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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Controversy concerning medical versus surgical management of elderly patients with secundum atrial septal defect (ASD II) remains unsolved. To clarify this problem, we studied relation between initial clinical findings and long-term prognosis of patients with isolated ASD II over 40 years of age. Of 47 patients medically managed, 13 patients died during the follow-up period. Among these, 11 died of congestive heart failure (CHF), and 2 died of non-cardiac disease. Mean age and follow-up period of these 11 were 68.1 +/- 9.0 and 6.7 +/- 5.1 years, respectively, and those of 34 survivors were 61.9 +/- 7.5 and 7.7 +/- 5.8 years, respectively. All 6 patients of functional capacity III-IV (NYHA classification), and 5 of NYHA II, died. Seven patients of NYHA II progressed to NYHA III-IV, and the other 20 of NYHA II and all 7 patients of NYHA I remained unchanged during the follow-up. Overt CHF (p less than 0.001), mitral and/or tricuspid regurgitation (p less than 0.01), combination with arterial hypertension and/or ischemic heart disease (p less than 0.05), atrial fibrillation (p less than 0.01), P-sinistrocardiale (p less than 0.001), and R/S (V6) less than 2.0 (p less than 0.01), cardiothoracic ratio greater than 55% (p less than 0.001), width of right descending branch of the pulmonary artery greater than 25 mm (p less than 0.01), and mitral valve prolapse in the echocardiogram (p less than 0.05) were significantly frequent in the cases clinical deterioration. Of 32 patients, whose functional capacities were NYHA II initially, 12 showed progression and 20 were unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prognostic significance of the initial clinical findings in patients over 40 years of age with secundum atrial septal defect]. 652 Apr 30

We developed a new echocardiographic approach to detect the interatrial septum (IAS) by tilting a transducer leftward, cephalad and backward from the right subcostal area. This technique could allow us to visualize the IAS moving perpendicularly to the ultrasonic beam. In normal subjects the IAS showed a small posterior deflection moving toward the left atrium due to atrial contraction following the P wave of the electrocardiogram. Following the onset of ventricular ejection the IAS rapidly moved anteriorly. During diastole the IAS showed an initial rapid posterior displacement and then a more gradual slope, reflecting rapid and slow filling phases, respectively. The magnitude and configuration of IAS motion showed variations dependent on atrial conditions of cardiac diseases. In atrial fibrillation there were f waves on the IAS echogram and in mitral stenosis a septal notch was recorded at the timing of a mitral opening snap. In mitral valve prolapse there was also a midsystolic notch of the IAS echogram almost coincident in time with the onset of a late systolic murmur. On the other hand, the IAS revealed a systolic increased excursion or paradoxical motion in mitral or tricuspid regurgitation, respectively. In hypertension and myocardial infarction the atrial kick of the IAS echogram showed an exaggerated excursion. In 125 out of the consecutive 150 cases (83.3%) we could record satisfactory IAS echograms by this new approach.
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PMID:[Clinical application of a new right subcostal approach in the evaluation of interatrial septal motion]. 667 95

The results of elective mitral valve replacement between January 1978 and June 1982 in 35 patients aged over 70 are reported. The early mortality was 22,8% and late mortality 17,1%, after a mean follow-up of 25,1 months. Patient-related risk factors included chronic mitral stenosis, often after a previous closed mitral valvotomy, increased cardiothoracic ratio, pulmonary arterial hypertension, functional tricuspid incompetence and a raised left ventricular end-diastolic pressure.
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PMID:Mitral valve replacement in the elderly. 671 Feb 70

