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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence and severity of ventricular arrhythmias was analyzed in 42 patients with pure or predominant mitral valve stenosis (age: 51 +/- 9 years; NYHA class: 2.7 +/- 0.5) and 23 patients with pure or predominant mitral valve regurgitation (age: 55 +/- 11 years; NYHA class: 2.7 +/- 0.6) employing 24 h ambulatory monitoring. Coronary artery disease was excluded by angiography in all patients. Ten patients (14%) had no ventricular premature beats (VPB), 5 patients (7%) greater than 1,000 VPB/24 h, 31 patients (44%) multiform VPB, 19 patients (27%) repetitive VPB and 7 patients (10%) ventricular tachycardia. There was no difference in VPB between patients with mitral valve stenosis and mitral valve regurgitation. The incidence and severity of ventricular arrhythmias was significantly higher (p less than 0.001) in patients with mitral valve disease compared to the VPB of 50 normals without identifiable heart disease. This was still valid, if only patients with normal left ventricular ejection fraction greater than 55% (n = 60) were compared (p less than 0.01). The occurrence of frequent and complex ventricular arrhythmias was not determined by age, NYHA class, pulmonary artery pressure, pulmonary artery resistance, size of the left atrium, mitral valve area, degree of mitral regurgitation or cardiac index. However, a significant inverse correlation was found between incidence and severity of VPB and left ventricular ejection fraction. A reduced right ventricular ejection fraction, on the other hand, barely affected the occurrence of complex ventricular arrhythmias. Thus frequent and complex ventricular arrhythmias may be a sign of reduced left ventricular function in patients with mitral valve disease.
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PMID:[Ventricular arrhythmias in mitral valve disease: incidence, severity and relations to hemodynamic parameters]. 372 58

In patients with valvar heart disease detection of coronary artery disease by conventional non-invasive methods may be difficult. The usefulness of thallium-201 exercise scintigraphy for detecting coronary artery disease was evaluated in 16 patients with aortic stenosis, 17 with aortic regurgitation, nine with mitral stenosis, and six with mitral regurgitation who were investigated by coronary angiography. Only two of 21 patients with greater than or equal to 50% coronary artery obstruction had normal thallium images. Three patients without angiographic evidence of coronary artery stenoses had perfusion defects demonstrated by thallium scintigraphy. Only one patient with greater than or equal to 75% coronary stenosis had a normal thallium scan. Angina pectoris or ST segment depression evoked by exercise test were not useful in distinguishing patients with coronary artery disease from those with normal coronary vessels. These data suggest that thallium exercise scintigraphy may be a useful non-invasive test for detecting coronary artery disease in patients with valvar heart disease.
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PMID:Detection of coronary artery disease by thallium scintigraphy in patients with valvar heart disease. 373 Feb 15

Fetal echocardiography has yet to have an impact on the treatment of congenital heart disease. Critical aortic valve stenosis was diagnosed by echocardiography before birth in a 35 week gestation fetus. The risks to the fetus and mother associated with prolonged rupture of membranes prompted their transport to a hospital with cardiac surgical and high-risk perinatal facilities. Prenatal and postnatal echocardiographic findings agreed regarding the diagnostic criteria for critical aortic stenosis and primary forms of cardiomyopathy were excluded. Results of fetal Doppler examination were consistent with valvular aortic stenosis and excluded mitral regurgitation. Determination of the left ventricular size excluded ventricular hypoplasia. The infant was delivered by cesarean section and underwent successful emergency aortic valvotomy at 12 h of age. Fetal echocardiography, in combination with a multidisciplinary postnatal approach, can be used in the successful treatment of a severe form of congenital heart disease.
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PMID:Prenatal diagnosis and postnatal management of critical aortic stenosis. 381 69

Echocardiographic investigation of 65 patients with systemic scleroderma showed that the left ventricular sizes and indices of central hemodynamics were frequently lowered in them; an increase in sizes was observed mainly in the patients with stage II-III of disease. In 3/4 of the same patients pericarditis was revealed; on the whole, it was detected in 26 (40%) examinees. One patient had changes which were typical of asymmetric obstructive cardiopathy. In location of the valvular apparatus signs of mitral stenosis were found in one patient, those of mitral insufficiency in one patient and those of aortic insufficiency in one patient. Signs of mitral prolapse were noted in 7 (10.9%) patients, i.e. twice more frequently than in the entire population. Echocardiography made it possible to specify the nature of cardiac pathology and brought to light some additional features of the involvement of different heart membranes in systemic scleroderma.
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PMID:[Echocardiographic study of heart function in systemic scleroderma]. 382 23

Intravascular volume changes are reported to affect the clinical and echocardiographic spectrum of patients with known mitral valve prolapse syndrome (MVPS). We tested whether acute blood loss can produce MVP in normal adults. Twenty-one subjects were studied with Doppler echocardiography before and after donating 550 ml whole blood. Two subjects demonstrated minimal (1+) prolapse postphlebotomy, but in only one echocardiographic view, and without mitral regurgitation by Doppler. Three subjects demonstrated slight, early (not late or pansystolic) mitral regurgitation after phlebotomy, but without prolapse. Left atrial dimensions decreased significantly after the blood donation but the left ventricular size was not significantly smaller. The 1+ MVP is within the range of superior systolic motion found in 35% of a normal population, free of heart disease, and without intervention. We find no evidence in our study or in the literature that pathologic degrees of MVP can be produced in normal subjects by physiologic alteration in blood volume.
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PMID:Does "physiologic" mitral valve prolapse occur with acute blood loss? 382 87

