UNLABELLED:To evaluate different methods for quantification, 55 adult patients with mitral insufficiency were investigated by Doppler color flow mapping (CFM). The maximal area, length and width of the regurgitant jet were determined using apical windows and these were then related to the angiographic findings (Sellers I-IV). In 11/55 patients reliable tracing of the regurgitant flow was not possible because of drop-outs and impaired signal-to-noise ratio. With none of the three systems was a reliable differentiation of moderate to severe forms of mitral incompetence possible because of wide overlapping of the CFM-values in the four angiographic classes. Relating the CFM-values to the diameter or area of the left atrium did not improve the correlations with the angiographic data. At best, the measurement of the maximal area allowed an approximate estimation of the degree of insufficiency: values greater than 6.5 cm2 were not found in patients with Sellers class I or II. Results below this limit could be found in all four angiographic classes. The variability for the estimation of the maximum area (linear regression analysis) was r = 0.96, SEE = 0.07 (intraobserver) and r = 0.94, SEE = 0.08 (interobserver).CONCLUSION:CFM is not a reliable method for classification of mitral regurgitation.

The myocardial perforation of a pacemaker electrode is an extremely rare complication associated with the danger of cardiac tamponade. We report on a perforation of a ventricular screw-in electrode with migration through the pericardium and bleeding in the left thoracic cavity. Two-dimensional echocardiography in combination with clinical, electrocardiographic and X-ray examination permits a reliable non-invasive diagnosis.

In order to study left ventricular contraction parameters of L-penbutolol and D-penbutolol (isopenbutolol) we evaluated TM-echocardiograms of 12 healthy volunteers at 30 and 60 minute intervals for 8 hours after oral administration of 40 mg L- and D-penbutolol and placebo. Three different observers determined end-systolic and end-diastolic dimensions, left ventricular shortening fraction (SF) as well as mean-, peak- and rate corrected circumferential fiber shortening (VCF) and calculated at each measuring point the difference from the control value (Delta). L-penbutolol demonstrated a typical beta-blocking effect with a significant (p less than 0.001) decrease of systolic (11.1 +/- 8.6 mm Hg) and diastolic blood pressure (6.7 +/- 4.6 mm Hg) and heart rate (10.0 +/- 7.4 bpm) as well as a significant (p less than 0.001) negative inotropic effect expressed by a decrease of SF (6.5 +/- 4.2%) and VCF-mean (0.40 +/- 0.15 circ/s), VCF-peak (1.04 +/- 0.61 circ/s) and rate corrected VCF (0.28 +/- 0.08 circ/s). However, we saw a similar but less distinct negative inotropic and chronotropic effect of D-penbutolol as compared to placebo. HR decreased by 5.3 +/- 6.2 bpm (p less than 0.001), SF decreased maximally by 5.0 +/- 3.2% (p less than 0.05), VCF-mean by 0.27 +/- 0.08 circ/s (p less than 0.001), VCF-peak by 0.71 +/- 0.31 circ/s (p less than 0.001) and rate corrected VCF by 0.22 +/- 0.04 circ/s (p less than 0.001). By means of TM echocardiography it was therefore possible to document a strong beta-blocking effect of L-penbutolol as well as a negative inotropic and negative chronotropic effect by the D-isomer of penbutolol.

By means of the pathological findings of 63 patients diagnosed by CT of the heart the radiodiagnostic signs of myocardial, pericardial and paracardial space occupying processes are demonstrated with emphasis on CT of the heart. In addition the electrocardiographic findings of 46 patients are compared with the CT-findings. Whereas there are no essential differences between the results of the two methods diagnosing intramural and greater intracavitary tumors, CT is to prefer at the differential diagnosis of pericardial and paracardial tumors. CT is superior to echocardiography diagnosing small intracavitary thrombi.