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A Case of Lutembacher's Syndrome:The Hemodynamic Effect of Propranolol on a Case Taneo Sakagami 1 , Masakazu Takahashi 1 , Coroh Shimizu 1 , Mamoru Kawakami 1 , Naoharu Sasaki 1 , Yohzi Aoki 1 , Akihiko Kawabe 1 , Tetsuya Imai 1 , Akira Eguchi 1 , Yoshiroh Ohyama 1 , Matsuzo Matsuoka 1 11st Department of Internal Medicine, Niigata University School of Medicine pp.649-652
Published Date 1969/7/15
DOI https://doi.org/10.11477/mf.1404202051
  • Abstract
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A 28-year-old woman was admitted because of exertional dyspnea and palpitation lasting for two years. On examinations, there were clinical findings suggestive of coexistence of mitral stenosis and atrial septal defect. These included an apical rumbling diastolic murmur, an opening snap, an accentuated first heart sound and left atrial enlargement revealed on an electrocardiogram and chest X-ray films, which are characteristic of mitral stenosis, and at the same time, a systolic murmur with the fixed splitting of the second heart sound in the second left interspace, which are characteristic of a left-to-right shunt at the atrial level and a high pulmonary wedge pressure of 28.5 mm Hg, so the dia-gnosis was confirmed. Then with the catheter-tip in the pulmonary artery, 0.1mg/ kg. of propranolol was administered intra-venously over five minutes. Fifteen minutes after the injection, the wedge pressure dec-lined to 18 mm Hg and the magnitude of the shunt was decreased from 56.1 % to 26.6 %.

Classical findings of mitral stenosis observed above have been reported less common in this syndrome, since an elevation of the left atrial pressure is prevented by the existence of the atrial septal defect. But in our case, it was revealed that the defect was too small (0.5 cm. in diameter) to act as above. It is inte-resting that the wedge pressure declined following the administration of propranolol, for this beta-adrenergic blocking agent has been told as acting in a reversed fashion on usual cases. Mitral stenosis has been said to be an exception as to the manner of reaction to this drug, and the prolongation of the diastolic phase was regarded as the essential cause of diminishing the wedge pressure. A same mechanism seems to exist in the present case which has mitral stenosis. This hemo-dynamic change seems to be important not only to diagnose the disease, but also to diminish, though not long enough, a possible danger of pulmonary congestion.


Copyright © 1969, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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