856 e-Letters

  • Discussion of worldwide perspective of valve disease should include mitral valve prolapse
    Tsung O Cheng
    Dear Editor:

    I enjoyed reading the recent article on the worldwide perspective of valve disease by Soler-Soler and Galve from Barcelona, Spain.[1] But I was surprised that no mention was made of mitral valve prolapse (MVP) anywhere in their article.

    MVP is the commonest valve disorder in the United States as well as in many parts of the world.[2] It also has a prevalence of 4.3% in Spain (see table).

    Prevalence (%...

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  • Coronary Endothelial Dysfunction after Kawasaki Disease
    Yoshihide Mitani
    Dear Editor

    Iemura et al's hypothesis that endothelial dysfunction is associated with coronary aneurysms which have regressed after Kawasaki disease (KD) is interesting[1]; however, there are two issues with respect to their study design that need to be considered, in addition to the issues reported before.[2, 3]

    (1) Is endothelial dysfunction associated with regressed coronary aneurysms per se late after KD?

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  • Pacing for vasovagal syncope
    Adrian Morley-Davies

    Dear Editor

    Kurbaan and Sutton provide a balanced view of the role of pacing in vasovagal syncope[1] - a common but complex and challenging medical condition.

    However, we feel that attention should be drawn to the methodological problems that bedevil interpretation of the North American Vasovagal Pacemaker Study (VPS).[2] This was not a randomised study of cardiac pacing, but rather a randomised trial...

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  • Re: Pacing for vasovagal syncope
    AS Kurbaan

    Dear Editor,

    We share many of the reservations that Morley-Davies and Byrne have regarding the North American Vasovagal Pacemaker Study (VPS).[1] However, this study should be considered in the context of the other available data supporting the role of pacing in selected patients. We also are interested in the study by Di Girolamo et al[2] suggesting a benefit for orthostatic training in those with neurocardio...

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  • Management of cardiocutaneous fistulae
    Peter G Danias

    Dear Editor,

    We thank Dr. Pocar and his colleagues for contributing their experience with another case of cardiocutaneous fistula [1], which confirms several points that we and others have previously discussed [2] [3] [4]. The clinical presentation of cardiocutaneous fistula is usually slow and indolent but may rapidly deteriorate. Therefore, when this diagnosis is established elective operation should be perfo...

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  • A further case of left ventricular opacification with intracoronary echo contrast during PTSMA
    RAP Skyrme-Jones

    We read the case report by Elliott et al (1) with great interest and would like to add to their findings. In three of five consecutive patients undergoing percutaneous septal ablation (PTSMA) for hypertrophic cardiomyopathy (HCM) they observed left ventricular cavity opacification during selective injection of the first septal perforator with the contrast agent Optison.

    We treated a 61 year old man with a long hist...

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  • Pseudo Brugada or true Brugada revealed by tricyclic agents?
    De Roy

    Dear Editor

    We have read with great interest the short case in cardiology reported by E Zakynthinos et al (1) in the March 2000 edition of Heart. The ECG recordings after acute ingestion of amitriptyline are remarkable, especially the ST segment elevation in the precordial leads V1 - V3, 6 to 100 hours after admission in the intensive care unit.

    The ECG pattern resembles markedly the ones described in...

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  • Cardiocutaneous fistula following left ventricular aneurysmectomy
    Marco Pocar

    Dear Editor:

    We read with great interest the review "Cardiocutaneous fistula" published by Dr. Danias and co-workers. At our Institution, we encountered a similar case, concerning a 72-year-old female, who developed this complication eleven months after coronary bypass sugery and linear resection of an anteroapical left ventricular aneurysm; the postoperative course had been complicated by mediastinitis necessit...

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  • Magnetic resonance imaging of atherosclerosis
    Stephen G Worthley

    I would like to acknowledge the interesting work published by Coulden et al [1] in the February 2000 edition of the journal. The concept of noninvasive arterial wall imaging with MR is an exciting new field with numerous potential implications, including atherosclerotic plaque characterisation. However, I would like to raise a few questions about the selection of MR imaging parameters.

    Firstly, I was interested t...

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  • Survival of patients with a first hospital admission for heart failure
    Kate MacIntyre

    To the Editor;

    Cowie et al(1) reported high case fatality rates in a population-based cohort of patients with incident heart failure between 1995 and 1996. Survival was 81% at one month, 75% at 3 months, 70% at 6 months, 62% at 12 months and 57% at 18 months. There are few population data that describe the contemporary survival of patients with heart failure.

    The Linked Morbidity Record Database con...

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