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Biomedical subjects

A Aintablian

Publications and source records attributed to A Aintablian.

At least 19 recordsLinked to original sources
PubMed1979

Atrial pacing induced left ventricular dysfunction: reversibility after aortocoronary bypass surgery.

Three patients with angina pectoris were studied before and after aortocoronary bypass surgery. Angiographic studies were performed with and without atrial pacing. Preoperative atrial pacing in all three patients resulted in angina and/or ST segment changes accompanied by regional left ventricular contractile abnormalities, decreased ejection fraction, as well as decreased left ventricular end-diastolic and stroke volumes. After surgery with all grafts patent, atrial pacing at similar heart rates did not produce an ischemic response. Left ventricular contractile pattern remained normal, and there was no change in ejection fraction though end-diastolic and stroke volumes decreased. These studies demonstrate that aortocoronary bypass surgery can abolish both the ischemic response and left ventricular dysfunction that accompany atrial pacing.

Angina Pectoris↗
PubMed1979

Late coronary bypass graft flow: quantitative assessment by roentgendensitometry.

Quantitative assessment of the flow in 45 saphenous vein aortocoronary bypass grafts in 30 patients was performed by a roentgendensitometric technique. Detalis of the technique are given. Mean graft flow for all grafts measured in the early postoperative period (two weeks) and again in the late postoperative period (six months to 3 years; average, 1.5 years) significantly decreased (72.6 +/- 34.7 to 57.4 +/- 28.6 ml/min; p less than 0.01). Mean graft diameter also significantly decreased over the same period (3.5 +/- 0.6 to 3.0 +/- 0.6 mm; p less than 0.01). Differences could not be related to graft site or to the time interval between early and late recatheterization. Changes in diameter did not correlate with changes in flow. During a 3-year follow-up, saphenous vein grafts significantly decreased in diameter and flow but still functioned adequately; and vein grafts generally remained larger than the recipient arteries. The determinant of adequacy of flow is the native coronary bed.

Absorptiometry, Photon↗
PubMed1979

Echocardiographic findings of posterior wall false aneurysm: case report and review of the literature.

A case of angiographically proven posterolateral left ventricular false aneurysm is presented. The patient underwent successful surgery. The echocardiogram revealed large echo-free spaces behind the posterior wall of the left ventricle, delineated by pericardial echoes and lined internally by extra echoes. These echocardiographic findings are consistent with false aneurysm containing a clot. This report indicates that in patients with previous infarction and distorted cardiac silhouette, echo-cardiography may be helpful in the diagnosis of true or false ventricular aneurysm.

Aged↗
PubMed1978

Unusual complications of coronary bypass surgery.

Five patients after coronary bypass surgery developed unusual complications. Three developed new apical thrombi which are thought to be due to the trauma of the left ventricular vent or deterioration of the left ventricular contraction. Significant new mitral regurgitation in one patient probably is secondary to papillary muscle dysfunction as the result of stenosis distal to anastomoses. The leakage of angoigraphic material around distal anastomatic site is due to technical error. Although these unusual complications are very rare, however, they should be considered as potential source of morbidity in asymptomatic patients who leave the hospital after bypass surgery.

Adult↗
PubMed1978

Significance of new Q waves after bypass grafting: correlations between graft patency, ventriculogram, and surgical venting technique.

New postoperative electrocardiographic Q waves have been described in eight of 40 per cent of patients undergoing bypass grafting for coronary artery disease. Various theories have been proposed to explain these new Q waves. Correlations of new Q waves to vein bypass occlusion, prolonged pump time or aortic cross-clamping time are controversial. Indeed, whether or not the appearance of new postoperative Q waves means real transmural myocardial infarction is not clear. We report herein our experience with postoperative Q waves in 56 patients with vein bypass grafts and the relationship of new Q waves to ventricular venting, graft patency, and the postoperative ventriculogram. Our observations indicate that: (1) Not all Q waves are due to occlusion of the saphenous bypass grafts (as noted by others). (2) A certain percentage of new Q waves may not reflect true transmural myocardial infarction, especially when all the vein grafts are patent and the postoperative ventriculograms show improvement. (3) Some new Q waves reflect true transmural infarction due to occlusion of grafts or of distal coronary arteries with deteriorated left ventriculograms. (4) The high incidence of new Q waves in patients with ventricular vents is probably due to direct myocardial trauma at the apex of the left ventricle.

