In order to assess the diagnostic usefulness of EMB in patients with clinically suspected myocardial diseases, with and without heart failure or dysrhythmias, a prospective study was carried out in 84 consecutive patients. With EMB, the histological diagnosis was considered specific in 33 patients (39.3%), confirmative in 12 patients (14.3%) and negative in 39 patients (46.4%). It was found particularly useful in patients with unexplained heart failure and idiopathic dysrhythmias and in the differentiation between restrictive cardiomyopathy and constrictive pericarditis. The procedure can be safely performed with minimal morbidity and there was no mortality in the present study.
Clinical, hemodynamic and angiographic findings of 24 adolescent or adult patients with coronary artery fistula were retrospectively analyzed. There were 7 males and 17 females with the average age of 41.4 years. Nineteen of 24 patients (79.2%) were symptomatic and 18 were older than 20 years of age. Continuous murmur was present in 17 patients, "to and fro' murmur was audible in 2, apical systolic murmur was audible in 1. The remaining 4 patients had no audible murmur. Location of murmur in all patients was unusual for patent ductus arteriosus. Cardiomegaly on chest X-ray was found in 17 patients (70.8%) in whom 8 had prominent pulmonary artery. Electrocardiographic abnormalities were detected in 10 of 24 patients (41.6%) i.e. left ventricular hypertrophy (4 patients) biventricular hypertrophy (2 patients), incomplete right bundle branch block (2 patients), and ischemic changes (2 patients). The intracardiac pressures were slightly elevated and the mean Qp/Qs ratio was only 1.4 +/- 1.2. Angiographically, 28 fistulas were demonstrated in 24 patients. The origins of fistula were from right coronary artery in 12 patients (50%), left coronary artery in 8 patients (33.3%) and both coronary arteries in 4 patients (16.7%). Fistulas drained into the right atrium in 5 patients (20.8%), into coronary sinus in 2 patients (8.3%), into right ventricle in 4 patients (16.7%), into pulmonary arteries in 10 patients (41.7%) and into left ventricle in 3 patients (12.5%).
Eight cases of ruptured interventricular septum associated with myocardial infarction were diagnosed at Siriraj Hospital between 1985-1995. Clinical congestive heart failure and holosystolic murmur were found in all. Diagnosis was confirmed by echocardiogram and right heart catheterization in all patients. Two patients died from congestive heart failure preoperatively and the third case died from organ failure and sepsis postoperatively. Another five cases underwent successful ventricular septal defect closure and coronary artery bypass with good results.
Spontaneous complete A-V block is very rare in hypertrophic cardiomyopathy. We report here two siblings with hypertrophic cardiomyopathy who developed spontaneous complete A-V block with deterioration of cardiac symptoms, necessitating implantation of permanent pacemaker.
Cor triatriatum presenting in adulthood is extremely rare. An 18-year-old female patient presented with a clinical picture masquerading mitral valvular heart disease. Both transthoracic and transesophageal echocardiography demonstrated a membrane in the left atrium with no other cardiac anomaly. The patient was successfully operated on without the need for catheterization.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)