Continuous arteriovenous hemofiltration (CAVH) was carried out in 8 patients with refractory congestive heart failure. All these patients had heart failure and oliguria for over 24 hours and intensive treatment with digitalis, diuretics, catecholamines and vasodilators was prescribed
Hemodynamics were followed closely during CAVH
During CAVH, pulmonary arterial pressure and pulmonary capillary wedge pressure were significantly reduced in all patients, the right atrial pressure decreased in 6 with right cardiac failure, the heart rate de-creased in 3 with tachycardia and the blood pressure and cardiac index were elevated in 3 with hypotension
These observations show that CAVH can be performed safely and effectively in patients with congestive heart failure, oliguria and hypotension

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Xamoterol, a β₁-partial agonist, was given to 10 patients with idiopathic dilated cardiomyopathy in NYHA functional classes II and III. The acute and chronic effects of xamoterol were assessed by changes in effort tolerance measured by multistage bicycle ergornetry, echocardiography, radionuclide ventriculography and right heart catheterization. The acute effect was determined after a single intravenous injection of 0.2mg/kg of xamoterol. Exercise heart rate decreased from 117±10 (mean±1SD) to 97±19beats/min (p<0.01), but blood pressure and cardiac index were unaffected. When the drug was given orally at 200mg/day for 3 months, exercise duration increased from 4.2±2.3 to 6.4±2.4min (p<0.01), echocardiographic ventricular ejection fraction from 29±12 to 33±14% (NS) and radionuclide left ventricular ejection fraction from 37±11 to 45±14% (p<0.01), while pulmonary wedge pressure during exercise decreased from 40±10 to 31±10mmHg (p<0.01). It may be concluded that xamoterol, by its action as a partial agonist, demonstrated both β-agonist and antagonist effects in patients with idiopathic dilated cardiomyopathy. It thereby had beneficial effects on left ventricular function with resultant improvements in effort tolerance and subjective symptoms during long term treatment

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The aim of the present study was to elucidate the effects of 4 different cardiovascular drugs on blood lactate levels during an intensive graded exercise test in 17 healthy male subjects. In acute studies, isosorbide dinitrate and nifedipine were used. In chronic studies, propranolol dihydrochloride and dilazep dihydrochloride were used. Oxygen uptake (_V_o₂), heart rate, blood pressure and blood lactate were measured at rest and during the final minute of each exercise session. Hemodynamic measurements during submaximum exercise were influenced by all drugs except isosorbide dinitrate. _V_o₂ during submaximum and maximum exercises remained unchanged by all drug treatments. Blood lactate levels at rest and during submaximum and maximum exercise also did not change significantly. Work load corresponding to blood lactate concentration of 4mM (W4mM) and the 1st and 2nd break points of lactic acid (W_BPLA1 and W_BPLA2) were almost the same in all treatments. It is concluded that the 3 criteria of blood lactate obtained during the graded exercise test are not affected by these drugs in healthy males

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Early elevation of the serum myoglobin level in acute myocardial infarction (AMI) has been noted for years. In this study, 39 patients admitted to the Coronary Care Unit with acute chest pain within 72 hours (mean 12±15 hours) or electrocardiographic changes suspected of acute myocardial infarction had a serum myoglobin latex agglutination test to evaluate its diagnostic accuracy in acute myocardial infarction. Of these 39 patients, 24 had documented acute myocardial infarction as their final diagnosis. By the time of admission, 18 of the 24 cases with infarction had positive myoglobin tests (sensitivity 75%). Of those 15 cases without myocardial infarction, 13 had negative myoglobin tests (specificity 87%)
If only those 17 cases admitted within 5 hours of the onset of chest pain were analyzed, the serum myoglobin test became positive in 8 of 10 cases with documented AMI but the 2 cases with negative results turned positive 2 hours later (sensitivity 80% to 100%). Due to the fact that myoglobin tests were negative in all other 7 cases without infarction, the specificity was 7/7 (100%). In contrast, the creatine phosphokinase isoenzyme study was positive only in 3 of these 10 patients with documented AMI in the first blood sample taken during admission
In conclusion, the serum myoglobin latex agglutination test is a quick and reliable method that helps in the early diagnosis of acute myocardial infarction.

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The study comprised 67 subjects, mean age 43.7 years, with suspected sick sinus syndrome, in whom rapid atrial pacing before and after combined atropine and propranolol was performed by Narula's method. Three groups were formed: group I-with normal sinus node recovery time (SNRT) and corrected sinus node recovery time (CNRT) before and after the autonomic blockade; group II-with functional disorders of the sinus node and group III-with intrinsic sinus node dysfunction. After autonomic blockade in groups I and II mean SNRT, CNRT, post-stimulation cycle lengths (except No.2 and Nos.5, 6, 10, respectively) shortened, whereas HR rose. In contrast, in group III mean SNRT, CNRT, post-stimulation cycle lengths (Nos.1, 2, 6, 10) and HR increased. Significant differences in post-stimulation cycle lengths were observed between groups I and III as well as groups II and III. In conclusion, rapid atrial pacing after combined atropine and propranolol helps us to diagnose latent sick sinus syndrome and extrinsic sinus node dysfunction more precisely, and significant differences in post-stimulation cycle lengths between the groups confirm diagnostic value.

