ABSTRACTS

CHANGES IN PATTERNS OF CPK KINETICS FOLLOWING CORONARY REPERFUSION. HBINRICH BLANKE,M.D., DOROTHEA VON HARDEN- BERG, KARL R. KARSCH,M.D., HELMUT KAISER,M.D., MITCHELL DRIESMAN, M.D., K.PETER RENTROP,M.D., Mount Sinai Hospi- tal New York, New York, USA, University of Goettingen, West Germany

Coronary angiography "as performed in 50 patients (pts) in the acute (mean 7 hours,after onset of symptoms) and chronic phase of myocardial infarction. 24 pts were treated conservatively (Group A); in 26 pts reperfusion "as achieved with intracoronary streptokinase (Group B). CPK values were obtained every 3 hours (hrs) for 48 hours; maximum CPK (CPK max) and cumulated CPK release (CPK rel) were calculated. Acute (a) and chronic (c) ejection frac- tion (EF) and length of akinetic segment (AKS) were deter- mined from biplane angiograms.

CPK max CPK rel EF, EF, AKS, AKSc (mIU/ml) (IU/ml) (%) (%I (cm) (cm)

A 1042+537 1355+880 52flO 48+14 8.7*5.8 8.7*6.9 B 917+855 1157f977 54fll 62f 9 7.6*6.5 2.1f3.9 The time interval between onset of symptoms and CPK max "as 23f7 hrs in Group A and 13f5 hrs in Group B. The following correlations between CPK release and AKS in the chronic stage were obtained:

A: CPK rel=73(AKS)+785 n=24, r=0.52, ~(0.01 B: CPK rel= 173(AKS)+667 n=26, r=0.74, p<O.OOl Conclusions: Acute reperfusion resulted in higher CPK release when corrected for-infarct size as determined by AKS,. We presume that this"is secondary to the washout of the enzyme from the infarcted area. Despite the early washout and high levels, a linear relationship still existed between CPK release and infarct size.

SPONTANEOUS PRESERVATION OF LEFT VENTRICULAR FUNCTION DURING MYOCARDIAL INFARCTION John Morrison, MD; Lawrence Ong, MD; Peter Reiser, MD, Lawrence Scherr, MD, North Shore University Hospital- Cornell University Medical College, Manhasset, NY

To assess the incidence of spontaneous myocardialpreserva- tiqn during myocardial infarction, creatine kinase-MB re- lease (CK-MB) and radionuclide descriptors were studied in 35 patients (pts). Initial (i) radionuclide studies were obtained at 11214 hrs (mea&D) after myocardialinfarction and final (f) studies at 15f7 days. Sequential changes in global LVEF were corrected for any sequential change in RVEF. In these pts, time to peak serum CK-MB correlated with the change in LVEF (y=O.13-0.008x; r=-0.56;SEE=O.O02; p=O.O02). Twenty pts had "slow" CK-E?B release;15 pts dis- played "fast" CK-MB. Comparing slow to fast CK-MB pts, time to peak CK-MB was 19*9, vs 9f3 hrs (p(.OOl) and total CK-MB duration was 72220 vs 60215 hrs (p=.O5). CK-MB in- farct size correlated with global LVEF in slow CK-MB pts (r-=-0.56; p=.Ol), but not in fast CK-MB pts (r=-.16). The radionuclide images were computer-divided into 5 left ven- tricular regions; 61 regions had Q-waves on 1%lead ECC. In slow CK-MB pts, the regional ejection fraction (ef) of these Q-wave regions did not change (efi=O.3620.20; eff= 0.3320.17; n=35; p=ns); Q-wave regions in fast CK-MB pts had an eff higher than efi (0.45iO.13 vs 0.36+0.14; t1=26; p=.oo2). In 16 pt$, thallium-201 was measured as average counts per pixel per region, 30 min and 3 hrs after injec- tion. Changes over 24 hrs were termed Tl-201 washout and expressed as % change in counts. 'In regions with Q-waves, the Tl-201 data was improved when f and i studies were com- pared in the fast CK-MB pts (-24*22 vs -7222; n=18;pc.001) but not in the slow CK-MB pts (n=I6; p=ns). These indepen- dent enzymatic and radionuclide data suggest that sponta- neous reperfusion results in myocardial preservation in certain patients during acute myocardial infarction.

