longer than 1 year. They reported macroscopic signs of complete healing, sutures buried in connective tissue, smooth endocardial surfaces and absence of thrombus formation. Feigenbaum4 has stated that the lateral wall of the left atrium in normal subjects can impinge on the atria1 cavity and might erroneously be called a “mass effect.” We believe the left atria1 “mass” observed in orthotopic cardiac transplant recipients represents the echocardiographic appearance of the donor-recipient atria1 anastomosis (suture line). The anastomosis is creat- ed by approximating 2 atria1 surfaces with a running suture, thus doubling the atria1 wall thickness along the suture line. This iatrogenic anatomic abnormality is re- sponsible for creating the abnormal atria1 echoes that are observed. It has been our experience that a similar mass effect can also be seen in the right atrium in many pa- tients. One can actually visualize the donor-recipient atri- al anastomosis across the right and left atrium echocar- diographically in some patients.

It could be speculated that this observation represents a phenomenon related to local surgical technique that creates a prominent atria1 anastomosis. However, 3 pa- tients transplanted at 3 other separate institutions all demonstrated prominent left atria1 echoes when exam- ined echocardiographically at this institution. Further-

more, Stevenson et al5 have previously described that the left atria1 donor to recipient anastomosis viewed by 2- dimensional echocardiography has a “snowman” conlig- uration.

Left atria1 echoes in orthotopic cardiac transplant re- cipients are a common echocardiographic finding. A characteristic, nonmobile, nonpedunculated mass ap- pears along the lateral left atria1 wall that is best observed in the standard apical 4-chamber echocardiographic win- dow. We conclude that the mass effect represents the donor-recipient atria1 anastomosis. Detection or exclu- sion of superimposed thrombus on the suture line is difli- cult and may be facilitated by serial echocardiographic examinations.

1. Fragomeni LS, Kaye MP. The registry of the International Society for Heart Transplantation: fifth official report-1988. JHeart Tmmplanfafion 1988:7:249- 253. 2. Shumway NE, Lower RR, Stofer RC. Transplantation of the heart, AduSurg 1966:2:265-i-284. 3. Uys CJ, Rose AG. Pathologic findings in long-term cardiac transplants. Arch Pathol Lab Med 1984:108:112-l 16. 4. Feigenbaum H. Cardiac masses, In: Echocardiography. Philadelphia: Lea & Febiger, 1986:579. 5. Stevenson LW, Dadoorian BJ, Kobashigawa J, Child JS, Clark SH, Laks H. Mitral regurgitation after cardiac transplantation. Am J Cardiol 1987,60:119- 122.

Providing Heart-Healthy Alternatives at Cardiology Meetings: Grilled Salmon or Beef Tenderloin? Kelly Maxwell, BA, Alice Ammerman, MPH, RD, William C. McGaghie, PhD, Clayton H. Bryan, BA, and Ross J. Simpson, Jr., MD

R ecognizing that physicians have changed their eating habits,’ such as reducing saturated fat in their

diets,* we offered more prudent food selections as part of a recent cardiology conference. Our goal was to provide options to those who choose to consume a diet consistent with the saturated fat and cholesterol recommendations of the National Cholesterol Education Program.3 This report demonstrates the ease of offering such options and presents the results of a survey assessing the acceptability and importance of such prudent foods to the physician attendees.

Three strategies within the capabilities of the usual catering staff were used. First, prudent options were se- lected from existing menus. For example, we chose ba- gels instead of donuts for breakfast and chicken salad instead of roast beeffor lunch. Second, the fat content of

From the Office of Educational Development, the Department of Nu- trition, School of Public Health, and the Department of Medicine, University of North Carolina School of Medicine, CB 7075, Burnett- Womack Building, Chapel Hill, North Carolina 27599-7075. This study was supported by Preventive Cardiology Academic Award no. HL1701-02 from the National Heart, Lung, and Blood Institute, the National Institutes of Health, Betheada, Maryland. Manuscript re- ceived February 21, 1989; revised manuscript received and accepted April 18, 1989.