Adult↗
PubMed1978

Results of aortocoronary bypass grafting in patients with subendocardial infarction: late follow-up.

Twenty-eight patients with subendocardial infarction (Group A) were compared with 28 patients with unstable angina (Group B) and 28 with stable angina (Group C) matched for age and sex. The three groups did not differ in prevalence of diabetes, hypertension, old infarction or duration of disease. There were no significant differences in number of diseased vessels, coronary score, abnormal left ventricular wall motion or left ventricular end-diastolic pressure. Angiograms performed 2 weeks postoperatively revealed closure of 3 of 31 grafts (16 patients) in Group A, closure of 3 of 34 grafts (17 patients) in Group B and closure of 6 of 50 grafts (22 patients) in Group C (differences not significant). Postoperative angiograms showed improved wall motion in 37 percent of Group A, 53 percent of Group B and 36 percent of Group C (differences not significant). Postoperative new Q waves appeared in one hospital in Group A and in two patients in Groups B and C. There were no hospital or late deaths. In a mean follow-up period of 29 months, 68 percent of patients in Group A, 61 percent in Group B and 54 percent in Group C were asymptomatic. Thus, bypass grafting was performed with similarly low mortality and morbidity in patients with subendocardial infarction and in those with angina; more than one third of postoperative angiograms in the three groups showed improved wall motion; and late follow-up studies demonstrated functional improvement in the majority of patients in all three groups.

Angina Pectoris↗
PubMed1978

Renal arteriovenous fistula masquerading as severe valvar heart disease.

Two patients with renal arteriovenous fistulae are described, who presented in high output failure. Murmurs were detected in these patients on routine physical examination years before, and when cardiac failure ensued they were assumed to have decompensated valvar heart disease. Full investigation revealed the arteriovenous fistulae and both patients made a good recovery after surgical ligation.

Aged↗
PubMed1978

Survival after coronary surgery.

A 4.4 year follow-up study has been done on a previously reported group of 200 consecutive patients who underwnet coronary bypass. The yearly mortality rate has been 1% (8/200 in 4 years). Our total group of 1,038 surgically treated patients has had an operative mortality rate of 1.3%, and an early graft patency rate of 89.6% has been recorded in the 60% of patients consenting to restudy. These results are compared to natural history studies with and without angiography. Comparison with recent prospective randomized studies of patients with chronic stable angina and those with unstable angina suggests that a low operative mortality rate and optimal technical performance are necessary to improve the survival rate of patiens with symptomatic obstructive coronary disease.

Adult↗
PubMed1977

Effects of contrast medium on left ventricular pressure and volume with emphasis on coronary artery disease.

Forty-one patients had left ventricular angiography repeated 3 minutes after an initial study in order to evaluate the effect of angiographic contrast medium on left ventricular end-diastolic pressure (EDP) and volume (EDV). Seven patients had no evidence of heart disease (normal group) and 34 patients had coronary artery disease. Single-vessel diseae was present in 10, double-vessel disease in 10, and triple-vessel disease in 14 patients. Seven other patients with radiopague epicardial clips previously attached to the left ventricle underwent cinefluorographic studies to determine end-diastolic intraclip distance at various intervals after a left ventricular angiogram. In all the groups studied there was a significant increase (p less than 0.005) in both the left ventricular EPD and EDV in the second angiographic study as compared to the first. This increase in EDV (deltaV) was similar in all groups. However, the increase in EDP (deltaP) was significantly greater (p less than 0.01) in patients with double- and triple-vessel disease as compared to the normal and single-vessel disease groups. Ejection fraction, per cent shortening of the heart axis, and contractile pattern in the normal subjects were not singnificantly different when the second angiographic study was compared to the first. In nine of 34 patients with coronary artery disease the second angiographic study demonstrated impairment in left ventricular contractile pattern not present in the first angiographic study. Cinefluorographic study demonstrated an increase in end-diastolic intraclip distance after the left ventricular angiogram. The change in intraclip distance corresponded directionally and temporally to the changes in left ventricular EDP. The present study revealed that the increase in left ventricular end-diastolic press-re associated with the injection of angiographic contrast medium can be explained by an increase in EDV and that such changes last for over 15 minutes and may be associated with alterations in the contractile pattern of the left ventricle.

