International journal of cardiology
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The clinical profile of right-sided infective endocarditis in India was studied from a review of records of patients with infective endocarditis admitted to this hospital. From November 1982 to November 1989, 109 patients with infective endocarditis showed vegetations on cross-sectional echocardiography confirming the diagnosis of infective endocarditis. In 19 (17.4%) patients, only the right side of the heart was involved: specifically the tricuspid valve alone in 10; tricuspid and pulmonary valves in 4; tricuspid valve and right ventricular outflow tract in 1; tricuspid valve and right ventricular free wall in 1; pulmonary valve alone in 2; and bifurcation of pulmonary trunk in 1. ⋯ All patients with isolated right-sided infective endocarditis had features of septicaemia, but a murmur of tricuspid regurgitation was audible in only 4 (50%) of them. We conclude that, unlike western reports, the pattern of right-sided infective endocarditis in India is different. No drug addict with right-sided infective endocarditis was seen; puerperal sepsis and septic abortion were the commonest causes of isolated right-sided infective endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Severe aortic stenosis may potentiate sudden life threatening complications during pregnancy. We report a case of successful percutaneous balloon aortic valvuloplasty in a pregnant patient with severe symptomatic aortic stenosis due to congenital bicuspid aortic valve at 14 weeks' gestation. Use of percutaneous valvuloplasty allowed asymptomatic progression of the pregnancy to term and normal delivery of a healthy 2920 g infant.
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Acute renal failure requiring dialysis occurred in 34 children (2.9%) following cardiac surgery over a five year period. 17 children (50%) recovered renal function with 11 (32%) long-term survivors. The long-term outcome for the survivors, in terms of renal function, was studied from 1 to 5 years after their episodes of acute renal failure. Three children had significant abnormalities of renal function despite normal urinalysis. Detailed assessment of renal function is advocated for children who survive acute renal failure following cardiac surgery.
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Comparative Study
Transoesophageal echocardiographic assessment of primum, secundum and sinus venosus atrial septal defects.
We compared the ability of transthoracic and transoesophageal echocardiography to determine the presence and site of an atrial septal defect and associated anomalous pulmonary venous connexions in 13 school age children (aged 5 to 15 years) and 12 adults (aged 25 to 68 years). Transthoracic echocardiography detected atrial septal defects in 12 children and 6 adults. Transoesophageal echocardiography confirmed the position of 16 (13 secundum, 3 primum) of these 18 defects but altered the diagnosis from a secundum defect to a sinus venosus defect in one and from a sinus venosus defect to a high secundum defect in another. ⋯ In an adult with inconclusive transthoracic findings, transoesophageal echocardiography enabled clear visualisation of the atrial septum and excluded an atrial septal defect. Transoesophageal echocardiography showed anomalous attachment of a pulmonary vein into the region of a sinus venosus defect (n = 3) but did not show anomalous connexions to the superior caval vein (n = 3) or the inferior caval vein (n = 1). Transoesophageal echocardiography provides a reliable method of diagnosing or excluding an atrial septal defect in patients with inconclusive transthoracic findings and is of particular diagnostic value in sinus venosus defects.
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To evaluate the effects of inotropic stimulation on ventriculo-arterial coupling, we determined both the slope of the end-systolic pressure-volume relationship (ventricular elastance) and the slope of end-systolic pressure-stroke volume relationship (arterial elastance) at rest and during dobutamine infusion (5 micrograms/kg/min). We also determined stroke work, end-systolic potential energy and the ventricular work efficiency defined as stroke work per pressure volume area (stroke work + potential energy). In the resting state, ventricular elastance was lower than arterial elastance and work efficiency was about 59.7 +/- 9.3% (mean +/- SD). ⋯ Enhanced ventricular elastance by 41% with dobutamine resulted in a significant reduction in both left ventricular end-diastolic and end-systolic volumes and was accompanied by the reduction in arterial elastance by 23%. Consequently, the ratio of arterial elastance to ventricular elastance decreased from 1.43 +/- 0.57 to 0.82 +/- 0.47, which resulted in an increase in stroke work, a decrease in potential energy and hence a marked increase in work efficiency. Thus, inotropic stimulation of depressed hearts could modulate ventriculo-arterial coupling towards optimization of either stroke work or mechanical efficiency.