TABLE I Conference Menu

Breakfast Coffee, 1 cup, 1 tsp. milk and 1 tsp. sugar Orange juice, 6 oz.

Morning break Lunch

Bagel, 2 tbs. cream cheese (low fat) Coffee, 1 cup, 1 tsp. milk and 1 tsp. sugar Vegetable soup, 1 bowl Chicken salad (with mayo/yogurt dressing) Date nut bread with 2 tbs. cream cheese

(low fat)

Afternoon break Dinner

Fruit salad with yogurt, 1 cup Apple juice, 6 oz. White wine, 2 glasses Shrimp (4) and cocktail sauce Carrots, broccoli and cauliflower, % cup Fresh fruit salad, Jk cup Cucumbers in a vinagrette dressing, fb cup Pasta salad (cheese tortellini), Y4 cup Asparagus spears, 1 Dinner roll, 1. pat of margerine

J \ Less prudent Prudent Beef tenderloin, 3 oz. Grilled salmon, 4 oz.

with 45 cup gravy Rice, 1 cup Au gratin potatoes, Angel food cake

Y2 cup with strawberries Angel food cake with

strawberries and whipped cream

THE AMERICAN JOURNAL OF CARDIOLOGY JULY 1. 1989 111

TABLE II Comparison of Conference Menu to National Recommendations* I

Total fat Saturated fat Polyunsaturated fat Monounsaturated fat

Carbohydrates Proteins Cholesterol (mg) P/S ratiot

Recommended by National Cholesterol Education Program (%)

-30 <lO 510 lo-15

10-20 <300

1

Conference Menu Options

Prudent (%)

29 8

10 11 54 17

305 1.2

Less Prudent (%)

38 15 8

15 48 13

448 0.5

* Expressed as parcmtage cd dories from maamutriants. + Polyunsatwated%aturated fat ratio cakubted from grams of fat in the diet.

TABLE III Palatability and Heart Healthfulness of Food Sewed at Professional Conferences

Heart healthfulness Poor Fair Good Excellent

Taste Poor Fair Good Excellent

This Meeting % (n)

0 (0) 13(3) 74(17) 13 (3)

0 (0) 4(l)

65 (15) =(71

Other Professional Meetings % (n)

25 (6) 401)

2 (5) W)

4(l) 21(5) 71(17)

4(l)

TABLE IV Importance of Food at Any Professional Conference

% (n)

Heart healthful food

Not at all important 15(4) Somewhat important 27 (7) Important 42(11) Very important 15(4)

Good tasting food Not at all important 0 (0) Somewhat important 15(4) Important 31(8) Very important 54(14)

some foods was reduced for all meals. For example, in the salad dressing, yogurt was substituted for some of the mayonnaise anda iowerfat cream cheese was substi- tuted for regular cream cheese. Third, we offered a low fat fish and vegetable dinner in addition to the beef and au gratinpotatoes served at the evening banquet. Table Z lists the conference menu.

To assess the nutritional content of the menu, we performed a dietary analysis of 2, one-day meal patterns using the Nutri-Calc Plus0 sofnare program. Break- fart, lunch and snacks were identical. The patterns dif- fered in that the prudent dinner consisted of gn’lledfish, rice and dessert while the less prudent dinner consisted of beef tenderloin with gravy, au gratin potatoes and des- sert with whipped cream. Missing fat and cholesterol values in the database were replaced with information from a recently published nutrient database.4

112 THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 64

To assess the palatability and importance of heart- healthful fmd, we developed a survey and mailed it to the physician attendees, who were asked to rate the heart healthfulness and taste of the food served at our confer- ence and at any professional conference they had attend- ed in the past 3 years. Valid percentages, based on those physicians who responded to the question, were calculat- ed for each response.

