The principal types of artificial prostesesand ventricular functions

Artifisyel protezlerin tiplerinin özellikleri ve ventrikül fonksionları. Artifisyel kalb kapaklarının tiplerinin özellikleri ve biolojik grefler disküze edilerek, kapak değişiminden sonra oskültasyon bulguları hakkında izahatta bulunulmuştur. İyi bir cerrahi uygulamayı takiben mitral valu değişiminden sonra sol ventrikül volümünde % 20 bir azalma ve aort valu değişiminden sonra sol ventrikül volümünde % 23 azalma vardır. Kapak değişiminden sonra hastanın aynı doktor tarafından tekrar dinlenilmesi komplikasyonların erken tanımına yardımcı olabilir.The principal types of artificial prostesesand ventricular functions. The principal types of artificial heart values and biologic grafts are discussed briefly and mentioned about the auscultatory signs after replacement. After satisfactory surgical applications the decrease in left ventricular volume is 20 % after mitral and 23 % after aorfic valve replacement. After replacement, repeated auscultation of the patient by the same physician may help in early recognition of complications

Natural history of cardiac valve diseases and replacement indications

New York Heart Association sınıflandırımına göre grade III de bulunan MD vakalarının % 65'i semptomlardan sonraki ilk 3 yılda kaybedilirler. Her gruptan MD vakalarının tabi seyrinde ise yaşama oranları genellikle ilk 5 yıl için % 80, ikinci 5 yıl içinse % 60 tır. Bu oranlar MY içinde aynı kalırken, mikst mitral vakalarında %66 ve %33’e düşer. AD da ise bu oranlar birinci ve ikinci 5 yıl için %48 ve %10 dur. AY ve AD de genellikle anginadan sonra 5, senkoptan sonra 3 ve kalb yetmezliğinden sonra 2 yıllık yaşama şansı vardır. Mitral lezyonlarda kapak değişimi tavsiyesi grade III ve IV için yapılırken, aortik lezyonlarda erken grade'lar tercih edilmektedir.65% of patients with mitral stenosis who are grade III according to New York heart association died in first three year after symtoms. General survival of all grades of stenotic patients are 80% on first 5 year and 60 % on second 5 year. Those ratios are nearly same in mitral insufficiency but in mixt mitral lesions 66 % and 33 %. After apperiance of symptoms in aortic stenosis, survival is 48 % in the first five years and 10 % in the second 5 years. The survival either in aortic stenosis or sufficency are 5 year after angina, 3 year after syncope and 2 year after heart failure. While the replacement indication on mitral lesion is valuable in grade III and IV, on aortic lesion replacement is offered especially in early grades

Short term reduction of left ventricular mass in primary hypertrophic cardiomyopathy by octreotide injections

Growth factors have been shown to be associated with primary hypertrophic cardiomyopathy. Octreotide, a long acting somatostatin analogue, can prevent the stimulating effect of growth factors and decrease the left ventricular mass in patients with acromegaly. In the light of these results, three patients with primary hypertrophic cardiomyopathy were treated with subcutaneous octreotide (50 mu g three times a day during the first week and 100 mu g twice a day for the following three weeks). Initially, two patients were in New York Heart Association class II in and one was in class III. At the end of a four week treatment session all were in class I. There were significant decreases in left ventricular posterior wall thickness, interventricular septum thickness, and left ventricular mass in all three patients. Both left ventricular end diastolic and end systolic diameters had increased in all of the patients at the end of the fourth week. Two of three patients showed improved diastolic filling: their hyperdynamic systolic performance returned to normal. No side effects were observed during octreotide treatment. The considerable improvement obtained with the short term octreotide treatment in patients with primary hypertrophic cardiomyopathy seems promising