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Biomedical subjects

A Nitenberg

Publications and source records attributed to A Nitenberg.

At least 127 records · Page 7Linked to original sources
PubMed1979

[Aneurysm of the membranous septum, left ventricular-right atrial communication and arrhythmias].

An aneurysm of the membranous part of the interventricular septum associated with a complex congenital malformation of the endocardial cushions was diagnosed in a 39 year old woman who presented with syncope. Diagnosis was made by echocardiography and confirmed by angiography. The operative findings were: a double aneurysm of the membranous septum, a left ventricular--right atrial fistula and two hemivalves attached to papillary muscles. The usfulness of echocardiography in the diagnosis of aneurysm of the membranous interventricular septum and in the follow up of ventricular septal defects from which they arise is emphasised. The pathogenesis of the arrhythmias observed (accelerated idioventricular rhythm, reciprocating tachycardias and syncope possibly related to transient heart block) is discussed.

Adult↗
PubMed1979

Evaluation of left ventricular performance in aortic stenosis, aortic regurgitation and mitral regurgitation from the stroke work/left ventricular mass ratio.

Evaluation of left ventricular performance in aortic stenosis, aortic regurgitation and mitral regurgitation from the stroke work/left ventricular mass ratio. Europ. J. Cardiol., 10/4, 279--294. 132 patients with a pure valvular dysfunction affecting a single orifice, namely aortic stenosis, aortic or mitral regurgitation, were studied. All patients, including 20 control subjects, underwent hemodynamic examination of both right and left heart chambers including left cineangiography. Using the stroke work index/myocardial mass ratio (SWI/MLV), for which the limits in normal subjects are narrow (0.81 +/- 0.03 . g-1) it was possible to divide these patients into three groups: Group I (SWI/MLV greater than 0.87 gm . g-1) characterized by a proportionately greater increase in stroke work index than myocardial mass (hyperfunctioning ventricle). Group II (0.87 gm . g-1 greater than or equal to SWI/MLV greater than or equal to 0.75 gm . g-1) characterized by a parallel increase in stroke work index and myocardial mass (normally functioning ventricle). Group III (SWI/MLV less than 0.75 gm . g-1) for which the increase in myocardial mass was proportionately greater than that of the stroke work index (hypofunctioning ventricle). As one progresses from group I to III, there is a concomitant fall in ventricular function with decreased mean velocity of circumferential fiber shortening (VCF), ejection fraction (EF) and increased enddiastolic volume (EDV) together with the hypertrophy of the left ventricle during the last stage. We conclude that the SWI/MLV ratio is an easy to calculate index, independent of the unerlying dysfunction, which evaluates left ventricular function by taking into account the myocardial mass.

Adult↗
PubMed1978

[Indices of left venticular performance and evaluation myocardial quality in mitral valve insufficiency, chronic aortic valve insufficiency and stenosis].

132 patients with pure mono-valvular cardiopathies (mitral incompetence, aortic stenosis and aortic incompetence) were classified into two groups according to the values of the systolic work index/myocardial mass ratio (SWI/MLV). Normal values of the ejection function (EF) and mean velocity of circumferential fibre shortening (VCF) for each cardiopathy were so obtained. Only patients with aortic stenosis of group I (SWI/MLV greater than or equal to 0.75 gm . g-1) had normal EF. All the other patients had EF and VCF values below normal although this did not always imply impaired myocardial function. Therefore the myocardial mass should also be considered in the evaluation of myocardial function and it would seem desirable to take this parameter into account in the management of these patients.

Adult↗
PubMed1978

[Changes in the subvalvular apparatus and left ventricular function in pure mitral stenosis].

Disordered left ventricular function and changes in the sub-valvular apparatus appear to be associated in patients with isolated mitral stenosis (MS). Left ventricular cine-angiography has demonstrated two groups of patients, according to the presence (group II) or absence (group I) of changes in the sub-valvular apparatus. There was no significant difference between the two groups in terms of age, heart rate, left ventricular end diastolic pressure, surface area of the mitral valve, or ventricular ejection time. However, group II patients had a lowered ejection fraction (EF), systolic ejection volume (SEB), speed of shortening of circular fibres (VCF), and systolic work index (SWI) compared with group I cases (respectively 0.49 +/- 0.06 and 0.58 +/- 0.04 for the EF, 36 +/- 7 ml.m-2 and 41 +/- 7 ml.m-2 for the SEV, 0.85 +/- 0.12 circ.s-1 and 1.09 +/- 0.16 circ.s-1 for the VCF, 45 +/- 11 gm.m-2 and 57 +/- 11 gm.m-2 for the SWI. Nevertheless, it appears that changes in the sub-valvular apparatus indicate rather than cause dysfunction of the left ventricle, which occurs in a certain number of patients who have a normal sub-valvular apparatus.

Adult↗
PubMed1978

[Evaluation of the contractile reserve of the myocardium by post-extrasystolic potentiation in aortic insufficiency].

Calculations were made of the indices of ventricular performance during the ejectional phase in 10 patients with a normal left ventricle and in 24 patients with aortic aneurysm, both under basal conditions and in the presence of extrasystoles produced incidentally during left biplanar cineventriculography. The fact that these indices were constantly raised implies the presence of post-extrasystole potentiation associated with an increase in contractility without significant changes in load. This technique, which provides a dynamic study of the behavior of the left ventricle in aortic incompetence allows us to assess the contractile reserve, and thus to give a more accurate prediction of the potential for recovery after operation.

