Japanese heart journal
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Japanese heart journal · Sep 1989
Congenital coronary artery fistulas. Diagnostic and surgical considerations.
Between 1974 and April, 1988, 9 patients with congenital coronary artery fistulas underwent surgical repair. Of these, 4 were female and 5 male, ranging in age from 6 to 50 years (mean 28.2 +/- 18.9). Seven patients were symptomatic (congestive heart failure and/or angina), whereas in 2 patients the diagnosis was established through the investigation of an asymptomatic continuous murmur. ⋯ There was no operative mortality and long term follow-up was uneventful after a mean follow-up of 5.4 +/- 5.2 years, with 8 patients still completely asymptomatic. Surgical therapy is recommended for patients having coronary artery fistulas in order to prevent fistula-related complications. In those cases requiring CPB, closure of the fistula from the involved chamber only is suggested.
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The difficulty in making an accurate diagnosis of acute pulmonary embolism is well known. To clarify the role of echocardiography, including Doppler echocardiography, in acute pulmonary embolism, we examined hemodynamic and echocardiographic parameters in 9 patients with acute pulmonary embolism just before and after treatment with urokinase. ⋯ Doppler echocardiography quantitatively evaluated the grade of tricuspid regurgitation, and accurately estimated systolic pulmonary artery pressure. We conclude that echocardiography, including Doppler echocardiography, sensitively reflects the right ventricular pressure and volume overload of acute pulmonary embolism, is quite useful for its diagnosis which is often difficult, and is suitable for noninvasive follow up of these patients.
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Japanese heart journal · Sep 1988
Case ReportsEffectiveness of continuous arteriovenous hemofiltration for patients with refractory heart failure.
Continuous arteriovenous hemofiltration (CAVH) was carried out in 8 patients with refractory congestive heart failure. All these patients had heart failure and oliguria for over 24 hours and intensive treatment with digitalis, diuretics, catecholamines and vasodilators was prescribed. ⋯ During CAVH, pulmonary arterial pressure and pulmonary capillary wedge pressure were significantly reduced in all patients, the right atrial pressure decreased in 6 with right cardiac failure, the heart rate decreased in 3 with tachycardia and the blood pressure and cardiac index were elevated in 3 with hypotension. These observations show that CAVH can be performed safely and effectively in patients with congestive heart failure, oliguria and hypotension.
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Six patients with d-transposition of the great arteries and 1 patient with tricuspid atresia were diagnosed echocardiographically. Balloon atrial septostomy (BAS) was performed successfully in all cases with the aid of two-dimensional echocardiography. ⋯ With the visualization of related cardiac structures during BAS, obstruction of the IVC with the balloon was also prevented. Using this method, bedside application of BAS is possible.
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Japanese heart journal · Jan 1988
Incorporation of venous resistance in Togawa's four quadrant diagram for Guyton's circulatory equilibrium.
Guyton indicates that the contribution of venous resistance to venous return resistance is magnified by the compliance ratio (30) of the venous compartment to the arterial compartment. Therefore, even a slightly increased venous resistance sensitively decreases venous return and hence cardiac output in the circulatory equilibrium. However, Guyton's diagram does not allow an easy and explicit evaluation of the effect of venous resistance on cardiac output. ⋯ However, Togawa's diagram does not include venous resistance. Therefore, I modified Togawa's diagram to incorporate venous resistance in the first quadrant for the cardiac output curve. The new diagram shows easily and explicitly that venous resistance sensitively tilts down either the venous return curve or the cardiac output curve and markedly decreases venous return and cardiac output.