Faculty Bibliography

This is a report of the echocardiographic findings in a 9-year-old white female with primary pulmonary arterial hypertension confirmed by catheterization and later at autopsy. The reported findings of an absent 'a' wave, a flat diastolic E to F slope, and a midsystolic closure of the pulmonic valve were observed. In addition, tricuspid valve prolapse was noted. Prolapse of the tricuspid valve may be part of the mechanism of tricuspid insufficiency in a patient with pulmonary hypertension

Sixteen of 994 patients with arteriosclerotic heart disease and dominant right coronary arteries had isolated left circumflex obstruction. Of these, 6 patients had significant (75%) narrowing in the main circumflex, 10 in 1 or the marginal branches and 1 in the atrioventricular groove branch. Angina was mild in 5, moderate to severe in 8, and unstable in 1. Four patients had prior myocardial infarction (MI), and 1 had a recent MI complicated by posterior papillary muscle rupture. The EKG was normal in 5, showed an MI in 2, LBBB in 1, RBBB in 2, ST-T wave changes in 3, LVH in 2, and atrial fibrillation in 2. Left ventricular angiography performed in the right anterior oblique projection revealed normal contraction in 9 patients, apical hypokinesis in 4, posterobasal hypokinesis in 1, and diffuse hypokinesis in 2. The left ventribular end diastolic pressure was normal in 11 patients and elevated in 5. The cardiac index was normal in 12 patients and reduced in 2. Isolated, nondominant, left circumflex coronary disease is an uncommon entity in symptomatic patients. However, when present, it may produce significant clinical and hemodynamic impairment

A 64-year-old patient was admitted to the hospital with a history of two syncopal episodes. The results of the physical examination, resting electrocardiogram and His-bundle study were all normal. Study with a 24-hour ECG monitor (Holter) was at first interpreted as demonstrating periods of sinus arrest. However, more careful examination revealed that these actually represented transient speeding of the monitor tape, perhaps secondary to a semiconductor malfunction. Such monitor malfunction may stimulate severe rhythm disturbances

A case is presented of a 60-year-old woman with fatigue, dyspnea, and chest pain. A chest x-ray film revealed an abnormal cardiac silhouette. Echocardiography revealed a large, echo-free area with well-demarcated, discrete borders adjacent to the right heart border. This structure decreased in size with inspiration and did not show pulsatile cardiac motion. Cardiac catheterization confirmed the extracardiac nature of the lesion and also showed a 'constrictive' pattern with equalization of diastolic pressures. Surgical exploration revealed a large cystic thymoma. With removal of the tumor, intracardiac pressures returned to normal

A case is presented of a 42-yr old woman with rheumatic heart disease in whom cardiac catheterization revealed severe mitral stenosis and a low cardiac output, but no gradient across the tricuspid valve. Echocardiography clearly demonstrated the presence of tricuspid stenosis and the valve was found to be severely stenotic at surgery. This establishes the value of echocardiography in detecting tricuspid stenosis and suggests that, in some cases, it may be more sensitive than cardiac catherization in detecting this lesion