The results of a series of 38 patients with a tricuspid valve prostheses (:76% Starr-Edwards ball valves) associated with correction of one or two left heart valvular lesions are presented. 24 patients underwent clinical and haemodynamic assessment on average 4,2 years after surgery. The conclusions were that signs of systemic venous hypertension were mainly related to residual right ventricular failure despite normal valve function and secondarily to the poor hemodynamic profile of these prostheses and their paradoxical motion. Using these results: 18% early mortality; 24% late mortality; 24% late thrombosis amongst survivors and 52% residual right ventricular failure; and 47,5% of excellent results. The clinical and haemodynamic profiles of the patients were analysed to determine the surgical indications. Apart from the correction of associated left heart valve lesions, it seems that the prognosis in tricuspid valve repair depends on the duration of tricuspid regurgitation and the severity of right ventricular myocardial disease. In elderly patients with chronic tricuspid regurgitation and severe right ventricular failure, long-term analysis showed 87,5% poor results, whilst in younger patients with a shorter history of tricuspid regurgitation and less severe right ventricular failure, there was 77,7% excellent long-term results. Semi circular annuloplasty is widely indicated in mild or severe functional tricuspid regurgitation. Tricuspid valve replacement, a much more serious operation, remains essential in chronic organic lesions and in some cases of massive functional tricuspid regurgitation. A regards the choice of prosthesis, the authors suggest the Hancock bioprosthesis as a logical choice in cases of severe right ventricular failure as they are less prone to thrombosis than mechanical prostheses and have good haemodynamic profiles. The evolution of the right ventricular failure even after correction of tricuspid regurgitation underlines the importance of preventative therapy by early correction of left heart lesions.
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PMID:[Long-term results of tricuspid prostheses]. 679 14

The cardiac profile of 38 patients readmitted to the hospital with the clinical and radiologic findings of pulmonary artery hypertension and right ventricular failure 2 months after ingestion of toxic rapeseed oil was determined with M-mode and two-dimensional echocardiography, pulsed Doppler flow studies and right and left heart catheterization and ventriculography. The echocardiogram and pulsed Doppler recordings revealed right ventricular enlargement in 84% of the patients, indirect evidence of pulmonary artery hypertension in 76% and tricuspid insufficiency in 13%. At cardiac catheterization (n = 11) the mean (+/- standard deviation) pulmonary artery pressure was 40 +/- 9 mm Hg, mean pulmonary systemic vascular resistance ratio was 0.45 +/- 0.12 and mean right ventricular end-diastolic pressure was 13 +/- 4 mm Hg. Pulmonary artery hypertension was sustained after the acute administration of 100% oxygen and persisted in six patients who were restudied within 6 months. Cardiac index and left heart pressures were normal in all but one patient. The contrast ventriculographic studies revealed right ventricular dilation in all patients, tricuspid regurgitation in three patients and a normal left ventricular contraction pattern in all but one patient. The data confirm that symptomatic pulmonary artery hypertension and associated right ventricular dysfunction can complicate toxic rapeseed oil ingestion and that these findings persist for at least 6 months.
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PMID:An epidemic of pulmonary hypertension after toxic rapeseed oil ingestion in Spain. 683 63

Twenty consecutive female patients (mean age 30.1 years) with Primary Antiphospholipid Syndrome (PAPS) were studied cardiologically through noninvasive methods and compared with 20 age-and sex-matched healthy subjects. On physical examination 13/20 patients (65%) with PAPS had a valvular abnormality. In 12/20 (60%) patients with PAPS the ECG was abnormal, mainly due to sinus tachycardia in 5 (25%) and acute myocardial infarction in 3 (15%). In 7/20 patients with PAPS (35%) abnormal pulmonary findings were detected by X-ray and in 6 (30%) they were related to dilated pulmonary arch and pulmonary hypertension. In 14/20 cases (70%) with PAPS, abnormal echocardiographic findings were present; 13/20 patients (65%) had valvular complications attributable to PAPS: mitral insufficiency in six cases; mitral valve prolapse in three and aortic insufficiency in three. Two had pulmonary artery hypertension and two, tricuspid regurgitation (one attributable to PAPS). All valve diseases were regurgitant with mild to moderate hemodynamic repercussion. No stenotic lesions were detected. The mean mitral thickness in patients with mitral valve involvement was 7.0 +/- 1.6 mm, compared to 2.8 +/- 0.7 mm in patients with normal valves and 3.1 +/- 0.9 mm in the control group (p < 0.001). The mean aortic valve thickness in patients with aortic valve involvement was 3.6 +/- 0.5 mm compared to 1.5 +/- 0.3 mm in patients with normal valves and 1.4 +/- 0.4 in the control group (p < 0.001). None of the patients from the control group had valve disease (p < 0.0001). Three cases (15%) had pericardial effusion diagnosed by echo. Two patients with PAPS died during the 4.7 +/- 1.2 years of cardiological follow up, due to acute myocardial infarction and embolic cerebrovascular accident, respectively. In conclusion, cardiologic complications are common in PAPS, including left side regurgitant lesions that might be hemodynamically significant, acute myocardial infarction, pericardial effusion and pulmonary hypertension.
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PMID:The heart in the primary antiphospholipid syndrome. 762 Feb 75

