The aim of the study was to assess the safety of dobutamine echocardiography (DE) in patients with aortic stenosis and left ventricular ejection fraction < or = 45%.
162 patients (mean age 59 +/- 13, ...64% males) with resting transvalvular peak gradient < 70 mmHg underwent standard DE (doses 5-40 micrograms/kg/min) in a multicenter study involving 10 centers from Poland and Hungary. This analysis involves a subset of 39 pts (34 M, 5 F, age 59 +/- 13) identified according to the criterion of EF < or = 45% and mean aortic gradient < or = 35 mmHg. Clinically indicated coronary arteriography was performed in all patients with left ventricular dysfunction.
Peak dobutamine dose was 29 +/- 10 micrograms/kg/min. Peak heart rate was 112 +/- 26 bpm. Systolic arterial pressure was 148 +/- 20 mmHg and diastolic pressure 86 +/- 14 mmHg. Transaortic mean gradient and aortic valve area increased 35 +/- 34% and 19 +/- 15% during peak dobutamine dose, respectively. Ejection fraction improved 16 +/- 14%. The test was positive in 17 (43.6%) patients, negative in 11 (28.2%) patients and non diagnostic in 11 (28.2%) patients. There were no deaths, myocardial infarctions or episodes of sustained ventricular tachycardia as a result of DE. The test was terminated when the following conditions were met: Target heart rate (23.%). Left ventricular asynergy (46.2%). Maximal established dose achieved (7.7%). Side effects (20.5%). The most common side effects were ventricular arrhythmias (35.9%), dyspnea (20.5%) and hypotension < 20 mmHg (10.3%).
Despite frequent side effects, DE can be safely performed in patients with aortic stenosis and depressed left ventricular contractility.
In 100 left human lungs the main bronchus, the pulmonary artery and the pulmonary veins were injected with 65% methyl methacrylate (Duracryl) and then digested in sulphuric acid. The resulting ...specimens were studied concerning the divisions of the lingular bronchus and the types of arterial and venous vascularization of the lingula. As a rule the lingular bronchus divided into two segmental bronchi. A single lingular artery was found in 80% of the cases and a single lingular vein in 58%. Atypical bronchial divisions were almost always associated with unusual types of vascularization. Patterns of bronchial division showed complete concordance with those of arterial vascularization of the lingula in 64% of the lungs and consistency with venous drainage patterns in 54%.
An 63-year-old male patient was admitted to the Department of Internal Medicine due to the presence of intra-abdominal and epigastric pain lasting one year. During hospitalization the following ...examination were performed: X-ray of the chest, cervical, thoracic and lumbar regions of the spinal column, panendoscopy and ultrasonography of the abdomen, none of which showed any abnormalities. The angio-CT of visceral arteries revealed isolated, critical stenosis of the celiac trunk in its proximal part. The symptoms regressed after procedure of stent implantation to the celiac trunk.
PDF