Aortic Aneurysm↗
PubMed1977

[Value of myocardial mass measurements in the hemodynamic and angiographic evaluation of aortic stenosis: 70 cases].

The prognosis of aortic stenosis is often evaluated according to clinical criteria; but it is well known that the myocardial mass is one of the important determinants of prognosis. Starting from the fact that the ratio systolic work/myocardial mass (WS/VM) is a stable one in normal subjects (0.81 +/- 0.03), we were able to divide up the 70 patients with congenital and acquired aortic stenosis into three groups as follows:--Group I. WS/VM greater than 0.87; this group is called hyperfunctional, and characterised by an increase in WS, and a myocardial mass which is ostensibly normal.--Group II: 0.87 larger than or equal to WS/VM larger than or equal to 0.75; this isofunctional group is characterised by parallel increases in mass and systolic work.--Group III: WS/VM less than 0.75; this group is called hypofunctional, and is characterised by an increase in mass unrelated to an increase in work. A comparison of the sensitivity of other parameters with that of WS/VM gives rise to optimism that the precision of determination of the prognosis will increase, as will that of the choice of the time to operative, but only those patients in groups I and II can expect a return to normal function and ventricular mass.

Adolescent↗
PubMed1977

[The value of myocardial mass determination in the evaluation of left ventricular functional value in chronic mitral insufficiency. Apropos of 44 cases].

The functional value of the left ventricle in chronic mitral incompetence, determined as a function of haemodynamic and angiocardiographic indices, has now become a difficult factor to determine because of the multiplicity of indices which exist, and because of disagreement about the pathological values which are often a function of the valvular pathology in the particular case. Moreover, the importance of myocardial hypertrophy is rarely taken into account. The ratio systolic work/myocardial mass (WS/WM) which lies between no limits in the normal subject (0.81+/-0.03 gm.g-1) has allowed us to classify 44 patients with chronic mitral incompetence into three groups: groupe I (WS/V(M) greater than 0.87 gm.g-1), characterised by an increase in WS proportionally superior to that of V(M) (hyperfunctional); group II (0.87 gm.g-1 larger than or equal to WS/V(M) larger than or equal to 0.75 gm-1), characterised by a parallel increase of mass and WS (isofunctional); group III (WS/V(M) less than 0.75 gm.g-1) in which the increase in mass is proportionally greater than the variation in WS (hypofunctional). A comparison between the selectivity of this relationship and that of other indices, which contain large areas of overlap between the various groups of patients, lead us to hope for a prognostic index which will take account of the myocardial mass and of the pump action of the left ventricle.

Adolescent↗
PubMed1976

[Changes in the morphology of the normal left ventricle during the phases of isovolumic contraction and relaxation. Consequences on the calculation of the volume and cardiac output by cineangiocardiographic methods].

It is well known that the left ventricular volume, as measured by the cineangiographic method, decreases during the phase of isometric contraction. What is more, the cardiac index and the ejection fraction measured by this method are definitely larger than those derived from dilution methods. These discrepancies can be explained by movements of the mitral valve during the phases of isometric contraction and relaxation. The systolic ejection volume (SEV) was measured by three different methods: 1. End-diastolic volume (EDV) -end-systolic volume (ESV) ; 2. EDV - pre-filling volume (PFV) ; 3. Pre-ejection volume (PEV) - ESV. It has emerged that the results given by the methods (2) and (3) correspond closely, and differ significantly from those given by method (1); they are also close to those obtained by the dilution method. This difference seems to arise from the fact that the movements of the mitral valve during the phase of isometric relaxation are diametrically opposite to those which occur during isometric contraction; thus, when the values EDV-ESV are used in the calculation of SEV, an overestimate is made because the mitral valve is not to be found in the same position within the ventricular cavity for both values.

Adolescent↗
PubMed1976

[Mitral insufficiency in obstructive myocardiopathies. Hemodynamic study and cineangiography].

A haemodynamic and 2-plane cine-angiographic study of 23 patients with obstructive cardiomyopathy has shown that the mitral valve has a limited opening capacity, an unusually anterior position in early systole and is displaced anteriorly during systole. Mitral incompetence is present in more than half of the cases, but usually remains as the only lesion. When it is severe, it is because there are additional lesion: perforation, rupture of the cordae. The behaviour of the mitral valve was fairly constant in all 15 cases of hypertrophic, hyperkinetic, cardiomyopathy, and mitral incompetence was common, and usually found in isolation. The mechanism is discussed, and the physiopathological and therapeutic implications of these facts are reviewed.

Adolescent↗
PubMed1976

[Cineangiocardiographic evaluation of mitral valve lesions. Validity of the method according to 100 angio-surgical correlations].

In order to assess their validity, the findings on left bidirectional cineventriculography have been compared with the operative findings in 100 patients with mitral valve disease. This method of investigation has been shown to be a reliable one for the precise and complete evaluation of mitral valve lesions. The information which it provides about the morphology and kinetics of the valve, the site of any calcification, the state of the suspensory apparatus, and the degree and cause of any mitral incompetence often has a decisive influence on the indications for surgery and the choice of operation.

Adolescent↗
PubMed1975

[Catheterization in orificial aortic stenosis].

By virtue of its relative simplicity and its rapidity, the investigation of aortic stenosis recently perfected (and used with a satisfactory percentage of success and without important incident) deserves wide usage in haemodynamic and angiograpnic laboratories. Even if it does not always provide the solution to a particularly delicate problem, which is often of vital importance, it provides data which, modifiable and better used, should provide an adequate notion of the anatomical and physiopathological state in aortic stenosis.

Aortic Valve Stenosis↗