Nutrient comparisons of the prudent and less prudent meal patterns are listed in Table ZZ. Those physicians who chose the prudent dinner option reduced their per- cent of daily calories obtainedfrom totalfat by 25% and from saturated fat by 50%. Cholesterol intake was re- duced by 43 mg, and their polyunsaturated to saturated fat ratio increasedfrom 0.5 to I .2 for the entire day. The less prudent dinner contained 1,770 calories with 47% of calories as total fat and 20% as saturated fat. The pru- dent dinner compared favorably to the diet recommend- ed by the Adult Treatment Panel of the National Choles- terol Education Program, while the less prudent option was similar to the typical American diet3J

The changes in the menu took minimal extra effort. There was no obvious increased cost for modtfying the reception, breakfast, snack or luncheon menus. However, the banquet cost (including the cost of fmd, beverages, gratuity, room rental and organizational fees) was in- creased by 4.5% due to the addition of the lower fat entree. This extra expense occurred because of our desire to maintain a “gourmet” menu while, on short notice, offering 2 entrees at the banquet.

Of the 31 physicians who received the survey, 27 (87%) returned it. Fiftv-nine percent of the respondents ate breakfast, 48% lunch, 44% the evening banquet, 30% all 3 meals and 11% did not eat any meals. The physi- cians ranged in age from 34 to 62 years (median 42). Eighty-nine percent practiced in North Carolina, 40% practiced in a specialty group, 30% in solo practice and 22% in a multispecialty group with the remainder either in industry or university affiliated.

As shown in Tables ZZZ and ZV, most physicians ac- cepted the more prudent menu and found the taste and heart healthfulness of the food served either “good’ or “excellent.” Compared to food served at other confer- ences attended in the past 3 years, most physicians rated the heart healthfulness and the taste of the food at our

conference as “good” or “excellent.” Moreover, most physicians indicated that not only palatability of the food, but the heart healthfulness of the food served at professional conferences, was “important” or “very im- portant” to them.

With minimal added effort or expense, we offered a more prudent menu at a regional cardiology conference. This menu was within the suggested guidelines of the Adult Treatment Panel for the percent of calories from saturated and monounsaturated fat and close to the guidelines for cholesterol and the ratio of polyunsaturated to saturated fat.3 According to the survey results, these efforts were accepted and appreciated.

These food options accommodate those who follow a more prudent diet and give a consistent message to at- tendees about the importance of diet in preventing coro- nary artery disease. They may improve physician percep- tion of the palatability of a prudent diet and may stimu-

late physicans to encourage their patients to adopt such a diet.6 We urge conference planners to offer lower saturat- ed fat and cholesterol food options at cardiology meet- ings.

1. Wyshak G, lamb GA, Lawrence RS, Curran WS. A profile of the health- promoting behaviors of physicians and lawyers. N Eng/ J Med 1980;303tl04-107. 2. Dismuke SE, Miller ST. Why not share the secrets of good health? The physicians’ role in health promotion. JAMA 1983;249:3181-3183. 3. The Expert Panel. Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med 198&l 48:36-69. 4. United States Department of Agriculture. Release 2, USDA Nutrient Data- base for the Individual Food Intake Survevs and Hisoanic National Health and Nutrition Examination Survey. Hyattsuilie, Mary&d: 1985. 5. Nationwide Food Consumption Survey. Continuing Survey of Food Intakes by Individuals, Report No. 85- 1 .-Hyattsuille~ Maryland:?JS Dqktment of Agricu6 ture, Human Nutrition Information Service: Nutrition Monitoring Division, 1985. 6. Kottke TE, Feels JK, Hill C, Choi T, Fenderson DA. Perceived palatability of the prudent diet: results of a dietary demonstration for physicians. Preu Med 1983:12:588-593.

THE AMERICAN JOURNAL OF CARDIOLOGY JULY 1. 1989 113