Citations

The use of roentgen videometry as a means of studying regional left ventricular wall dynamics and performance was evaluated in 32 patients undergoing coronary arteriography. Nine patients had normal coronary arteriograms and hemodynamic findings (group 1), 8 patients had generalized decrease in left ventricular contraction and abnormal hemodynamic findings (group 2), and 15 patients with coronary artery disease had regional wall dynamics abnormalities (group 3). Sixty-per-second determinations of wall thickness were performed in selected sites of the left ventricle. Measurements performed included end-diastolic wall thickness (EDTw), mean and peak rates of systolic wall thickening (m and p dTw/dt), and fractional systolic increase in wall thickness (ΔTw/EDTw). In patients with uniformly performing ventricles (groups 1 and 2), these parameters correlated well with other parameters of ventricular function. Best distinction between the "normal" group (group 1) and the "abnormal" group (group 2) was achieved when the rates of thickening (m and p dTw/dt) were utilized ( P < 0.001). In patients of group 3, three types of abnormal regional wall dynamics could be determined and quantified objectively: hypokinesia (decreased p dTw/dt), akinesia (p dTw/dt = 0), and dyskinesia (p dTw/dt < 0). The severity of the abnormality of the wall dynamics correlated well with the presence or absence of a previous infarction on the electrocardiogram, and the anatomic location was strongly correlated with the distribution and severity of coronary artery lesions within a given ventricle.

The echocardiographic features of Ebstein's anomaly include a large anterior chamber, paradoxic ventricular septal motion (type B), increased velocity and amplitude of anterior tricuspid leaflet (ATL) motion, and delayed closure of the ATL. This delayed closure has been thought to be secondary to right bundle-branch block (RBBB). We have studied two patients by simultaneous echocardiography and phonocardiography. The findings in both patients were similar. One patient had RBBB and therefore resembles the previously reported patients. However, the other patient had W-P-W preexcitation syndrome, type B, and is reported here in more detail. The ATL closure of this patient was markedly delayed in spite of right ventricular preexcitation. This finding gives further insight into the altered pathophysiology in Ebstein's anomaly and implies that the delayed ATL closure is probably not due to RBBB and may be a specific feature of this anomaly.

The effect of oral aspirin in doses known to influence in vitro platelet aggregation was evaluated in patients undergoing brachial artery catheterization. Neither arterial thrombus formation nor pulse reduction was affected in patients given aspirin when compared to controls. Aspirin in small doses does not decrease the incidence of vascular occlusion after brachial artery catheterization.

Echocardiograms were performed on 20 children who were 1-14 years old. Ten children had secundum atrial septal defects (ASD 2°); four had partial and two had complete atrioventricular canal defects (AVC); and three had partial and one had total anomalous pulmonary venous connection (APVC). Twenty-eight normal children were also examined. Echocardiograms of nine patients with ASD 2° revealed increased right ventricular dimension index (RVDI) and abnormal (paradoxic) ventricular septal (VS) motion. The remaining patient with ASD 2°, who had a Qp/Qs of 1.2 (smallest in the series), had a normal echocardiogram. All four patients with APVC had increased RVDI, and three had abnormal VS motion. The patient with normal septal motion had associated mild aortic stenosis, but he too had a small left-to-right shunt (19%). The echocardiograms of two patients with partial AVC revealed features similar to ASD 2°, but in the third patient who had significant mitral regurgitation (MR) the VS motion was normal, indicating that the degree of associated MR influences the VS motion in this anomaly. The septal motion was normal in both patients with complete AVC. Three patients in the series had abnormal systolic anterior motion of mitral valve. Postoperative echocardiograms revealed persistence of increased RVDI and "paradoxic" VS motion.

Background— Alterations at the level of the coronary circulation with aging may play an important role in the evolution of age-associated changes in left ventricular (LV) fibrosis and function. However these age-associated changes in the coronary vasculature remain poorly defined primarily due to the lack of high resolution imaging technologies. The current study was designed to utilize cardiac micro–computed tomography (micro-CT) technology as a novel imaging strategy, to define the 3-dimensional coronary circulation in the young and aged heart and its relationship to LV fibrosis and function. Methods and Results— Young (2 months old; n=10) and aged (20 months old; n=10) Fischer rats underwent cardiac micro-CT imaging as well as echocardiography, blood pressure, and fibrosis analysis. Importantly, when indexed to LV mass, which increased with age, the total and intramyocardial vessel volumes were lower, whereas the epicardial vessel volume, with and without indexing to LV mass, was significantly higher in the aged hearts compared with the young hearts. Moreover, the aged hearts had a significantly lower percentage of intramyocardial vessel volume and a significantly higher percentage of epicardial vessel volume, when normalized to the total vessel volume, compared with the young hearts. Further, the aged hearts had significant LV fibrosis and mild LV dysfunction compared with the young hearts. Conclusions— This micro-CT imaging study reports the reduction in normalized intramyocardial vessel volume within the aged heart, in association with increased epicardial vessel volume, in the setting of increased LV fibrosis, and mild LV dysfunction.

Purpose In 1995, the Children's Cancer Group (CCG) opened a trial for patients with Hodgkin's lymphoma evaluating whether low-dose involved-field radiation therapy (IFRT) improved event-free survival (EFS) for patients achieving a complete response after chemotherapy. We present the long-term study outcome using final data through March 2007. Patients and Methods Between January 1995 and December 1998, 826 eligible patients were enrolled onto CCG 5942. Four hundred ninety-eight patients achieving an initial complete response to chemotherapy were randomly assigned to receive IFRT or no further therapy. EFS and overall survival (OS) were assessed from the date of study entry or random assignment, as appropriate. Results Ten-year EFS and OS rates for the entire cohort were 83.5% and 92.5%, respectively. In an as-treated analysis for randomly assigned patients, the 10-year EFS and OS rates were 91.2% and 97.1%, respectively, for IFRT and 82.9% and 95.9%, respectively, for no further therapy. For EFS and OS comparisons, P = .004 and P = .50, respectively. Bulk disease, “B” symptoms, and nodular sclerosis histology were risk factors for inferior EFS. Conclusion With a median follow-up of 7.7 years, IFRT produced a statistically significant improvement in EFS but no improvement in OS. For individual patients, the relative risks of relapse versus late effects of IFRT must be considered. Patient and disease characteristics and early response assessment will aid in deciding which patients are most likely to benefit from IFRT.