In acute aortic regurgitation, left ventricular pressure rises rapidly during diastole, which produces presystolic mitral valve closure. This does not occur in chronic aortic regurgitation. Since normal, nonregurgitant mitral valve closure may depend on properly coordinated atrial and ventricular contractions, we hypothesized that abnormal mitral valve closure occurring before systole in acute aortic regurgitation may produce diastolic mitral regurgitation detectable by Doppler echocardiography. Accordingly, we performed ultrasonic Doppler examination of seven patients with acute aortic regurgitation and 12 patients with chronic aortic regurgitation. Regurgitant aortic flow was severe in all cases. Doppler sampling within the left atrium demonstrated regurgitant mitral flow in late diastole in all patients with acute aortic regurgitation. The onset of diastolic mitral regurgitation coincided with mitral valve preclosure in patients with acute aortic regurgitation and occurred regardiess of the position of the mitral leaflets at the initiation of closure. In contrast, none of the 12 patients with chronic aortic regurgitation had mitral valve preclosure or diastolic mitral regurgitation (p < 0.05 versus acute aortic regurgitation). We conclude that diastolic mitral regurgitation accompanies mitral valve preclosure, which occurs in acute but not chronic aortic regurgitation. Thus diastolic mitral regurgitation may be a Doppler sign of acute aortic regurgitation, in the absence of a markedly prolonged PR interval. Furthermore, this observation suggests that normal, nonregurgitant mitral closure requires more than an increase in left ventricular pressure above left atrial pressure, regardless of the position of the mitral leaflets before closure.

We have reported a case of left atrial myxoma in association with an atrial septal defect in a patient followed up over a number of years for recurrent sterile pleural effusions and chronic obstructive lung disease of undetermined cause. During hospitalization for pneumonia, an intracardiac mass and atrial septal defect were found by echocardiography, and verified at operation to be a left atrial myxoma.

The rare occurrence of mitral stenosis and coexistent left atrial myxoma is reported. The patient had a 25-year history of rheumatic heart disease and was referred for evaluation of progressive mitral stenosis without clinical suspicion of left atrial myxoma. The tumor was discovered by routine echocardiography in the course of evaluation of mitral stenosis. However, prior to surgery the patient experienced an episode of embolization of the tumor without major clinical sequelae. The utility of echocardiography in this case and in patients with mitral stenosis is discussed as well as the patient's spontaneous "cure."

This study sought to assess the reliability of biplanar transesophageal echocardiography in the diagnosis of ascending aortic dissection and to test the utility of M-mode information in the differential diagnosis of ascending aortic ultrasound artifacts and intimal flap images.Transesophageal echocardiography is a useful technique in the diagnosis of aortic dissection. However, ultrasound artifacts in the ascending aorta are an important limitation.Transesophageal echocardiography was performed in 132 consecutive patients with clinically suspected aortic dissection. Two-dimensional and M-mode echocardiography and color Doppler were used to diagnose intimal flap and artifact images. Diagnoses were validated either anatomically or with reference techniques.The sensitivity and specificity of transesophageal echocardiography in the diagnosis of ascending aortic dissection were 96.8% and 100%, respectively. Ninety-three artifacts were observed in 56 (55%) of 101 patients without ascending aortic dissection. Two-dimensional echocardiography easily identified 74 artifacts (80%). Color Doppler showed no ascending flow abnormalities in 71% of artifact images. M-mode echocardiography showed three location and mobility artifact patterns related to the posterior wall of the aorta or the right pulmonary artery. In contrast, intimal flap movement showed no relation to the aortic wall movement in 25 cases (83%). Blind analysis of transesophageal echocardiographic study tapes underlined the utility of M-mode in the differential diagnosis. Ranges of sensitivity, specificity and positive predictive value (established by including doubtful results as either positive or negative) improved from 87.1–93.5% to 93.5- to 96.8%, from 85.1–94.1% to 99–100% and from 65.9–81.8% to 96.8–100%, respectively, with the inclusion of M-mode data.Biplanar transesophageal echocardiography permits reliable diagnosis of ascending aortic dissection. Ultrasound artifacts are common, but assessment of the location and mobility of intraluminal images by M-mode echocardiography definitely improves diagnostic accuracy.

Ascending aortic root dissections were repaired in two cases using Dacron graft prostheses. In each instance, native aorta was wrapped around the graft resulting in a postoperative false positive echocardiographic picture of de novo dissection.

The efficacy of contrast-enhanced computed tomography to define graft patency status was studied in 42 patients with 100 aortocoronary vein grafts. The status of each graft had been determined earlier by angiography. A rotary fan beam whole body scanner with a 2 second scan duration was used. Initial scans determined the optimal level for study of the graft; patency was assessed by computed tomographic enhancement of the graft after intravenous bolus injection of 30 ml meglumine and sodium diatriazoate. The computed tomographic studies were evaluated without knowledge of the angiographic findings; graft status by computed tomography was interpreted as patent, occluded or equivocal. Overall, computed tomography correctly defined graft patency status in 79 of the 100 grafts and incorrectly identified it in 9; in 12 grafts, the computed tomographic diagnosis was equivocal. Computed tomography correctly identified 61 of 74 patent grafts and 18 of 26 occluded grafts. Patency status was correctly defined by computed tomography in 35 of 37 grafts to the left anterior descending artery, 23 of 30 grafts to circumflex branches and 19 of 31 grafts to the right coronary artery. These data indicate that computed tomography is a promising noninvasive method of determining patency of aortocoronary bypass grafts, especially of grafts to the left anterior descending artery.

