To classify interatrial septal anomalies in adults, 24 458 Doppler-echocardiographic studies performed between 1. 1. 1987 and 31. 12. 1992 were reviewed. Patients below 16 years of age or with complex congenital heart disease, or after surgical closure of an atrial septal defect, were excluded. Additionally, all 823 transesophageal echocardiographies done between 1. 1. 1993 and 31. 12. 1994 were analyzed to see whether a patent foramen ovale was present. Among 294 patients with interatrial septal anomalies (prevalence 1.2%; male:female = 1:1.4), 298 congenital anomalies of the interatrial septum were detected. 63 % of interatrial septal anomalies constituted newly detected anomalies. Age ranged from 16 to 84 (median 43) years. In 21% of the patients the left-to-right shunt was greater than or equal to 50% (QP/QS greater than or equal to 2). In 25% pulmonary hypertension was present and 25% of the patients underwent surgery. A patent foramen ovale was present in 0.16% of all transthoracal and in 5.7% of all transesophageal echocardiographies. Secundum defects constituted 46%, atrial septal aneurysms 24%, patent foramen ovale 13%, atrioventricular canals 11%, and superior sinus venosus defects with anomalous pulmonary venous return 6% of all diagnoses. Associated anomalies were mitral valve prolapse in 14%, pulmonary valve stenosis in 3%, left-sided persistent vena cava superior and Chiari network in 2% each, anomalous pulmonary venous return, ventricular septal defect, bicuspid aortic valve, and Ebstein's anomaly in 1% each. 4% of the patients showed further cardiac lesions. Conclusions: Anomalies of the interatrial septum in adults were frequent and often newly detected, In a high percentage of patients with interatrial septum the left-to-right shunt was hemodynamically relevant.

UNLABELLED:To classify interatrial septal anomalies in adults, 24,458 Doppler-echocardiographic studies performed between 1. 1. 1987 and 31. 12. 1992 were reviewed. Patients below 16 years of age or with complex congenital heart disease, or after surgical closure of an atrial septal defect, were excluded. Additionally, all 823 transesophageal echocardiographies done between 1. 1. 1993 and 31. 12. 1994 were analyzed to see whether a patent foramen ovale was present. Among 294 patients with interatrial septal anomalies (prevalence 1.2%; male:female = 1:1.4), 298 congenital anomalies of the interatrial septum were detected. 63% of interatrial septal anomalies constituted newly detected anomalies. Age ranged from 16 to 84 (median 43) years. In 21% of the patients the left-to-right shunt was > or = 50% (QP/QS > or = 2). In 25% pulmonary hypertension was present and 25% of the patients underwent surgery. A patent foramen ovale was present in 0.16% of all transthoracal and in 5.7% of all transesophageal echocardiographies. Secundum defects constituted 46%, atrial septal aneurysms 24%, patent foramen ovale 13%, atrioventricular canals 11%, and superior sinus venosus defects with anomalous pulmonary venous return 6% of all diagnoses. Associated anomalies were mitral valve prolapse in 14%, pulmonary valve stenosis in 3%, left-sided persistent vena cava superior and Chiari network in 2% each, anomalous pulmonary venous return, ventricular septal defect, bicuspid aortic valve, and Ebstein's anomaly in 1% each. 4% of the patients showed further cardiac lesions.CONCLUSIONS:Anomalies of the interatrial septum in adults were frequent and often newly detected. In a high percentage of patients with interatrial septum the left-to-right shunt was hemodynamically relevant.

OBJECTIVES AND BACKGROUND:Severe primary tricuspid regurgitation in the adult is a rare finding. This study describes the diagnostic findings and the treatment of an isolated congenital cleft of the anterior leaflet of the tricuspid valve as the morphologic substrate for severe tricuspid regurgitation.METHODS:The clinical, echocardiographic findings and the follow-up findings of five patients (all male, 20 to 56 years old) with this disorder are described. Four of the five patients underwent cardiac surgery that confirmed the diagnosis.RESULTS:In three of five patients, exertional fatigue was the limiting symptom (New York Heart Association functional classes II and III). The clinical findings included a holosystolic murmur and supraventricular arrhythmias in all patients. Cardiac catheterization, performed in four patients, yielded the incorrect diagnosis of Ebstein's anomaly in three. In one patient the cleft was associated with an atrial septal defect of the secundum type. In four of five patients successful reconstruction of the tricuspid valve with a DeVega annuloplasty was performed. One patient had a partial excision of the right atrium, and one had a closure of a coexisting atrial septal defect. One patient refused operation.CONCLUSIONS:Tricuspid valve anomalies can be accurately identified by Doppler echocardiography. Surgical repair is the treatment of choice in patients with severe tricuspid regurgitation due to a congenital cleft of the anterior leaflet of the tricuspid valve.

