Two patients with partial absence of the right and left pulmonary veins respectively are descriptionbed. Congenitally absent pulmonary veins are a rare phenomenon and the diagnosis is often missed or delayed. When children present with haemoptysis and/or recurrent respiratory infections with no obvious underlying cause, absence of the pulmonary veins must be part of the differential diagnosis. Special investigations to be done in these patients are chest roentgenograph to compare the lung volumes, radio-isotope scan, echocardiography and cardiac catheterisation. Magnetic resonance imaging may be helpful in defining the cause and site of obstruction of the pulmonary veins. Depending on the cause, surgery might be considered.
The severity of acute pulmonary hypertension (APHT) in acute respiratory distress syndrome was examined in 20 patients. All patients had significant APHT (mean pressure 40.6 ï¿½ 6.3 mmHg) on admission to the intensive care unit. There was evidence of right ventricular (RV) failure, with a right ventricular stroke work index (RVSWI) of 9.20 ï¿½ 3.3 g.m/m2 and a central venous pressure of 18.0 ï¿½ 4.0 mmHg. The RV afterload, i.e. pulmonary artery elastance (Ea = stroke volume/peak pulmonary artery pressure), was raised. Stroke volume could not be predicted from Ea or RVSWI alone, but regression analysis indicated that the ratio of RVSWI/Ea (i.e. ventriculo-arterial coupling) could account for 88% of the stroke volume.
Since it was introduced in the late 1950s, direct-current cardioversion has been the standard procedure used to transfer patients with chronic atrial fibrillation to sinus rhythm. This review gives an overview of technical aspects of cardioversion, its risk and complications together with some clinical aspects, including factors of importance for a successful result. The haemodynamic benefits of sinus rhythm versus atrial fibrillation are also briefly emphasised, as are risk factors for thromboembolic events related to cardioversion. This review provides easily available information to those utilising this technology. A programme for cardioversion may be implemented on the basis of this.
Chronic rheumatic heart disease is common in South Africa and requires lifelong supervision. Experience of a cardiac clinic in a second-tier hospital serving a large rural population is descriptionbed.