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Amongst 22 patients with corrected left-to-right shunts, a diminution in heart size and reduction in central pulmonary arteries and pulmonary plethora was found in about half the patients. A good operative result can be expected, particularly in younger patients with less severe lesions, where the vessels had not been subjected to a high pressure for a long period. The failure of vessels to return to normal is assurmed to be due to changes in the vessel walls. Possible causes for persistent cardiomegaly are, in addition to persistent shunts, coronary artery disease, obesity, inadequate digitalisation and aortic and mitral insufficiency.
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PMID:[The radiographic appearances following correction of left-to-right shunts (author's transl)]. 15 76

Coronary- and LV-angiography in coronary heart disease are indicated I) to clarify whether or not surgery is required (e.g. aorto-coronary-bypass operation, aneurysmectomy) in 1) drug resistent angina pectoris, 2) myocardial aneurysms (or the suspicion of), 3) VSD following myocardial infarction and/or 4) as preoperative investigations in mitral regurgitation or 5) other valve lesions. II) These investigations are furthermore indicated in the under-50-yr.-old considering their prognosis and diagnosis 1) following myocardial infarction 2) to clarify a pathological exercise test with or without angina pectoris 3) in the differential diagnosis of myocardial diseases and 4) occasionally in patients with a number of risk factors or exposed to particular occupational hazards or from families with a high incidence of early deaths from heart disease. Coronary- and LV-angiography are contraindicated in 1) generalized stenosing atherosclerosis, 2) acute myocardial infarction, 3) failure from other organ-systems (e.g. kidney), 4) drug resistent endogenous risk factors and/or relevant obesity, 5) biological age over 60-65.6) continued nicotine dependence. In many cases the specific diagnostic investigations will include the assessment of coronary flow at rest and during maximal drug induced coronary dilatation. This enables us to estimate the coronary reserve and to diagnose coronary insufficiency in patients with normal coronary angiograms.- Instructive morphological and/or functional results illustrate this presentation.
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PMID:[Indications for coronary arteriography and left ventriculography in coronary heart disease (author's transl)]. 125 Nov 19

Transesophageal echocardiography has been proven to be of particular value in all patients with transthoracic echocardiograms of low quality related to pulmonary emphysema, obesity and chest deformation as well as in intensive care unit patients. Similarly, transesophageal Doppler echocardiography is of particular value in all cases in which the transthoracic Doppler, due to methodological problems, is of limited value. Mitral regurgitation can be detected and quantified and flow direction described. Only in 12/25 patients with mild, 11/12 patients with moderate and 5/8 patients with severe insufficiency was regurgitation detected by transthoracic echocardiography as compared to transesophageal echocardiography with which the lesion was consistently detected. In two patients with severe and clinically-inapparent mitral regurgitation related to papillary muscle rupture, the diagnosis was established only by the transesophageal approach in an emergency situation. Atrial septal defects were detected in 8/15 patients and the size of the defect analyzed. With transesophageal Doppler echocardiography, the relation of left-to-right and right-to-left shunts could be described. In 7/16 patients with aortic dissection, true and false lumen were differentiated by analysing the flow pattern within both lumina. In 9/16 patients differentiation was enabled through delineation of the false lumen which was filled with thrombotic material. Detection of aortic regurgitation and tricuspidal regurgitation is possible but analysis of flow patterns is difficult because flow direction is nearly orthogonal to the ultrasound beam. First attempts to quantify cardiac output have been performed. For the future, transesophageal color flow Doppler mapping appears to be a most promising method.
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PMID:[Diagnostic value of the transesophageal Doppler echocardiography]. 330 69

Doppler echocardiographic measurement of time-velocity integral of blood flow across the aortic annulus ("stroke distance") or of stroke volume (SV) have been proposed as noninvasive measures of cardiac pump performance that could elucidate the hemodynamics of hypertension. To evaluate the performance of these measures of hemodynamic volume load in a population with a wide range of body build and other characteristics, we obtained technically adequate imaging and Doppler echocardiograms in 1,935 of 2,212 (87%) American Indian Strong Heart Study participants, without mitral regurgitation or segmental left ventricular (LV) dysfunction, in Arizona, Oklahoma, and South/North Dakota. The subjects ranged widely in age (48 to 81 years) and body mass index (17.0 to 62.6 kg/m2); 65% were women; 1,161 were normotensive and 774 were hypertensive. As a reference standard, LV and stroke volumes were calculated from LV internal dimensions by the Teichholz method. Doppler SVs were moderately related to LV SVs (r = 0.63), but Doppler SV was slightly lower in both normotensive (mean = 69.8 and 72.9 mL, respectively) and hypertensive subjects (71.1 v 73.6 mL). Aortic stroke distance was less closely related than was aortic annular area to LV SV (r = 0.34 v 0.40, P < .001). Aortic annular area (r = 0.44) but not stroke distance (r = 0.04) was moderately correlated with body surface area. Stroke distance was inversely related to annular area (r = -0.29) and in subjects stratified by aortic annular diameter 1.6 to 1.9, 2.0 to 2.1, and 2.3 to 2.9 cm, mean LV SV increased from 67 to 74 to 80 mL, but average stroke distance fell from 22.8 to 21.6 to 20.1 cm. Stroke distance also failed to identify gender differences in LV SV but did identify that due to obesity. Thus Doppler SV closely parallels independently measured LV SV but slightly underestimates SV in both normotensive and hypertensive adults, whereas aortic stroke distance yields misleading comparisons between genders or individuals of different body sizes.
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PMID:Relations of Doppler stroke volume and its components to left ventricular stroke volume in normotensive and hypertensive American Indians: the Strong Heart Study. 919 7