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A technique for recording a three-lead electrocardiogram (ECG) without increasing the number of channels and electrodes in a commercially available two-channel Holter recorder was devised. On channel 1, a V₅-like lead (CM₅ lead) was recorded for 24 consecutive hours. On channel 2, the device could switch continuously between a V₂-like lead (CM₂ lead) and a II-or III-or aV_F-like lead (CMf lead) every 30sec.
Fifty eight patients with angina pectoris were studied using this new device. There were 2 patients with variant angina pectoris, one of whom showed ST elevation in the CM₂ lead coupled with ST depression in the CMf lead and the other ST elevation in the CMf lead coupled with ST depression in the CM₂ lead. The number of patients having ST depression confined to the CM₅ lead only, CM₂ lead only and CMf lead only was 17, 2 and 3, respectively. In 41 patients, 127 transient episodes of ischemic type ST changes were observed during daily activity. Only 35 (28%) of these episodes were associated with anginal symptoms and the remaining 92 episodes occurred unrelated to such symptoms.
Accordingly, 3-lead Holter monitoring using this device is useful, particularly for the detection of variant angina, and makes it less likely for asymptomatic ischemic ST changes to be overlooked as compared to the 2-lead conventional Hotter monitoring system

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Anatomically isolated aortic valve disease accounted for 1.1% of all and 5.2% of cardiac autopsies over a 20 year period. Among a total of 100 symptomatic cases, 52% had congenitally bicuspid, 43% had tricuspid and 5% had congenitally unicuspid valves. Nineteen percent had undergone fibrous sclerosis, including 1% unicuspid, 3% tricuspid and 15% bicuspid valves. Thirty nine percent had been affected by infective endocarditis, including 20 bicuspid and 19 tricuspid valves. The remaining 42 showed fibrocalcification, including 4 unicuspid, 17 bicuspid and 21 tricuspid valves. The nature of the valvular disease showed a correlation with the age of the patient. Infective endocarditis, fibrosis and calcific disease occurred in an ascending age pattern, at average ages of around 30 years, mid to late thirties and mid to late forties, respectively. The lesions occurred much earlier on the bicuspid than on the tricuspid valves, except for infective endocarditis. The bicuspid deform-ity was not found to make the aortic valve more prone to infection, nor did infection occur earlier on it than on the tricuspid valve. Four of the 100 cases, all tricuspid, were considered to be of rheumatic origin, the reasons for which are discussed. Certain well established associated cardiac lesions were identified

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The clinical diagnosis of congenital left ventricular-right atrial (LV-RA) communication is difficult. Echocardiography appears to be a useful method in the diagnosis of this congenital cardiac defect. In previous reports authors have described M-mode echocardiographic findings of this anomaly. We present here two-dimensional echo findings in a patient with congenital LV-RA communication.
A 12 year old boy presented the following echocardiographic findings. A perimembranous septal defect and an abnormal tricuspid septal leaflet were seen. The defect was located at the membranous atrioventricular septum, resulting in a communication between the RA and the LV. Pulsed Doppler echocardiography demonstrated turbulent flow through the defect during systole, suggesting an LV-RA communication. M-mode echo examination of the septal tricuspid leaflet revealed systolic fluttering of the tricuspid valve. Peripheral vein contrast echocardiography showed passage of the echo contrast material from the RA to the LV (positive contrast effect). At the same time there was a negative contrast effect during ventricular systole, indicatinga left to right shunt from the LV to the RA.
After surgical repair of the anomaly, systolic flutter of the tricuspid valve and the other findings disappeared echocardiographically, as they did in the other reported cases.
We can conclude that two-dimensional echocardiography with M-mode evaluation is a reliable method for the diagnosis of congenital LV-RA communication, and that this method should be applied to all cases where this anomaly is suspected clinically

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The potential usefulness of two-dimensional Doppler to quantitate valvular regurgitation depends on the relationship between the dimensions of the velocity maps and the regurgitant volumes. We previously found a significant linear regression between aortic regurgitant fraction and jet area, but because of a shallow slope, postulated an exponential or curvilinear relationship. A retrospective analysis of intraoperative electromagnetic flowmeter measurements of aortic flow and epicardial color flow maps of regurgitant jets gave us a more direct examination of the relationship over a wider range of lower flows. Regurgitant volume was calculated from reverse aortic flow and was compared to jet length, area (by planimetry) and volume (from Simpson's rule). Both linear and curvilinear regressions were determined. Correlation coefficients were similar but consistently closer to unity with the exponential equations, and data points were more closely distributed along a curved rather than a straight line. Length regressions were flatter and the volume regressions were steeper than the slopes of the area equations. Thus, the relationship of the gradual slope of the color flow jet area to the regurgitant volume is geometrically determined and limits quantitative application

