No abstract

The variety of echographic features associated with the mitral valve prolapse syndrome (MVPS) is not yet completely understood. Therefore, ultrasound recordings were obtained in 33 patients in whom mitral prolapse had been documented by biplane left ventricular cineangiography. Echographic abnormailities of the mitral leaflets during systole were recorded in 26/27 MVPS patients and 6/6 with ruptured chordae tendineae. In MVPS, the midsystolic mitral buckling, emphasized in early echocardiographic studies, was observed in only 12 patients. In our study, the most common aberrancy was abnormal pansystolic mitral motion in 14 patients, which in 12 was similar to the pansystolic bowing observed in all six patients with torn chordae. An additional echographic abnormality in MVPS was localized mitral collapse throughout systole in 10/14 patients with pansystolic prolapse; this finding was the most striking defect noted in five, in two of whom it was the only disturbance. Phonocardiography in MVPS showed typical midsystolic click and/or late systolic murmur in only 15/26 patients of whom ten had midsystolic mitral buckling. A variety of systolic clicks and/or murmurs occurred in the 14 patients with generalized bowing and/or localized collapse throughout systole on echocardiography. Thus, the mitral echographic spectrum of MVPS is comprised of three different abnormal patterns of systolic prolapse: buckling in midsystole, pansystolic bowing, and pansystolic collapse. These echocardiographic disorders commonly occur in the absence of classical auscultatory findings in MVPS and the most frequent abnormality on ultrasound is pansystolic bowing of both mitral leaflets.

No abstract

Controversy attends the extent and temporal sequence of improvements in hemodynamic function resulting from the return of atrial contraction following cardioversion of supraventricular arrhythmias. Thus, mitral, left atrial (LA) and left ventricular (LV) echograms were obtained before and one hour after conversion of supraventricular arrhythmias to normal sinus rhythm by direct current countershock in patients with chronic coronary disease or cardiomyopathies without valvular dysfunction. The duration of the rhythm disturbance varied from one day to five years in 22 patients and was indeterminate in 13. Atrial systole immediately produced prominent mitral "A" waves with anterior valve excursion of 7.5 mm (range 3 to 12) in 33 of the 35 patients (94%). The two patients with atrial electromechanical dissociation reverted to atrial fibrillation within one week. Cardioversion caused a decline in LA diameter (3.5 to 3.2 cm, P less than .001) and a rise in LV end-diastolic dimension (5.2 to 5.5 cm, P less than .001) while LV end-systolic dimension was unchanged (4.2 cm). Thereby stroke volume rose. Heart rate fell an average of 16 beats/min. Depressed cardiac output was improved + 0.84 L/min/m-2. Thus, in the majority of patients with acute or chronic supraventricular arrhythmias without mitral valve disease, cardioversion promptly restores effective atrial contraction, decreases LA size, and results in substantial hemodynamic benefit.

To determine the effects of early ambulation on peripheral venous thrombosis in the coronary care unit, 29 patients with acute myocardial infarction had daily 125I-fibrinogen point counting of both legs using a standard portable technique in the first 3 to 7 days after admission. Twenty-one patients underwent early ambulation during the initial 3 days, while 8 remained at complete bed rest for 5 days. Only 2 of 21 early ambulated patients had positive fibrinogen point counts, in contrast to 5 of 8 nonambulated patients (P less than 0.01). With heart failure, only 2 of 9 ambulated patients had positive point counts, compared with 4 of 5 nonambulated patients (P less than 0.05). In 16 patients undergoing venography, point counts were confirmed in 6 positive and 10 negative findings. These results show that the high frequency of peripheral venous thrombosis in immobilized acute myocardial infarction patients, particularly those with heart failure, can be effectively reduced by early ambulation.