A fistula connecting the right coronary artery to the right atrium: A hitherto undescribed association

A case of double right coronary artery accompanying a fistulous connection is presented. An additional right coronary artery is an extremely rare congenital abnormality. In this case, the second right coronary artery was draining into a cardiac chamber via a fistulous connection. This is the first case in the literature to present these abnormalities coexisting in the same patient

Value of QT dispersion in diagnosis of restenosis after intracoronary stent implantation

We studied the ECGs of patients with single vessel disease before and after (long term) coronary stent implantation. The interlead variability of the QT interval, known as QT dispersion (QTd), is believed to reflect the regional variations in ventricular repolarization and, thus, may provide an indirect marker of arrhythmogenicity. There are no reliable noninvasive markers of significant restenosis after stent implantation. The effect of coronary revascularization on QTd in patients who underwent coronary stenting has not been investigated extensively. The aim of this study was to evaluate the value of QTd in predicting restenosis after intracoronary stent implantation. QTd with 12 lead surface ECG was measured in 48 patients (21 with restenosis and 27 without restenosis; 33 male; mean age, 58 +/- 10.8 years) before the procedure and after long-term follow-up (mean, 6.8 +/- 3.2 months). All patients had coronary angiographic control at the end of the follow-up period. QTd (as the difference between the maximum and minimum QT interval measured from 12 lead EGG) and rate-corrected QT (QTcd) were evaluated at rest. In 27 patients without restenosis, QTd and QTcd decreased from 58 +/- 14.4 and 62.8 +/- 20.4 ms to 26.3 +/- 9.2 and 29.6 +/- 10.6 ms in the long term follow-up, respectively (P 0.05). In conclusion, increased QT interval dispersion may be an inexpensive and simple marker of restenosis after intracoronary stent implantation. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved

Left atrial appendage-flow velocity predicts cardioversion success in atrial fibrillation

Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 +/- 0.14 vs 0.27 +/- 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (>0.28 m/sec, odds ratio = 2.8; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area (p = 0.18) and LAA ejection fraction (p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion

Effect of left and right lateral decubitus positions on mitral flow pattern by Doppler echocardiography in patients with systolic or diastolic dysfunction

Doppler echocardiographic asessment of the mitral valve provides a considerable amount of information regarding the diastolic filling characteristics of the left ventricle. Patients with congestive heart failure usually complain of increasing dyspnea in left lateral decubitis (LLD) position, compared with the right lateral decubitus (RLD) position which is called trepopnea. In this study, the effects of LLD and RLD positions on mitral flow velocities in patients with systolic or diastolic dysfunction were examined. Sixteen patients with systolic dysfunction (Group I), 16 patients with diastolic dysfunction (Group 2), and 16 normal subjects (control group) constituted the study group. Peak early diastolic (E) and atrial (A) flow velocities, EIA ratios, deceleration time (DT), flow duration (PD), the velocity time integral of mitral total flow during diastole (VTI), transmitral mean gradient during diastole (MGR) were calculated in each decubitis position. In group I; DT was shorter, VTI and FD were significantly lower and E/A ratio was significantly higher than normal control subjects in LLD position. In group I, RLD position resulted in an increase in DT (124.81 +/- 21.6, 155.6 +/- 23,p = 0.004), increase in VTI (0.13 +/- 0.03, 0.16 +/- 0.09, p = 0.02) and a decrease in E/A ratio (1.92 +/- 1, 1.62 +/- 0.88, p = 0.006) suggesting a decrease in left ventricular preload on changing position. On the other hand, no significant change on mitral flow pattern was detected after turning over the RLD position in patients with diastolic dysfunction. There was also no significant mitral flow change in the control group on RLD position. The results of this study suggest that the Doppler derived mitral flow pattern is significantly altered by a postural change from the LLD to RLD positions in patients with systolic dysfunction. This may help to explain the trepopnea in these patients

Chylous ascites due to constrictive pericarditis

Chylous ascites due to constrictive pericarditis is an extremely rare clinical entity, possibly caused by the augmented lymph production and high impedance to lymph drainage due to central venous hypertension. The authors describe a patient with chylous ascites caused by constrictive pericarditis in the absence of lymphatic obstruction. Cardiac catheterization is essential for the confirmation of accurate diagnosis of constrictive pericarditis. Magnetic resonance imaging of the heart is also very helpful in the diagnosis. The patient was symptom free and his ascites and edema completely resolved after pericardiectomy

Heart rate variability, late potentials and QT dispersion as markers of myocardial involvement in patients with Behcet's disease

BACKGROUND: Myocardial involvement in Behcet's disease has been reported to be relatively rare

Head-up tilt table testing with low dose sublingual isosorbide dinitrate in the evaluation of unexplained syncope: A comparison with isoproterenol infusion

O Aslan, S Guneri, O Badak, et al. Head-up tilt table testing with low dose sublingual isosorbide dinitrate in the evaluation of unexplained syncope: A comparison with isoproterenol infusion