British heart journal
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British heart journal · Mar 1984
To catheterise or not to catheterise? An approach based on decision theory.
To determine whether or not patients require cardiac catheterisation before surgery a computer based mathematical model was constructed based on decision theory. The model was specifically applied to sick infants under 3 months of age with suspected coarctation of the aorta, and a three way sensitivity analysis was carried out to assess the effects on the model of changes in the probabilities that underlie the decision itself. ⋯ Factors that tended significantly to move the decision towards catheterisation to rule out coarctation rather than neither to operate nor to catheterise were: a lower risk of surgery for coarctation if present; a higher risk of failing to operate on a patient who had coarctation; a high specificity of cardiac catheterisation; a lower incrementation of surgical risk by previous cardiac catheterisation; and a lower relative risk of catheterisation if coarctation was absent. In this institution, the model argues strongly against cardiac catheterisation in the great majority of sick infants with coarctation.
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British heart journal · Mar 1984
Case ReportsCross sectional echocardiographic feature in carcinoid heart disease. A mechanism for tricuspid regurgitation in this syndrome.
In a patient with severe tricuspid regurgitation and mild pulmonary stenosis due to carcinoid heart disease cross sectional echocardiography showed nodular thickening and coaptation of the tricuspid leaflets at the beginning of systole. The leaflets were, however, seen to be increasingly pulled apart as right ventricular systole proceeded. This finding, which is probably due to traction on the leaflets by the thickened chordae tendineae, is therefore a mechanism of valvular incompetence, perhaps accounting for the particularly severe tricuspid regurgitation seen in carcinoid heart disease.