Complications following venous punctures are unusual. We describe a case of a false common femoral vein aneurysm following right heart catheterization in a patient with systemic venous hypertension due to tricuspid regurgitation. The initial interpretation of the Doppler ultrasound study lead to a digital subtraction femoral arteriogram which was normal. Magnetic resonance venography demonstrated a femoral venous pseudoaneurysm.
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PMID:Pseudoaneurysm of the common femoral vein as a late complication of right heart catheterization. 782 Aug 42

Tricuspid valve regurgitation and pulmonary hypertension have been evaluated with echo-color-Doppler technique in 100 patients (80 females and 20 males, mean age 54 years) affected by mitral valve stenosis. Pure mitral stenosis was present in 13 patients; 87 had an associated mitral regurgitation. The severity of mitral valve disease was based on the planimetric and functional (Doppler-derived) evaluation of valvular area. No relationship was found between extent of tricuspid regurgitation and severity of mitral valve disease, whereas pulmonary artery hypertension was significantly related to mitral valve involvement, above all Doppler mean gradient (r: 0.63, p < 0.005) and valvular area (r: -0.52, p < 0.01). The study suggests that in patients with mitral valve disease tricuspid regurgitation is independent of the degree of mitral valve involvement, whereas pulmonary hypertension is related to transvalvular gradient and to mitral valve area, but does not depend on the duration of the disease. This is evident only in patients who maintain the sinus rhythm.
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PMID:[Tricuspid insufficiency and pulmonary hypertension in mitral disease: an echocardiographic study]. 801 15

A patient with an intracranial fourth ventricular cyst developed right heart endocarditis from an infected ventriculoatrial shunt inserted previously. Investigation revealed pneumonic involvement of the right lung, moderate tricuspid regurgitation, mild pulmonary artery hypertension, and a large right atrial vegetation. The shunt was removed and treatment of endocarditis started, before undertaking excision of the cyst under general anesthesia. During the operation there was a sudden deterioration in the patient's condition rapidly leading to death. Clinical features suggested intraoperative pulmonary embolism; both venous air embolism and a dislodged atrial vegetation were considered. However, in the absence of specific monitoring equipment and autopsy, the actual cause could not be ascertained. This clinical report highlights the anesthetic problems related to posterior fossa surgery in patients with right-sided endocarditis and suggests some possible management strategies.
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PMID:Posterior fossa surgery in postshunt endocarditis patients: some anesthetic issues. 808 Oct 98

The present study reports the development and characterization of a murine model of right ventricular dysfunction following graded constriction in the pulmonary artery via microsurgical approaches. To analyze in vivo ventricular function, a technique of x-ray contrast microangiography was developed to allow the quantitative analysis of ventricular volumes and of ejection fraction in normal and pressure-overloaded right ventricle. Severe, chronic pulmonary arterial banding for 14 days resulted in right ventricular dilatation and dysfunction, associated with right atrial enlargement, and angiographic evidence of tricuspid regurgitation. These effects were dependent on the extent of hemodynamic overload, since more moderate pulmonary arterial constriction resulted in hypertrophy with maintenance of right ventricular function. With severe pulmonary artery constriction, the murine right ventricle displays a failing heart phenotype including chamber dilation with reduced function that resembles right ventricular dysfunction in man during chronic pulmonary arterial hypertension. Northern and immunoblot analyses demonstrate a marked down-regulation of phospholamban mRNA and its corresponding protein with both levels of constriction, while a less pronounced but significant depression of sarcoplasmic reticulum Ca(2+)-ATPase protein was observed with severe overload, suggesting that this pattern is an early genetic marker of ventricular dysfunction. By coupling mouse genetics with this murine model and the ability to assess cardiac function in vivo, one should be able to test the role of the down-regulation of phospholamban and other defined alterations in the cardiac muscle gene program in the onset of the failing heart phenotype.
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PMID:Molecular and physiological alterations in murine ventricular dysfunction. 814 76


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