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Biomedical subjects

A A Klein

Publications and source records attributed to A A Klein.

29 records · Page 2Linked to original sources
PubMed1981

Acute effects of vasodilators on left-to-right shunts in infants and children.

Based on the favorable experience with vasodilator therapy in adult heart disease and the results of acute dogs experiments, we undertook the hemodynamic evaluation of hydralazine and phentolamine during diagnostic cardiac catheterization. We studied seven infants and children with left-to-right (leads to R) shunts at atrial, ventricular, or ductal levels to determine whether vasodilator therapy might be useful in the treatment of infants with congestive heart failure (CHF) due to large L leads to R shunts. Shunts, flows, and resistances were measured by the indicator dilution and Fick techniques before and after administration of the drug. At a dose sufficient to produce an effect, the shunt flow increased after each drug. There is no evidence from studies at cardiac catheterization of therapeutic efficacy for vasodilators in the treatment of CHF due to cardiac L leads to R shunts.

Child↗
PubMed1979

Atrial myxoma mimicking a collagen disorder.

A 14-year-old boy had a protracted illness characterized by bilateral tenderness and weakness of the extremities; the illness was considered to be a connective tissue disease similar to polymyositis. Not until nine months later, when the patient had new cardiac murmurs, pulmonary edema, and then a cerebrovascular accident, was the true nature of his illness suspected. The diagnosis of left atrial myxoma with the triad of constitutional, obstructive, and embolic effects was confirmed by echocardiographic studies and cardiac catheterization. The tumor was successfully removed.

Adolescent↗
PubMed1977

Intracardiac conduction intervals in children with congenital heart disease: comparison of His bundle studies in 41 normal children and 307 patients with congenital cardiac defects.

His bundle electrograms were recorded in 348 patients aged 2 months to 24 years following routine diagnostic cardiac catheterization. Among 41 children found to be free of anatomic or hemodynamic abnormality the following mean values were obtained: P-H interval, 93.4 +/- 15.3 msec; P-A time, 21.2 +/- 7.1 msec; A-H interval, 72.2 +/- 15.9 msec; and H-V interval, 39.8 +/- 5.2 msec. The remaining 307 patients were analyzed by diagnosis of congenital heart disease. The mean P-H interval was found to be significantly increased in both ostium primum and secundum atrial septal defect (ASD) with A-H prolongation in primum ASD and P-A prolongation in secundum ASD. The mean H-V interval was significantly prolonged in ostium primum ASD and in patients with severe aortic stenosis, aortic insufficiency. and mitral regurgitation. Grouping of the patients physiologically revealed that patients with moderate-to-severe right ventricular volume overload had P-H prolongation, and patients with severe left ventricular volume or pressure overload had H-V prolongation. The clinical implications of these findings are discussed.

Adolescent↗
PubMed1976

The postpericardiotomy and similar syndromes.

A syndrome of pericardial and often pleural reaction with effusions and with fever occurs in three different settings. It bears the descriptive term of the condition which it follows: the postpericardiotomy syndrome, the postmyocardial infarction syndrome, and the postpericardial trauma syndrome. The manifestations, incidence, theories of etiology, treatment, and possibility of prevention were discussed. The syndrome is probably due to an immunologic response with an associated viral illness, since in a prospective study of children undergoing cardiac surgery in which the pericardium was entered, we found that the development of heart-reactive antibody in high titer and a significant rise in antiviral antibody occurred in patients with clinically evident syndrome.

Adolescent↗
PubMedDate not supplied

Incidence and risk factors for mitral valve prolapse in severe adolescent idiopathic scoliosis.

Mitral valve prolapse (MVP) is known to be associated with thoracic skeletal anomalies. To determine the incidence and risk factors for mitral valve prolapse in the adolescent population with severe idiopathic scoliosis (IS), a prospective follow-up study on 139 adolescent patients with IS from the Pediatric Orthopedic Service was undertaken. Data collected included age, sex, medical and family history, physical exam, electrocardiogram and echocardiogram, spinal x-rays, and pulmonary function tests. MVP was detected by echocardiogram in 13.6% (19/139) of patients with IS as compared with 3.2% in 154 age- and weight-matched controls (p < 0.006). All patients with MVP were asymptomatic and a systolic click or murmur was detected on the single preoperative exam only in 37% (7/19) of them. Patients with MVP and IS weighed less (45.1 +/- 2.0 vs 51.8 +/- 0.1 kg, p < 0.002) as compared with those IS patients without MVP. The electrocardiogram was abnormal in 21% (4/19) of patients with MVP as compared with only 1.6% (2/120) of patients with IS but no MVP. The two groups did not differ with respect to age at diagnosis, severity of scoliosis, positive family history of scoliosis, or the presence of restrictive lung disease. Though IS was more prevalent in females (79%), the presence of MVP was not related to gender. MVP was persistent in 10 of the 19 patients reevaluated by echocardiogram 2-4 years after spinal surgery. We conclude that MVP is four times more common in patients with severe IS than in the normal adolescent population, and is associated with a lower body weight in IS patients with MVP than in IS patients without MVP. The persistent nature of MVP, even after corrective spinal surgery, may be related to factors other than geometric changes of the heart caused by abnormal thoracic curvature.

Adolescent↗
PubMedDate not supplied

Blood pressure, heart rate, and plasma catecholamines in normal and hypertensive children and their siblings at rest and after standing.

Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), plasma norepinephrine (NE), and epinephrine (E) levels at rest and in response to orthostatic stress of quiet standing were compared in 19 subjects with borderline hypertension (BH) (SBP-135 mm Hg, DBP-80 mm Hg), nine with significant hypertension (SH) (SBP-150 mm Hg, DBP-95 mm Hg), 14 normotensive siblings (NS) of hypertensives (SBP-113 mm Hg, DBP-64 mm Hg), and 21 age-matched normotensive controls (NC) (SBP-116 mm Hg, DBP-61 mm Hg). Group resting plasma NE levels were significantly higher in BH (454 pg/ml, p less than 0.001 pg/ml) and SH (384 pg/ml, p less than 0.01 pg/ml) than in NC (281 pg/ml) or NS (309 pg/ml), and more than 2 SD above the NC mean value in 50% of BH, 28% of SH, and 7% of NS. Plasma E levels were similar. On standing, mean arterial pressure (MAP) rose 13.7 mm Hg in NC, 3.9 mm Hg in BH, and 2.8 mm Hg in NS, and fell 7.3 mm Hg in SH. These differences reflect the frequent occurrence of hypotensive responses in study group subjects, which were not observed in NC. The mean rise in plasma NE with standing was blunted in hypertensives, increasing 40% to 50% compared with 95% in NC. In BH and NS, SBP was positively correlated with plasma NE levels at rest and with standing. These observations offer support for the hypothesis that altered adrenergic sympathetic nervous system (SNS) activity is present in a subgroup of young hypertensives and can be a contributing factor to their hypertension. Findings of similar SNS activity in some normotensive siblings suggest that genetic factors might be involved.

Adolescent↗