Phentermine and fenfluramine are widely used in the treatment of obesity. Despite the fact that primary pulmonary hypertension and mitral valve insufficiency have been associated with fenfluramine use, many of these patients need medication to achieve weight loss. Small degrees of weight loss have been shown to significantly improve obesity-related medical conditions such as hypertension, hypercholesterolemia, and noninsulin-dependent diabetes mellitus. Current practice is to give phentermine and fenfluramine in the morning and afternoon. Doses for phentermine have ranged from 15 to 37.5 mg and for fenfluramine from 20 to 120 mg per day. We report five cases of severely obese women with medical complications who were treated with phentermine 8 mg twice per day (at 1:00 p.m. and 4:00 p.m.) and fenfluramine 20 mg per day (at 4:00 p.m.). Because many obese patients skip breakfast and eat more in the afternoon and evening, medication was dosed in order to cover these high-risk eating periods. Overall, these patients lost a mean of 22.4% of their initial weight (range 18.6% to 32.8%) over an average of 8.4 months (range 3.5 to 16 months). These cases suggest that short-term weight loss can be achieved with a low dose of fenfluramine when both medications are given in the afternoon to better target the eating patterns of obese subjects.
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PMID:Lower dosages of phentermine-fenfluramine given in the afternoon: five cases with significant weight loss. 1020 59

In a 3-year prospective echocardiographic study of patients with clinical features of mitral valve prolapse who presented to the cardiology clinic of the medical out patients clinic of the Lagos University Teaching Hospital comprising of sixty-two patients. The most common complaints found were vague chest discomfort (42%) and chest pain. (28%) Their mean body mass index was 20.8 +/- 5.56 Kg/m2. The most common auscultatory sign was apical clicks (8%). Hypertension (12%) was the most common clinical association while the anterior leaflet (87%) was more affected. Mitral regurgitation was present in 35.7% of cases, which were mostly mild in severity (93%). There were statistical differences in the chamber and wall dimension measurements of those with isolated mitral valve prolapse when compared with those associated with other clinical conditions. (p < 0.05). Subjects with isolated mitral valve prolapse were found to have significant differences in the echocardiographic measurements when compared with those with coexisting diseases suggesting that mitral valve prolapse is a relatively benign condition except coexisting with other conditions like hypertension, valvular defects and obesity. These associated conditions tended to increase cardiac risk.
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PMID:Clinical and echocardiographic assessment of Nigerian patients seen at the Lagos University Teaching Hospital with features of mitral valve prolapse. 1112 84

Left ventricular hypertrophy LVH is supposed to be a useful marker of cardiovascular complications during the course of hypertension. Occurrence of other risk factors of atherosclerosis in these hypertensive patients such as hyperlipidemia and smoking deteriorate the prognosis too. The authors compared clinical findings in hypertensive patients with and without left ventricular hypertrophy defined by echocardiography. Hospital records of 185 hypertensive patients treated at our medical department during years 1996-1999 were analysed. Left ventricular hypertrophy was defined by echocardiography (Penn convention) as left ventricular mass index > 134 g/m2 in men and > 110 g/m2 in women. Presence of LVH was found in 109 patients (mean age 66.7 years), absence of LVH in 76 patients (mean age 64.7 years). Both groups of hypertensive patients were matched by demographic parameters by the presence of hyperlipidemia and by smoking habits. Hypertensive patients with diabetes mellitus and obesity were excluded. They were statistically significant in the incidence of heart failure, myocardial infarction, renal failure and mitral regurgitation, and non-significant in the incidence of left ventricular diastolic dysfunction. There were more cardiovascular complications in LVH-positive patients than in those with LVH-negative findings. The incidence of stroke was slightly higher in LVH-negative patients. Left ventricular hypertrophy in patients with hypertension brings usually a complicated course of the disease. The authors recommend to examine the patients with arterial hypertension for the presence of left ventricular hypertrophy as it complicates the course of the disease significantly. (Tab. 3, Fig. 2, Ref. 26.)
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PMID:[Left ventricular hypertrophy in hypertension]. 1115 71

