British heart journal
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British heart journal · Apr 1984
Comparative StudyComparison of cinefluoroscopy and M mode echocardiography for detecting aortic valve calcification. Correlation with severity of stenosis of non-rheumatic aetiology.
The density of aortic valve calcification was estimated using cinefluoroscopy and M mode echocardiography in 86 patients with pure aortic stenosis. The results were compared with the degree of outflow obstruction measured haemodynamically. ⋯ Echocardiography gave accurate information about the distribution of calcium within the cusps, but this was not of value in predicting the degree of obstruction. The amount of calcium in the aortic valve as assessed by simple cinefluoroscopy is a useful guide to the severity of aortic stenosis in patients in the middle and older age groups.
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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.
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British heart journal · Apr 1983
Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction.
To study the value of the electrocardiogram in diagnosing right ventricular involvement in acute inferior wall myocardial infarction, the electrocardiographic findings were analysed in 67 patients who had had scintigraphy to pin-point the infarct. All 67 patients were consecutively admitted because of an acute inferior wall infarction. A 12 lead electrocardiogram with four additional right precordial leads (V3R, V4R, V5R, and V6R) was routinely recorded on admission and every eight hours thereafter for three consecutive days. ⋯ The diagnostic value of a QS pattern in lead V3R and V4R or ST elevation greater than or equal to 1 mm in lead V1 was much lower. ST segment elevation in the right precordial leads was short lived, having disappeared within 10 hours after the onset of chest pain in half of our patients with right ventricular involvement. When electrocardiograms are recorded in patients with an acute inferior wall infarction within 10 hours after the onset of chest pain, additional right ventricular infarction can easily be diagnosed by recording lead V4R.
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British heart journal · Apr 1983
Experience with the modified Blalock-Taussig operation using polytetrafluoroethylene (Impra) grafts.
Between June 1978 and January 1982, 115 patients underwent 122 subclavian artery-pulmonary artery shunts using polytetrafluoroethylene (PTFE Impra) grafts. Forty-six of the patients had a ductus dependent pulmonary circulation, the patency of which was maintained by an infusion of prostaglandin E2 in 29 cases. There were nine hospital deaths, four of which were related to shunt failure. ⋯ The actuarial estimate of shunt patency was 90% (+/- 3%) at two years for all patients and 74% (+/- 10%) for neonates. There was no statistically significant difference in two year shunt patency between 4 mm grafts (88 +/- 5%) and 6 mm grafts (96 +/- 3%). The modified Blalock shunt using a PTFE graft is an effective pulmonary-systemic shunt with a good short term patency.