We have presented two patients with heart failure due to cardiac amyloidosis. The diagnosis was suspected from the echocardiogram and was confirmed by rectal biopsy. The echocardiogram features, which include thickening of the heart walls and other intracardiac structures, differentiate cardiac amyloidosis from other forms of heart disease. Thus, echocardiography should be helpful in the preliminary evaluation of patients with obscure heart failure and may obviate the necessity for more invasive studies.

We have presented an unusual case of a left intraventricular cardiac tumor which was detected during cardiac catheterization, done to evaluate unexplained chest pain. An echocardiogram showed the tumor to be continuous with the interventricular septum and in front of the mitral valve. At operation, the lesion was attached to the interventricular septum and, microscopically, proved to be a lipoma. This is believed to be the first reported intraventricular lipoma detected ante mortem and successfully removed.

Echocardiograms were performed in 35 patients prospectively with mitral stenosis to determine the usefulness of the left atrial emptying index (AEI) in estimating mitral valve orifice area (MVOA). Twnety-five control patients without evidence of cardiac disease had an AEI of 0.91 +/- 0.01. In the mitral stenosis group, the mean AEI was 0.47 +/- 0.09, with Gorlin and Gorlin calculated MVOAs of 1.44 +/- 0.56. There was close correlation between the AEI and MVOA (r = 0.93). The AEI did not correlate well with the left atrial size (r = 0.10), or the EF slope of the mitral valve (r = 0.20). The AEI was useful in separating patients with mitral stenosis into mild, moderate, and severe groups. Twelve out of 12 patients with severe mitral stenosis (MVOA less than or equal to 1.0 sq cm) had an AEI of less than or equal to 0.42. Ten out of 13 patients with moderate mitral stenosis (MVOA of 1.1--1.5 sq cm) had an AEI of 0.43 to 0.51. Eight out of ten patients with mild mitral stenosis (MVOA greater than or equal to 1.6 sq cm) had an AEI of greater than or equal to 0.52. The overall predictive value of the AEI in subclassifying the severity of mitral stenosis was 86 percent. In conclusion, the AEI appears to be a sensitive index in estimating MVOA in mitral stenosis.

Hypertension has been shown to have a component of increased vascular resistance. In general, the terms increased resistance and vasoconstriction have been used interchangeably. This study demonstrates that in the bulbar conjunctiva of human essential hypertensives, the decrease in number of arterioles may be just as significant as the arteriolar constriction. When compared to 12 age and sex matched normotensive controls, 12 untreated essential hypertensives had a 20% reduction in arteriolar density and a 5% decrease in arteriolar diameter. Both of these findings were significant at the 5% level. In a calculated “Poiseuille resistance,” the vessel rarefaction and the vessel constriction would contribute approximately equally to the increased resistance. These findings support the contention that microcirculatory density and caliber should be considered in discussions of alterations of vascular resistance.

Comments and Corrections1 June 1976Mitral-Valve Echocardiography in Rheumatoid ArthritisA. M. NOMEIR, M.D., L. E. WATTS, M.D., R. TURNER, M.D.A. M. NOMEIR, M.D.Search for more papers by this author, L. E. WATTS, M.D.Search for more papers by this author, R. TURNER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-84-6-756 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The paper, "Absence of Echocardiographic Abnormalities of the Anterior Mitral Valve Leaflet in Rheumatoid Arthritis," (Ann Intern Med 83:500-502, 1975) by Davia and colleagues is an interesting one. Because our findings (1) were quoted in their article, certain comments should be made.Our study was an attempt to identify potential cardiac abnormalities in rheumatoid arthritis by using echocardiographic techniques as part of the overall prospective survey. We found mild slowing of the EF slope in several patients with rheumatoid arthritis, as compared with large groups of normal persons and as reported from other studies. This finding does...References1. NOMEIRTURNERWATTS ARE: Cardiac involvement in rheumatoid arthritis. Ann Intern Med 79:800-806, 1973 LinkGoogle Scholar2. LEBOWITZ W: The heart in rheumatoid arthritis (rheumatoid disease). A clinical and pathological study of sixty-two cases. Ann Intern Med 58:102-123, 1963 LinkGoogle Scholar3. BACONGIBSON PD: Cardiac involvement in rheumatoid arthritis. An echocardiographic study. Ann Rheum Dis 33:20-24, 1974 CrossrefMedlineGoogle Scholar4. PRAKASHATASSIROSEN RAK: Prevalence of pericardial effusion in patients with rheumatoid arthritis without cardiac symptoms. N Engl J Med 289:597-600, 1973 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Neurology The Bowman Gray School of Medicine of Wake Forest University Winston-Salem, NC 27103 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 June 1976Volume 84, Issue 6Page: 756-757KeywordsEchocardiographyRheumatoid arthritis ePublished: 1 December 2008 Issue Published: 1 June 1976 PDF downloadLoading ...

Twenty-two patients with symptomatic atrioventricular block were treated with permanently implanted transvenous pacemakers. The pacemaker was relatively simple to implant; only local anesthesia was required, and there were no hospital deaths. One late death occurred in a patient with severe coronary artery disease, and there was one failure of the system due to perforation of the ventricle. Interruption of pacing occurred nine times in six patients due to dislocation of the catheter tip or pulse generator problems. No deaths resulted and adequate pacing was reinstituted by minor procedures in all of the patients except one who had resumed normal atrioventricular conduction. Nineteen of the patients at the time of this report are alive, free of syncopal attacks, and paced with an adequate ventricular rate.

The authors review their experiences with the replacement of valves by prostheses of one type or another. They have found that improvement in operative management and increasing technical experience have had a favorable effect on their mortality rate. However, they demonstrate that the death rate remains high for valve replacements, and indicate that the long-term results of valve prostheses is still to be assessed.