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Case histories of 84 patients with fevers lasting from 2 weeks to 6 months and suspected infective endocarditis (IE) were analyzed. Infective endocarditis was diagnosed in 15 patients. From the viewpoint of IE diagnosis by the DUKE criteria, the major criteria possess the highest diagnostic value. Use of only minor DUKE criteria gave false-positive results in diagnosis of IE in feverish patients with angiitis, hemopoietic diseases, and malignant tumors with remote metastases. The diagnosis of IE should be based on the DUKE criteria, clinical picture, and data of laboratory tests (pericarditis, shift of the leukocytic formula to the left, increased level of circulating immune complexes, high erythrocyte sedimentation rate, etc.).

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Respiratory function was studied in 9 patients with mitral prolapse because of myxomatous degeneration of valvular cusps. Respiratory disorders were diagnosed in 7 of them. Respiratory organ abnormalities in cusp prolapses result from hereditary deficiency of the connective tissue with visceral manifestations. Valvular cusp prolapse and their myxomatous degeneration may serve as markers of impairment of the respiratory organs and other viscera related to "weakness" of the connective tissue.

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Among patients admitted to the therapeutic department of the general hospital for 5 years, diagnosis of pericarditis was made in 110 patients (0.44%). Among the most common causes of secondary pericarditis were: chronic renal failure (31.8%), diffuse lesion of the connective tissue (17.7%), tumor metastases to the pericardium (15.5%). Primary pericarditis was, as a rule, of tuberculous etiology. Morphologically, it was adhesive or adhesive-exudative, constrictive, exudative in 13, 4.5 and 76% of patients, respectively. Half of the patients with exudative pericarditis had 300 to 800 ml of fluid in the pericardial cavity. Typical clinical manifestations were dyspnea and tachycardia. X-ray was diagnostically valuable in pericardial exudate 300 ml and more. ECG voltage fell in exudate more than 400-500 ml. Echocardiography remains an effective tool in diagnosis of pericarditis. The treatment consisted of antibiotics, antiinflammatory therapy, evacuation of the liquid from the pericardial cavity.

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Calcinosis of the mitral fibrous ring (CMFR) was detected echocardiographically in 11.7% of the examinees with ischemic heart disease (IHD) at the age over 60 years. In CMFR the mitral opening significantly narrows, maximal transmitral diastolic gradient rises, mitral regurgitation becomes more pronounced. In one-third of the patients calcinosis involves the posterior wall disturbing its kinematics. Narrowing of the mitral opening in IHD patients accompanying CMFR is considered to be moderate nonvalvular mitral stenosis.

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Pulsed Doppler echocardiography was used to analyse diastolic transmitral blood flow in 2 groups of patients with coronary heart disease, each including 30 persons. The groups differed in the presence or absence of large postinfarct cardiosclerosis. Diastolic dysfunctions of the left ventricular myocardium were marked by the lower maximum rapid filling rate, increased maximum atrial/rapid filling rate ratios, decreased mean slowing in rapid filling rate, and elevated left ventricular end-diastolic pressure. More profound impairments in diastolic blood flow were recorded in patients with postinfarct cardiosclerosis-complicated coronary heart disease. Pulsed Doppler echocardiography is shown to be useful in the assessment of diastolic function of the left ventricular myocardium in coronary heart disease.

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Pulse dopplerography examination of the blood flow rate in the large hepatic veins evidenced the possibility of the assessment of the right ventricular failure. Systolic blood flow appeared to be slow in case of sinus rhythm right ventricular failure, while the acceleration of the blood flow occurred in case of atrial fibrillation. Absolute ratio between the maximal rate of the systolic blood flow and the maximal rate of the diastolic flow of the spectrum of Doppler's frequency of pulse dopplerography of large veins in case of the right ventricular failure was lowered irrespective of the pattern of the cardiac rhythm.

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Diastolic mitral block was revealed by ++Doppler echocardiography in patients with atrioventricular block degree I, II and III in atrial flutter. The leading mechanism in pathogenesis of diastolic mitral regurgitation lies in delayed contraction of the left ventricle in relation to the left atrium causing incomplete closure of mitral cusps. Other factors contributing to diastolic mitral insufficiency involve overloading of the left ventricle and rigidity of its myocardium. All the patients with atrioventricular block and diastolic mitral regurgitation showed tricuspid diastolic regurgitation. Diastolic mitral regurgitation induces volumetric overloading of the left atrium.

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During pulse dopplerography of the large hepatic veins in patients with tricuspid valve failure, the differences in the shape of the spectrum of Doppler's frequencies were revealed as dependent on cardiac rhythm. In sinus rhythm, the curve of the systolic flow is recordable beneath the baseline, in atrial fibrillation, over the baseline. In scanning of the large hepatic veins in patients with tricuspid valve failure, the shape of the curves of the spectrum of Doppler's frequencies coincides with the shape of the curves of liver pulsation. Tricuspid valve failure in sinus rhythm leads to a decrease of the maximum velocity of the systolic flow in the hepatic veins. There is a close correlation between the maximum velocity of the systolic flow of tricuspid regurgitation and the maximum velocity of the systolic flow in the large hepatic veins. Pulse dopplerography of the large hepatic veins is a safe enough method of the diagnosis of tricuspid valve failure and can be used in difficult cases when analysing the tricuspid blood flow from standard projections.

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Secondary valve prolapse emerges in a variety of heart diseases: coronary heart disease, dilated and hypertrophic cardiomyopathies, acquired valvular heart disease, infectious endocarditis, pulmonary hypertension, etc. Valve prolapse results from dilation of valvular fibrous rings, dysfunction of papillary muscles, mitral lesions in valvulitides. Secondary valve prolapse in dilatation of valvular opening entails manifest disorders of systemic and intracardiac hemodynamics except for cases of aortic root dilatation. In decreased valvular opening secondary valve prolapse is not associated with considerable shifts in hemodynamics. Secondary valve prolapse suggests primary structural and functional defects in the heart rather than promotes the development of circulatory insufficiency.

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Late diastolic mitral regurgitation (diastolic backflow of blood from the left ventricle to the left atrium at the end of left-ventricular diastole) is registered by Doppler echocardiography in patients with acquired heart defects and dilated cardiomyopathy. This phenomenon is based on the appearance at the end of left-ventricular diastole of the left ventricle/left atrium pressure gradient which is opposite to a normal relationship. Late diastolic regurgitation is more often encountered in patients with incompetence of the mitral and aortic valves. It is caused by disturbances of the work of the left heart and of kinetics of the mitral valve in relatively low frequency of cardiac contractions and is encountered in sinus rhythm and atrial fibrillation, and does not depend on the value of the transmural diastolic gradient. The clinical significance of mitral regurgitation remains unclear.

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The results of the measurement of the mitral opening in mitral stenosis patients by planimetry and by the computation method via the half-cycle of the atrioventricular pressure were found to be in satisfactory agreement except those in a group of patients with concomitant failure of the semilunar aortic valve. Moderate or appreciable mitral regurgitation and stenosis of the aortic ostium associated with mitral stenosis exerted no substantial effect on the accuracy of the design parameter of the mitral opening.

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