Gradient-echo (GRE) and spin-echo (SE) magnetic resonance (MR) imaging was performed in 31 patients with chronic left ventricular (LV) thrombi. Thrombi were confirmed or excluded at surgery or by means of other corroborative diagnostic techniques. MR images were evaluated by three reviewers without knowledge of results of corroborative studies. Diagnoses were graded unequivocal if agreed on by three observers and probable if agreed on by two observers. With SE imaging, 12 of 18 confirmed thrombi were detected unequivocally, five were considered probable, and one was not detected. With GRE imaging, 16 of the 18 thrombi were visualized unequivocally; two were considered probable. With SE technique, thrombus was unequivocally excluded in nine of 13 cases and exclusion was considered probable in four. One finding was false-negative. Exclusion of thrombus with GRE imaging was unequivocal in 10 of 13 cases and probable in two, and one finding of thrombus was false-positive. GRE imaging resulted in improved differentiation of thrombi from the surrounding blood pool and myocardium and thus was diagnostically superior to SE imaging in detection of LV thrombi.

Reproducibility of results is an important point in assessing the utility of intraoperative transesophageal echocardiography for evaluating changes in left-ventricular function. The purpose of the present study was to define the intra- and interobserver reproducibility of the qualitative assessment of left-ventricular regional wall motion and the quantitative assessment of global left-ventricular function. In addition, the interstudy reproducibility of two examinations was tested when the probe was displaced and replaced in the esophagus. A transesophageal short-axis view at the level of the papillary muscles was obtained in 86 patients undergoing cardiac surgery. In the 80 patients with adequate images, regional wall motion was visually graded and area ejection fraction was calculated by two observers and assessment was repeated by the same observer one day later. The same observer graded wall motion differently in only 5% (24/480) of segments. Grading by two observers differed in 9% (43/480) of segments. Assessment differed by one grade at the most and in not more than 2 out of 6 segments per patient. Repeated measurements of area ejection fraction (AEF) by the same observer correlated well (r = 0.97 before and r = 0.97 after cardiopulmonary bypass) with a mean percent difference of 6%. A similarly close correlation was found for measurements of two observers (r = 0.90 and r = 0.93, respectively) with a mean percent difference of 10% for area ejection fraction. The correlation for the first and second examination in the same patient by one observer was acceptable (r = 0.78 and r = 0.80, respectively) with a mean percent difference of 15% for area ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

In ten patients with coronary heart disease molsidomine achieved a clear-cut decrease in pre- and after-load of the heart at rest. Due to decreased venous return at rest there was a fall in stroke volume resulting in a fall of systolic and diastolic aortic pressure. But at the same level of standardised exercise, systolic and diastolic arterial pressure and cardiac output were similar with or without molsidomine. Without changing after-load, there was a fall in pulmonary artery mean pressure (P less than 0.005), probably due to an increase in left-ventricular compliance and (or) a fall in pulmonary vascular resistance. A rise in venous capacity or a decrease in venous return during exercise was excluded as a possible mechanism of molsidomine action.

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The therapeutic effectiveness of aprindine (Amidonal) was evaluated by trend analyses in 25 patients with predominantly severe forms of ventricular extrasystoles. The arrhythmia was stopped or improved in most instances. Severe side-effects for which the drug had to be discontinued occurred in three patients. The drug has a long half-life (about 20-30 hours). As a result, there can be cumulative dose-dependent side-effects, largely of a CNS type, disappearing after the dose has been reduced. Thirteen patients continued to be treated on an ambulatory basis, the oral maintenance dose averaging 100 mg/d, the mean follow-up period 11 1/2 months. There was no evidence of side-effects on liver, electrolytes, renal function or blood.