THURSDAY, APRIL 29, 1982 AM SURGICAL MANAGEMENT OF CONGENITAL HEART DISEASE I 8:30- 1o:oo THE SYMPTOMATIC PATIENT WITH EBSTEIN'S ANOMALY OF THE TRICUSPID VALVE: BENEFICIAL EFFECT OF PLASTIC REPAIR Valentin Fuster, MD, FACC; Gordon K. Danielson, MD, FACC; Emilio R. Giuliani, MD, FACC: Douglas D. Mair, MD, FACC, Mayo Clinic, Rochester, Minnesota

At the Mayo Clinic, the natural history of Ebstein's anomaly was analyzed on the basis of experience with 85 consecutive patients (pts) in whom the diagnosis "as documented by cardiac catheterization (73) or by 2-D echocardiography alone (12). The median follow-up "as 12 years. Of the total group, 30 (35%) of the pts remained in functional Class I or II and 55 (65%) pro- gressed at some time into Class III or IV.

In pts in Class III or IV, a comparison was made, between pts treated medically (9) and those treated surgically (33) with a plastic repair consisting of pli- cation of the free wall of the atrialized portion of the right ventricle, a posterior tricuspid annuloplasty, and right atria1 reduction.

Of the 9 nonoperated pts, 3 died and 4 others continue to be significantly disabled and their cardiac size remains the same or has increased. Of the 33 surgically treated pts, there were only 3 operative deaths (9.1%) and 2 late deaths (6.1%), 4 of these deaths probably due to dysrhythmias; of the 28 survivors, 23 (82%) had sig- nificant symptomatic improvement and associated decrease in heart size.

Plastic repair of the tricuspid valve appears to be of benefit in the symptomatic patient (Class III or IV) with Ebstein's anomaly of‘the tricuspid valve.

SUPRAVALVULAR AORTIC STENOSIS -- EXPERIENCE WITH PATCH AORTOPLASTY AND EFFECT OF "CUSP TUCK" Greg Flaker, MD; Douglas Teske, MD; James Kilman, MD, FACC: Don Hosier, MD, FACC; Charles Wooley, MD, FACC: Ohio State University Hospital and Children's Hospital, Columbus, Ohio

Supravalvular aortic stenosis (SVAS) has distinctive morphologic features which influence the results of cor- rective surgery. Fifteen patients underwent patch aorto- plasty for SVAS. Eleven had segmental supravalvular nar- rowing (hourglass), four had diffuse narrowing of the ascending aorta (hypoplastic). Gradients ranged from 40- 170 mm Hg. At surgery the margins of the aortic valve cusps were frequently firmly attached to the supravalvular tissue. A Dacron patch was inserted in the non-coronary cusp, freeing the posterior attachment. The anterior supravalvular tissue "as resec%ted but inevitably residual attachment between this anterior tissue and the anterior commissure remained. Three surgical deaths occurred in the early 1960's, two with hypoplastic SVAS. Of the re- maining twelve patients followed for 1-12 years, ten are asymptomatic, one has angina, and one expired (cancer).

"Cusp tuck" -- the persistent attachment of the anterior commissure to the residual supravalvular tissue -- resulted in the angiographic appearance of a thick band between the right and left coronary cusps during diastole and "as present in all eight patients who had postoperative catheterizations. Four of the eight had gradients (23-48 mm Hg) across the aortic valve. Two had aortic valve insufficiency. No significant supravalvular gradient was found.

Patch aortoplasty for SVAS provided good clinical re- sults with asymptomatic patients for up to 12 years. HOW- ‘aYe=, "cusp tuck" resulted in residual aortic valvular abnormalities which may be important in the long-term management of these patients.

1034 March 1982 The American Journal of CARDIOLOGY Volume 49