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Gated magnetic resonance tomography (MRT) was conducted in 40 patients (13 normal volunteers, 9 hypertensives and 18 patients with hypertrophic cardiomyopathy) using a 0.35 Tesla superconducting magnet. Multisectional spin echo imaging (35/400 msec) was obtained in coronal, transversal and sagittal planes. Myocardial wall thickness was measured in different segments and the three groups were compared to each other. 15/18 patients with hypertrophic cardiomyopathy (HCM) had asymmetrical regional thickening involving the septum and the anterior wall, in 8/15 the lateral wall was also hypertrophic. The distribution pattern in 3/15 patients with HCM was symmetric. Involvement of the right ventricle was found in 14/18 patients with HCM. There were significant differences (p less than 0.001) in wall thickness for the septal segment in all three groups and for the ratio septal to posterior wall between the HCM and the hypertensives and the normal volunteers. We conclude that MRT can differentiate HCM from hypertensives and normals, and is superior to echocardiographic imaging in the evaluation of the distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy.

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127 patients with diagnosis of acquired mitral and aortic valve disease confirmed by cardiac catheterization were followed for 5-17 years (mean 10 years) under conservative management. At the end of the study, 80 patients were still alive, and 68 of them were examined again. 23 patients died, and no information was available on 24. Analysis of the natural course of the disease showed that results obtained with different classification systems (NYHA, clinical findings, hemodynamic data) were not comparable. However, the majority of mitral and combined mitral-aortic lesions remained stable over the years, independent on the initial classification of the lesion. Aortic valve disease became hemodynamically worse in the absence of subjective and clinical change.

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Prosthetic valve replacement was performed in 113 patients above the age of 60 with advanced valvular heart disease, whose prognosis without surgical correction was extremely poor. Although there was high risk of early mortality in isolated aortic valve disease (20%), in isolated mitral valve disease (28%) and in multiple valve disease (50%), improvement for the survivors was evident. Late mortality was rather low. Individual risk can be estimated by considering the patient's age, type and stage of valvular disease as well as the clinical condition and hemodynamic parameters.

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The value of prosthetic valve replacement is determined not only by the improvement in life expectancy but also by the quality of life. This statement resulted from an analysis of 168 patients undergoing isolated aortic -- or mitral -- valve replacement between 1970 and 1976. Besides numerous complications -- probably often avoidable such as side effects of incorrect anticoagulation -- long term results of 125 surviving patients were satisfactory over a period of 3-9 years after surgery. Though complete restitution was rare, subjective and objective improvement -- different and dependent on type and degree of valve disease -- was persisting and the effect on social and professional incorporation surprisingly positive.

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The natural history of congenital heart disease in older patients will become increasingly difficult to delineate, since many of uncomplicated defects were repaired early in life. Therefore the frequency of clinical and hemodynamic progress in non-operated patients with atrial septal defects seems to be of great interest. We are able to compare 27 patients aged more than 60 years with a group between 40 and 59 years. In 80 out of 103 patients totally, the clinical findings could be completed with catheterization data. The progress of deterioration with age in spite of intensive medical care could be demonstrated by mostly statistical significant signs of greater right-ventricular overload in the Ecg, cardiac arrhythmias--usually atrial fibrillation--changes in the X-ray findings and increasing pulmonary hypertension.

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The operative risk of prosthetic replacement of the mitral valve in 97 patients and of the aortic valve in 126 patients showed a good correlation with the decrease in preoperative pulmonary function (p less than 0,01). The overall mortality rate reached 12,4% respectively 13,4% during the first 28 days after surgery. Depending upon the stage of ventilatory impairment the mortality rate varied between 0 to 50% in the mitral group and between 6,5 to 50% in the aorti group. The impairment of respiratory function is caused by the disturbed hemodynamic function demonstrated by a negative correlation between pulmonary artery pressure and vital capacity.

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