Biomedical subjects
Publications and source records attributed to P Lunde.
Osteogenesis imperfecta is an hereditary defect in the synthesis of collagen fibres. The disease can cause cardiac defects, such as aortic and mitral incompetence. Surgical repair of these defects is complicated by tissue friability and bleeding problems. We describe a case where an incompetent aortic valve was successfully replaced by a mechanical prosthesis.
The reproducibility and accuracy of routine echocardiographic measurements made by an inexperienced doctor using tele-instruction were evaluated. Thirty-eight patients were first examined at a local hospital by an inexperienced doctor instructed by a specialist 450 km away at a university hospital. The specialist then examined the patients at the local hospital using the same equipment, after an average of 50 days. The accuracy of M-mode and quantitative Doppler measurements was comparable to that observed in reproducibility studies made under normal examination conditions. There were no systematic measurement errors. No important M-mode information was missed except evidence of left ventricular hypertrophy in six patients. In the two-dimensional examination there were differences of clinical significance in only three patients. There were no clinically important differences in the Doppler quantification of mitral and aortic regurgitation. Tele-instructed echocardiography is also an excellent educational tool, allowing an inexperienced examiner gradually to take responsibility for the local echocardiographic service.
This paper evaluates instruction via video conferences in the training of a physician previously inexperienced in echocardiography, and the diagnostic precision of this method. An inexperienced doctor performed the investigations in 38 patients at a local hospital and the ultrasound signals were transferred to a referral hospital 900 km away where a cardiologist served as instructor. The instructor was blinded to all patient identifications and later examined the patients directly. M-mode, two dimensional echo and Doppler data were assessed. There was a difference of possible clinical importance in only two patients in the two-dimensional assessment, and in one patient in the quantification of mitral regurgitation. For the M-mode measurements, the differences observed were comparable to the results of other investigators, for the Doppler measurements they were slightly larger. Except for a left ventricular aneurysm in one patient, no diagnoses of clinical importance were missed. Our experience is that teleechocardiography is a method that is suitable for basic training in echocardiography, and that the diagnostic precision is sufficient for the method to be applied clinically.
Left ventricular wall perforation after acute myocardial infarction, without immediate rupture to fatal haemopericardium, is a rare complication that may result in a pseudoaneurysm. Transoesophageal echocardiography demonstrated a posterior wall perforation and the unique blood flow pattern at the neck of a pseudoaneurysm 6 days after acute myocardial infarction. In a second patient with angina and congestive heart failure 7 years after an acute myocardial infarction echocardiography demonstrated a huge pseudoaneurysm. Surgical repair was successful in both patients. Turbulence of blood at the neck of a pseudoaneurysm generates a murmur, and systolic regurgitation into a large aneurysm may cause symptoms of heart failure. Exact diagnosis, anatomical relations and size can be assessed with echocardiography. Angiography is required before surgery only to rule out coronary artery pathology. Occasionally a pseudoaneurysm may persist for many years but because of a high risk of rupture, prophylactic repair is indicated soon after diagnosis.
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We describe a case of endocarditis caused by Propionibacterium acnes after a series of 'vitamin' injections and semipermanent acupuncture needle maneuvers by a natural healer. The patient had prosthetic heart valves. We found that the most probable source of infection was the treatment by the natural healer and therefore wish to warn against invasive treatment of such high-risk patients by laymen. If such treatment is insisted upon in spite of such warnings, antibiotic prophylaxis should be considered.
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The echocardiographic features of flail tricuspid leaflet of unknown aetiology is reported. The diagnosis was made in a previously healthy 11 year old boy presenting with recurrent attacks of supraventricular tachycardia. M-mode echocardiography showed rapid early systolic movement of the tricuspid valve away from the transducer and holosystolic, coarse fluttering of its small, redundant part. The sector scan, showing the free movement of a part of the septal tricuspid leaflet into the right atrium during systole was confirmatory. It was felt that Ebsteins anomaly could be excluded. The recurrent attacks of supraventricular tachycardia were difficult to treat pharmacologically, and may have been related to the flail tricuspid leaflet which mechanically triggered the arrhythmia through an aberrant pathway.
A 24-year-old asymptomatic women presented with a large posterior mediastinal mass and a vertebral defect. Cardiac enlargement was found at roentgenographic and echocardiographic investigation. The ECG was abnormal and right heart catheterization showed cardiac output 17.1 l/min with a large left-to-right shunt at the level of the right atrium and the superior caval vein. The mass was seen on angiograms to be fed by numerous vessels originating from the descending aorta between the aortic arch and the coeliac axis. Computed tomography demonstrated a homogeneous, highly vascular structure. Radical excision was successfully accomplished in a two-step procedure aided by partial cardiopulmonary bypass. This seems to be the first report of a macrofistulous arteriovenous malformation in the mediastinum.
Haemodynamic studies were performed at rest and during exercise in five chronic haemodialysis patients at two different states of hydration, called "normal hydration" and "over-hydration" (mean change in body weight 2.9 kg). Apart from an increase in mean aortic pressure and cardiac index there were no signs of cardiac dysfunction at rest at normal hydration. On exercise the mean pulmonary artery and wedge pressure increased significantly while cardiac output doubled. Overhydration caused considerable increases in right and left sided heart pressures at rest, without any increase in cardiac index. These changes became more pronounced during exercise. Anaemia and arteriovenous shunting make dialysis patients very sensitive to volume load. Extreme anaemia should be avoided, and keeping dialysis patients in a state of low volume load should be given high priority.
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A family with inherited congestive cardiomyopathy is presented. The diagnosis is based on clinical, morphological and laboratory evaluations. The first observed sign of the disease is arrhythmia and/or conduction defects. The onset of symptoms of pump failure is in adult life, and affected persons die within several years. Three persons have died suddenly. Septal hypertrophy was present in two affected persons. The mode of transmission is probably autosomal dominant. The recognition of arrhythmia as an early sign of the disease offers the opportunity of an early diagnosis.
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A patient with acute myocardial infarction and sinus bradycardia has been treated with 0.5 mg atropine intravenously. Shortly after the injection he showed a sinus tachycardia, then developed ventricular ectopic beats, ventricular tachycardia and ventricular fibrillation, which was treated successfully with electrical countershock.
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Rupture into the inferior vena cava was found in three (1.4%) of 211 abdominal aortic aneurysms operated on in an 18-year period, and in 4.4% of all 68 cases in which the aneurysm had ruptured. One of the three patients initially presented with isolated chest symptoms. All three survived surgical repair, though major bleeding occurred in one. Preoperative recognition of the characteristic clinical features of an aortocaval fistula is important. Computed tomography and ultrasound studies were used to confirm the diagnosis and visualize the anatomy before the operation in one case.