Giornale italiano di cardiologia
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The hemodynamic effects of standard dose of Nitroglycerin (NTG) ointment (23 +/- 4 mg) and oral Isosorbide Dinitrate (ISDN) 10 mg were compared in the treatment of left ventricular failure. Ten patients, 8 males and 2 females (mean age 59 +/- 9 years), affected by acute myocardial infarction (7 cases). Ischemic cardiomyopathy (2 cases) and hypertensive cardiomyopathy (1 case) were submitted to right heart catheterization by triple lumen Swan-Ganz catheter. ⋯ These changes were statistically different from those produced by ISDN (p less than 0,05). Thus NTG ointment, at this dose, improved cardiac performance, while oral ISDN 10 mg did not. It is concluded that the hemodynamic effects of NTG ointment are prompt and sustained.
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Between 1966 and 1979 60 patients underwent resection of organic subaortic stenosis at the National Heart Hospital. There was a male:female ratio of 40:20 and an age range of 4 to 56 years (mean 18 years). 22 patients (36.7%) had a single or multiple additional cardiac abnormalities including left ventricular outflow tract obstruction (12 cases), right ventricular outflow tract obstruction (3 cases), ventricular septal defect (6 cases), patent ductus arteriosus (5 cases), aortic coarctation (1 case), congenital mitral stenosis (1 case) and mitral atresia associated with a single ventricle (1 case). Isolated resection of the organic sub-aortic with myotomy and wedge resection was performed in 47 patients and Cooley technique in 2 patients. ⋯ There were 7 non-fatal complications: a myocardial infarction, AV block and pacemaker insertion; three mild aortic regurgitations; one mild mitral regurgitation; an arrhythmia due to Wolf Parkinson White syndrome; and an aortic and mitral valve replacement after 9 years. 43 other patients have been followed for 1 to 14 years and are symptom free. Left bundle branch block is present in two of them. Resection of organic sub-aortic stenosis with myotomy and wedge resection is a safe technique and offers an excellent prognosis for this group of congenitally compromised patients.
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Case Reports
[Hyperbaric oxygenation in cerebral air embolism occurring during open-heart surgery (author's transl)].
Hyperbaric oxygenation was used in two patients with extensive neurologic damage from cerebral air embolism occurring during open-heart surgery. One patient made a full recovery. ⋯ First consideration must be given to the prevention of this complication, but once an embolus has occurred, hyperbaric treatment should be instituted promptly and early. Therefore every team engaged in open-heart operations should be familiar with the diagnosis and the therapy of air embolism.
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In spite of great technological improvement in Ambulatory ECG Monitoring (AEM), there is still debate about its reliability in detecting ECG signs of myocardial ischemia and about the utility of AEM and Exercise Stress Testing (ET)--apart and/or in association--to predict Coronary Artery Disease (CAD). 50 consecutive male patients (pts) (mean age 51 +/- 69 years, 37 to 64 years) were studied for precordial chest pain. 17 had evidence of previous myocardial infarction. Resting ECG was normal in 21 pts and abnormal in 29; no pt received therapy during the examination period. ⋯ The percentage of false negative results was similar in AEM and ET (22.7% vs 22.2%); the false positives were few with both tests: 2 pts and 1 pt respectively; Bayesian probability (post-test likelihood for disease) calculated using the prevalence of CAD estimated from 2124 male pts who underwent coronary angiography in our Laboratory, for a given test result was very high: 97.1% +/- 1.3% (AEM), 98.6% +/- 1.1% (ET) and 98.1% +/- 1.1% (AEM & ET if concordant); post-test likelihood for CAD in a patient who did not show the given test result decreased to 67.8% +/- 1.3% (AEM), 60.9% +/- 1.1% (ET) and 52.1% +/- 1.1% (AEM & ET if concordant). The application of Bayes' theorem to these two non invasive tests improves the evaluation of patients with suspected CAD; the association of AEM and ET enhances the diagnostic accuracy.