Evidence suggesting that mitral regurgitation (MR) may be induced by appetite suppressant medications heightens the importance of understanding the prevalence and correlates of MR, especially its relation to obesity, in population-based samples. MR was assessed by color Doppler echocardiography in 3,486 American Indian participants in the Strong Heart Study. Mild (1+) MR was present in 19.2%, moderate (2+) MR in 1.6%, moderately severe (3+) in 0.3%, and severe (4+) in 0.2% of participants. In univariate analyses, MR was unrelated to gender, diabetes, or lipid levels, but was more frequent in North/South Dakota (28.3%) than in Oklahoma (21.6%) or Arizona (14.3%) (p <0.001). MR was related to lower body mass index (BMI) (p <0.001), older age (p <0.001), higher systolic blood pressure (p = 0.003), higher serum creatinine (p <0.001), and higher urine albumin/creatinine ratio (p <0.001). In multivariate analyses, the presence and severity of MR were independently associated with higher serum creatinine, lower BMI, mitral stenosis, prior myocardial infarction, female gender, mitral valve prolapse and, variably, older age. In conclusion, MR, mostly mild, is detected by color Doppler echocardiography in >20% of middle-aged and older adults. MR is independently associated with female gender, lower BMI, older age, and renal dysfunction, as well as with prior myocardial infarction, mitral stenosis, and mitral valve prolapse. It is not related to dyslipidemia or diabetes.
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PMID:Prevalence and correlates of mitral regurgitation in a population-based sample (the Strong Heart Study). 1116 64

The presence of diabetes mellitus and other risk factors of atherosclerosis, such as obesity, smoking and hyperlipidemia, in hypertensive patients makes the prognosis worse. Authors compared the clinical findings in diabetic hypertensive patients with and without left ventricular hypertrophy, the presence of which was diagnosed and defined by echocardiography. The study is based on the analysis of hospital records of 115 hypertensive patients treated at our department during the period 1998-1999. Left ventricular hypertrophy (LVH) was defined by echocardiography as left ventricular mass index > 134 g/m2 in men and > 110 g/m2 in women. Left ventricular hypertrophy was found in 79 patients (mean age 64.6 ys) but not in 36 patients (mean age 63.3 ys). Both groups were matched as to age and sex, intensity and duration of hypertension and diabetes, obesity, smoking and hyperlipidemia. In LVH-positive patients, there was a statistically significant incidence of heart failure, mitral regurgitation and renal involvement and a more non-significant incidence of left ventricular diastolic dysfunction, myocardial infarction, chronic atrial fibrillation and stroke than in LVH-negative ones. Left ventricular hypertrophy usually complicates the course of hypertension. Authors recommend to investigate the presence of left ventricular hypertrophy in hypertensives as it carries a much more complicated course of the disease. (Tab. 5, Ref. 28.)
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PMID:Relation of left ventricular hypertrophy to cardiovascular complications in diabetic hypertensives. 1188 69

Left ventricular hypertrophy has been suggested to mediate the relation between hypertension and left atrial enlargement, with associated risks of atrial fibrillation and stroke. However, less is known about correlates of left atrial size in hypertensive patients with left ventricular hypertrophy. We assessed left atrial size by echocardiography in 941 hypertensive patients, age 55 to 80 (mean, 66) years, with electrocardiographic left ventricular hypertrophy at baseline in the Losartan Intervention For Endpoint reduction in hypertension study. Enlarged left atrial diameter (women, >3.8 cm; men, >4.2 cm) was present in 56% of women and 38% of men (P<0.01). Compared with the 512 patients with normal left atrial size, the 429 patients with enlarged left atrium more often had mitral regurgitation, atrial fibrillation, and echocardiographic left ventricular hypertrophy. They also had higher age, systolic blood pressure, pulse pressure, weight, body mass index, left ventricular internal chamber dimension, stroke volume, and mass and lower relative wall thickness and ejection fraction (all, P<0.05). In logistic regression analysis, left atrial enlargement was related to left ventricular hypertrophy and eccentric geometry; greater body mass index, systolic blood pressure, and age; female gender; mitral regurgitation; and atrial fibrillation (all, P<0.05). Thus, left atrial size in hypertensive patients with electrocardiographic left ventricular hypertrophy is influenced by gender, age, obesity, systolic blood pressure, and left ventricular geometry independently of left ventricular mass and presence of mitral regurgitation or atrial fibrillation.
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PMID:Correlates of left atrial size in hypertensive patients with left ventricular hypertrophy: the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. 1189 55


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