We performed a randomized trial comparing intracoronary administration of streptokinase versus dextrose placebo within six hours after the onset of symptoms of acute myocardial infarction in 40 patients. The base-line clinical, hemodynamic, and angiographic findings were similar in the control and streptokinase-treated groups. Reestablishment of flow occurred in 12 of 20 patients treated with streptokinase and in 2 of 20 given placebo (P less than 0.05). Left ventricular function, angiographic ejection fraction, and regional wall motion, measured before and immediately after intervention, and serial radionuclide ejection fractions, measured at treatment, at 12 days, and at 5 months, were compared according to type of treatment (streptokinase vs. placebo) and outcome of therapy (reperfusion vs. no reperfusion). No statistically significant differences between groups were found. Thus, although streptokinase was more effective than placebo in achieving reperfusion, we detected no improvement of left ventricular function as a result of reestablished coronary flow.

SUMMARY Mitral insufficiency with mitral annular calcification occurring predominantly in elderly females has been described. We studied six patients with mitral diastolic obstruction associated with mitral annular calcification without stenosis of the mitral leaflets. Three were males and three were females, ages 43 In this report, we present six patients with severe mitral annular calcification in whom a large pressure difference was recorded across the mitral valve at the time of cardiac catheterization. We propose that in these patients, the mitral annular calcification itself causes the observed pressure difference. Material and MethodsThe six subjects of this study were selected from patients who underwent right-and left-heart catheterization (Judkins or Sones technique) for evaluation of valvular disease. All six patients had fluoroscopic and radiographic evidence of severe mitral annular calcification.Complete hemodynamic measurements were obtained in each patient. Pressure differences across the mitral valve were determined by simultaneous pressure recordings using fluid-filled catheter systems from the pulmonary wedge position (Swan-Ganz catheter) and left ventricle ( fig. 1). Great care was

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