Two Japanese boys, 6 and 10 years old, required operation for severe Kawasaki heart disease. Both had multiple coronary arterial aneurysms and stenoses, and one had mitral regurgitation as well. The operations consisted of anastomosis between the left internal mammary artery and the left anterior descending artery and insertion of an autologous saphenous vein between the aorta and the posterior descending artery in both patients. The mitral valve was replaced in the one with mitral regurgitation. Angina pectoris has been completely relieved as confirmed by postoperative angiocardiography. Late results of coronary bypass grafting with the saphenous vein in pediatric patients with Kawasaki disease have been less than satisfactory because of the high occlusion rate of the graft. The internal mammary artery may be superior, at least theoretically, to the saphenous vein graft because it is a "living graft" with a high possibility of growing and with less susceptibility to degeneration. This is the first report of successful operation utilizing an internal mammary artery graft in coronary bypass for Kawasaki disease.
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PMID:Severe Kawasaki heart disease treated with an internal mammary artery graft in pediatric patients. A first successful report. 387 81

The clinical diagnosis of tricuspid regurgitation (TR) is often difficult. Two-dimensional pulsed Doppler echocardiography offers a sensitive and specific method for detecting and semi-quantitating tricuspid regurgitation. The clinical, radiographic, radionuclide, echocardiographic, and when available, the right cardiac catheterization findings were evaluated in 36 patients with a diagnosis of tricuspid regurgitation by pulsed Doppler. Ten healthy subjects served as controls. The underlying cardiac cause was rheumatic heart disease in 7 (20%), ischemic heart disease in 12 (33%), dilated cardiomyopathy in 5 (14%), hypertensive heart disease in 2 (5%), aortic valve stenosis and/or regurgitation in 3 (8%), mitral valve prolapse with mitral regurgitation in 1 (3%), and congenital heart disease in 6 (17%). Seven patients (19%) had a temporary or permanent transvenous right ventricular pacing wire. A systolic murmur was heard in 29 patients (81%) with 16 (46%) having an elevated jugular venous pressure. Tricuspid regurgitation was clinically suspected in only 2 patients (6%). Isolated tricuspid regurgitation was uncommon, seen in 6 patients (17%), and usually secondary to congenital heart disease, ischemic heart disease, with the use of a transvenous pacing wire and following mitral valve replacement. Right cardiac catheterization was performed in 10 patients, of which 7 demonstrated elevated right atrial and pulmonary artery pressure. Pulsed Doppler echocardiography offers a practical and accurate method of detecting and evaluating the severity of tricuspid regurgitation. Tricuspid regurgitation is generally a functional disorder, and frequently occurs in association with left sided valvular heart disease, cardiomyopathy or congenital heart disease.
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PMID:The clinical spectrum of tricuspid regurgitation detected by pulsed Doppler echocardiography. 390 35

This is a review of relative indications and contraindications for the selection of patients for coronary arteriography. Patients with angina pectoris at rest ("unstable" angina pectoris) and after low levels of effort despite a good medical regimen, those with chest pain that cannot be distinguished from angina pectoris at low or moderate levels of effort with or without abnormal 201Tl perfusion scans or radionuclide ventriculograms during stress, and those with suspected significant left main coronary arterial stenosis based on exercise testing should undergo coronary arteriography. In addition, coronary arteriography is usually an important part of the clinical evaluation of the patient with unexplained and clinically important congestive heart failure, recent myocardial infarction treated with thrombolytic therapy, a mechanical complication of myocardial infarction requiring cardiac surgery, including a large ventricular septal defect, hemodynamically important mitral insufficiency, or a large ventricular aneurysm leading to heart failure, hemodynamically important valvular, subvalvular, or supravalvular heart disease in whom corrective surgery is contemplated, suspected anomalous origin or communication of a major coronary artery, and sudden death syndrome unrelated to acute myocardial infarction.
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PMID:Selection of patients for coronary arteriography. 390 56

The specificity of the persistence of antibody to the streptococcal group A carbohydrate for mitral valve disease induced by rheumatic fever was examined. Levels of the antibody were determined in serum samples of 30 patients with rheumatic mitral insufficiency, 30 patients with mitral valve prolapse, and an equal number of normal individuals and patients with congenital heart disease. Antistreptolysin titers and anti-deoxyribonuclease B titers were also assayed in all sera. There were no differences in the incidence of elevated antibody titers or in the geometric means of the antibody titers for the normal individuals, the patients with congenital heart disease, and the patients with mitral valve prolapse. In contrast, the frequency of elevated anti-streptococcal group A carbohydrate titers and the geometric means of these titers were significantly higher in the patients with rheumatic mitral valve disease than in patients with mitral valve prolapse. This confirms the specificity of the persistent elevation of anti-streptococcal group A carbohydrate to patients with mitral valve disease induced by rheumatic fever and also suggests that the persistence of this antibody in patients with rheumatic valvular disease is not a result of a functional abnormality of the mitral valve.
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PMID:Specificity of persistence of antibody to the streptococcal group A carbohydrate in rheumatic valvular heart disease. 396 59

A teenager with Marfan's syndrome required resuscitation and was found to have multiform premature ventricular contractions and ventricular tachycardia. Of 24 children with Marfan's syndrome, eight (33.3%) were found to have ventricular dysrhythmias, including three with ventricular tachycardia. Six of these eight patients had mitral valve prolapse, and five had prolonged QT or QTU intervals corrected for heart rate. However, only two patients had severe mitral regurgitation, five had only mild heart disease, and one had no detectable heart lesion. The role of mitral valve prolapse and/or delayed repolarization in the development of ventricular dysrhythmia was explored. Delayed repolarization, especially when combined with mitral valve prolapse, is associated with occurrence of ventricular dysrhythmia. Serious ventricular dysrhythmia can occur in children with Marfan's syndrome with or without substantial valve disease, and the dysrhythmia appears to progress with age.
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PMID:Ventricular dysrhythmias in children with Marfan's syndrome. 397 8


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