In 12,576 consecutive Doppler-echocardiographic studies (DE) performed on 11,450 patients over 3 years (1987-1989), 183 newly diagnosed congenital heart abnormalities were detected in 161 patients. The age of the 161 patients (86 female, 75 male) ranged from 16 to 84 years (median 34.5). The highest incidences of pathologies were those of ASD II (29%) and VSD (11%). With decreasing frequency the following abnormalities were diagnosed: pulmonary valve disease (8%), interatrial septal aneurysms (7%), membranous subvalvular aortic stenosis (5%), anomalous pulmonary venous connections (4%), atrioventricular canal defects (4%), persistent left superior venae cavae (4%), patent ductus arteriosus (4%), aneurysms of the membranous septum (4%), and sinus venosus defects (3%). Less common findings were coarctation of the aorta (2.5%), persistent sinusoids (2.5%), arteriovenous fistulas (2.5%), congenital LV-aneurysms (2.5%), Ebstein's anomalies (1%), anomalies of the papillary muscles (1%) and RV-dysplasias (1%). Rare findings were a cor triatriatum, a tetralogy of Fallot, a partial defect of the pericardium, a pulmonic atresia with VSD, an isolated cleft of the tricuspid valve, and finally a connection of a hepatic vein to the right atrium. In conclusion, we found an incidence of 1.4% in newly diagnosed congenital heart disease in adolescents and adults undergoing DE. 32 of 159 patients (20%) were referred to surgery, while endocarditis prophylaxis was indicated in 45%.

In a 53-year-old male who presented with diabetes insipidus as the first symptom of chronic myelocytic leukemia, computed tomography of the sella showed infiltration of the posterior pituitary gland. Busulfan treatment was given for one month and the infiltration had disappeared ten weeks after initiation of therapy. At the same time the severity of the diabetes insipidus diminished for a period of three months. Diabetes insipidus is a rare complication of chronic myelocytic leukemia: only 8 similar cases have been reported in the last 75 years.

Seit längerer Zeit werden Vasodilatatoren erfolgreich in der Behandlung der schweren Herzinsuffzienz eingesetzt [11]. Da bei diesem Krankheitsbild das Renin-Angiotensin-Aldosteron-System aktiviert ist, erscheint der Einsatz eines Angiotensin-Converting-Enzyme-(ACE)-Inhibitors von besonderem Interesse. Unter der Behandlung mit Captopril, dem ersten peroral verabreichbaren ACE-Inhibitor, fand sich in mehreren Studien eine signifikante Verbesserung der hämodynamischen Parameter sowohl im Akutversuch wie im Langzeitverlauf [1, 7, 8, 10]. Die vorliegende Studie faßt unsere Langzeiterfahrungen mit Captopril bei auf Digitalis und Diuretika nur ungenügend ansprechender Herzinsuffizienz zusammen.

Between 1976 and 1982 18 patients with acute and 13 with chronic pericarditis (excluding constrictive pericarditis) were seen at the Medical Outpatient Clinic, University Hospital, Zürich. The prominent symptom in acute pericarditis was chest pain (15/18 patients versus 0/13 in chronic pericarditis, p less than 0.001) and in chronic pericarditis dyspnea (7/13 patients versus 1/18 in acute pericarditis, p less than 0.005). Pericardial friction rub and ST elevation were significantly more frequent in acute than in chronic pericarditis. In contrast, elevation of venous pressure occurred more often in the chronic than in the acute form. During the follow-up of 3.2 years the NYHA class decreased from 2.5 to 1.2 (p less than 0.001) in the group with acute pericarditis although 7 recurrences occurred in 3 patients within the first two years. The follow-up in the patients with chronic pericarditis was 4.4 years and the NYHA class decreased from 2.4 to 1.4 (p less than 0.05). There were, however, two deaths in the group with chronic pericarditis and pericardiocentesis and/or pericardiectomy had to be performed in 8/13 patients.