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The relationship between myocardial total force and length at the end of systole appears to be linear, and the slope of this relationship is considered to be an appropriate index of myocardial contractile state, independent of preload and afterload. However, direct measurements of this relation may be impossible in the intact human heart, and thus, alternative indices such as the left ventricular end-systolic stress-length, stress strain, pressure-volume, and pressure-dimension slopes have been proposed to evaluate myocardial contractility in the intact heart. However, the mathematical relationship between the myocardial end-systolic total force-length relation and any of these left ventricular end-systolic relations remains unclear. In this study, assuming a linear myocardial endsystolic total force-length relation in an intact ventricle, we obtained mathematical formulae for the left ventricular end-systolic stress-strain, pressure-radius, and pressure-volume relations, using a cylinder model of the left ventricle. The results obtained using these formulae and the cylinder model were found to match accurately findings obtained from earlier experimental and clinical studies of these left ventricular end-systolic relations. Thus, this model could mathematically account for the relationships between the slopes of the myocardial end-systolic total force-length relation and these left ventricular end-systolic relations

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If characteristic muscle properties such as myocardial viscosity and/or shortening deactivation influence left ventricular ejection in the whole heart, the slope of the left ventricular end-systolic pressure-volume relation should be a function of both the contractile state and the loading mode. Thus, the load dependence of the end-systolic pressure-volume relation was examined using isolated, perfused canine hearts ejecting saline into a hydraulic loading system. The instantaneous left ventricular volume was measured with a plethysmograph. Under constant coronary flow and heart rate, two regression lines for end-systolic pressure-volume relations in two sets of loading modes were obtained: (1) Preload (left ventricular end-diastolic pressure; 4-15mmHg) changes under fixed afterload impedance (preload changes); (2) Afterload impedance (peripheral resistance; 1.9-9.6×10³dyn sec cm^-5) changes under fixed left ventricular end-diastolic volume (afterload changes).
The slope of the end-systolic pressure-volume relation with afterload changes was steeper than that with preload changes (6.3±0.7 vs 4.8±0.6mmHg/ml, p<0.05). Accordingly, under constant coronary flow, the slope of the end-systolic pressure-volume relation depended on load-ing conditions within the physiological range of afterload impedance and preload. This finding supports our hypothesis and implies that the slope change is of limited value as a contractile index in the ejecting heart

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The ability of irreversible acylcarnitine-transferase inhibitors, sodium 2[5-(4-chlorophenyl)-pentyl]-oxirane-2-carboxylate (POCA) and 2-tetradecyl-glycidic acid (TOGA), to reduce myocardial ischemic injury was studied in Langendorff-perfused hearts exposed to ischemia (zero mmHg) followed by aerobic reperfusion (60mmHg). Rat hearts were pretreated with either POCA (15mg/kg) or TDGA (5mg/kg) s.c.120 min before the perfusion. Treated hearts showed a decreased release of creatine kinase and lactate on reperfusion after 30min ischemia. POCA-treated hearts showed significantly higher ATP concentrations than control hearts on reperfusion. POCA also improved the maximum recovery of the pressure-rate product but with a significant delay. During the ischemic period, though, POCA decreased the ATP concentration at a rate three times that of controls during the first 10min. No further reductions were observed for up to 30min of ischemia. TOGA also showed a reduction of ATP. Thus, the observation that POCA stimulated ATP synthesis and reduced creatine kinase release on reperfusion after ischemia suggests that this agent provides some protection to the ischemic myocardium. How-ever, during ischemia, it is likely that the depletion of ATP concentration induced by POCA resulted in delayed recovery of mechanical function on reperfusion

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An elderly woman with Lutembacher's syndrome remained asymptomatic until the age of 55, when she was treated for exertional dyspnea with digitalis and diuretics. She died of gastrointestinal hemorrhage and hepatic failure at the age of 69. The autopsy revealed a large atrial septal defect and mitral stenosis without rheumatic changes. This patient is the oldest reported survivor of Lutembacher's syndrome with nonrheumatic mitral stenosis

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A 74 year old man was found at necropsy to have multiple coronary arteriosystemic fistulae involving all three major coronary arteries and both ventricles. This is the second such case reported. All terminal branches of the coronary arteries entered the myocardium and numerous tiny vessels opened into the cardiac chambers. No coronary veins or coronary sinus were recognized. This vascular anomaly is considered to result from the abnormal persistence of intertrabecular spaces within the embryonic myocardium

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A rare case of subvalvular aneurysm diagnosed by two-dimensional echocardiography and confirmed at cardiac catheterization is presented

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A right ventricular (RV) tumor manifested by ventricular tachycardia (VT) accompanied by syncopal attacks was found in a 14 year old boy by two-dimensional echocardiography. Surgery was performed on February 10, 1981, with the aid of a cardiopulmonary bypass. The tumor was completely removed as a mass from the anterolateral portion of the RV wall. The wall was closed directly without any patch. The mass was 60gm in weight and 7 by 4 by 4cm in size. Fibroma was diagnosed by pathological study. The patient is doing well 6 years postoperatively. We conclude that two-dimensional echocardio-graphy should be used to exclude cardiac tumors such as fibroma in young patients who have VT

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