Atrial fibrillation is a common, potentially preventable cause of disabling stroke in the elderly, particularly in elderly women, resulting from embolism of stasis-precipitated thrombi formed in the left atrial appendage. In 1989, the first randomized clinical trial of anticoagulant therapy in atrial fibrillation showed that warfarin produced a large reduction in ischemic stroke.1 In the ensuin...

Long-term pervenous right atrial pacing has been used in five patients with intact atrioventricular (A-V) conduction for the treatment of refractory ventricular arrhythmias in two subjects and marked sinus bradyeardia in three, two of whom also had paroxysmal supraventricular arrhythmias. The pervenous method was used to avoid a thoracotomy, and atrial pacing was chosen over ventricular pacing ...

We present a new formulation of the motion of a flexible body with a vortex-sheet wake and use it to study propulsive forces generated by a flexible body pitched periodically at the leading edge in the small-amplitude regime. We find that the thrust power generated by the body has a series of resonant peaks with respect to rigidity, the highest of which corresponds to a body flexed upwards at t...

SIR LAUDER BRUNTON (1902) suggested that the only proper and logical approach to the problem of mitral stenosis was "to lengthen the slit." This suggestion has now been carried into effect. Allen and Graham (1922) and Pribram (1926) published single unsuccessful cases. Souttar (1925) described a case which survived the operation and was said to have been improved. He employed his finger to dila...

An echogenic band like structure was seen in the left atrium on two dimensional transthoracic echocardiography (2D TTE). Full volume three dimensional (3D) TTE and colour Doppler established the surrounding anatomical landmarks, and demonstrated the absence of obstruction related to this band. 3D TTE confirmed that this band like structure was consistent with the ridge between the left atrial a...

Left juxtaposition of the atrial appendages is usually associated with cyanotic congenital heart disease. Recognition of this rare anomaly is important before therapeutic or surgical procedures that involve the atrial septum can be undertaken (for example, septostomy, the Mustard or Senning operation and the Fontan anastomosis). The diagnosis of left juxtaposition of the atrial appendages is mo...

Pediatric cardiologists treating patients with severe congenital cardiac defects define "visceral heterotaxy" on the basis of isomerism of the atrial appendages. The isomeric features represent an obvious manifestation of disruption of left-right asymmetry during embryonic development. Thus, there are two subsets of individuals within the overall syndrome, with features of either right or left ...

In anesthetized dogs, electrograms were recorded simultaneously from six atrial epicardial sites and a limb or esophageal lead in order to study the mechanism of atrial flutter induced electrically after an intercaval crush in comparison with atrial tachysystole induced by aeonitine. In the former, with limb lead records resembling classical human flutter in form and regularity, activation occu...

The most complex combinations of congenital cardiac malformations are found in the setting of bodily isomerism. The question remains, however, as to whether evidence of cardiac isomerism is always to be found in the setting of bodily isomerism, also known as "heterotaxy." We have previously shown that, when assessed on the basis of the extent of the pectinate muscles relative to the atrioventri...

UNLABELLED Spontaneous echo contrast (SEC) is frequently observed in patients with structural and functional cardiovascular abnormalities. Literature describes cases of SEC either from agglutination of red blood cells and plasma proteins or from microcavitations. SEC secondary to the former is an independent predictor of future thromboembolic events and is most commonly observed in the left atr...