Adult↗
PubMed1977

Comparative study of the postoperative flow in the saphenous vein and internal mammary artery bypass grafts.

Postoperative coronary bypass flow was evaluated in two groups of randomly selected patients with grafts to the left anterior descending artery (LAD). Saphenous vein bypass grafts were placed in 27 patients and internal mammary artery grafts in 25 patients. Postoperative flow studies were performed in both groups with roentgendensitometric methods based on the transit time of radiopaque media along the graft plus the mean graft diameter. There was no significant difference between the two groups of patients for age, duration of symptoms, or the frequency of hypertension, diabetes mellitus, prior myocardial infarction, or cardiomegaly. Intraoperative bypass flows were 75+/-27 and 77+/-24 ml. per minute for the saphenous vein group (SVG) and internal mammary artery group (IMAG), respectively. There was no significant difference in the heart rate or mean aortic pressure at the time of the roentgendensitometric flow study. The mean graft diameters were 3.0+/-0.5 and 1.9+/-0.3 mm. for the SVG and IMAG, respectively (p less than 0.001). The ratios of graft diameter to LAD diameter were 1.9+/-0.3 and 1.2+/-0.2 for the SVG and IMAG, respectively (p less than 0.001). The roentgendensitometric postoperative flows were 68+/-27 ml. per minute in the SVG and 46+/-16 ml. per minute in the IMAG (p less than 0.01). The present study indicates that flow in significantly higher in saphenous vein than in internal mammary artery bypasses and that the difference in flow may in part be explained on the basis of the graft diameter.

Angina Pectoris↗
PubMed1977

Isolated aortic valve stenosis in the eighth decade.

Aortic valve stenosis was evaluated in 26 patients in the eighth decade of life, representing 20% of all patients referred for aortic valve stenosis. There were no clinical features which distinguished this older group from younger patients. Coronary artery disease was present in 46% of the older group, 30% in the younger. Angina pectoris or an infarction pattern on the electrocardiogram was not useful in predicting coronary artery disease in either group. A dominant left coronary circulation was more frequent (22%) in the younger than the older group. This was related to the higher incidence of congenitally deformed aortic valves (55%) found in the younger, compared in the advanced age group (5%). The surgical mortality in the younger and advanced age group was 8 and 20%, respectively. Mortality in both groups was related in more than half the patients to coronary artery disease.

Age Factors↗
PubMed1976

Reappraisal of the functional significance of the coronary collateral circulation.

A review of data in 465 patients with complete obstruction of either the left anterior descending or right coronary artery was undertaken to evaluate the functional role of the collateral circulation. Complete obstruction of a dominant right coronary artery was observed in 288 patients, 83 percent with distal filling and visualization of the posterior descending artery by way of collateral vessels. Complete obstruction of the left anterior descending artery was noted in 177 patients, 71 percent with filling and visualization distal to the obstruction by way of collateral vessels. Among patients with obstruction of the left anterior descending artery, there was a significantly greater frequency of congestive heart failure and cardiomegaly in those without collateral vessels than in those with collateral vessels. The former also had a significantly greater frequency of both electrocardiographic evidence of an anterior wall myocardial infarction and angiographic findings of anterior wall asynergy. The frequency of inferior myocardial infarction and inferior wall asynergy was not influenced by the presence of collateral vessels. These observations indicate that the collateral circulation plays a significant protective role in the presence of obstruction of the left anterior descending artery, which is not apparent with obstruction of the right coronary artery.

Adult↗