In affections of two arteries ECG is of no particular value.

Echocardiography and exercise electrocardiography in the assessment of long-term outcome after percutaneous mitral valvuloplasty.

Before and immediate (invasive examination) and long-term follow-up (4.5 year; echocardiography, exercise electrocardiography) studies after percutaneous transvenous mitral valvuloplasty (PTMV; Inoue technique) were prospectively performed in 123 consecutive patients with pure or dominant mitral stenosis. These patients consisted of two groups: Group A with suitable valve morphology (n = 108, mean age 49.6 years, echocardiographic score 8.2 +/- 1.5), and Group B with less favourable valve morphology (n = 15, mean age 59.3 years, echocardiographic score 11.3 +/- 2.3) rejected for surgery because of high surgical risk. PTMV is a safe and effective nonsurgical method of treatment for symptomatic mitral stenosis and has long-lasting results in patients with pliable mitral valve as well as in patients with less suitable valve morphology. Echocardiography (Doppler approach) is the most efficient noninvasive method for assessment of PTMV effect. Exercise electrocardiography test is a valuable complementary method for objective measurement of patient working capacity and to confirm the success of PTMV.