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Biomedical subjects

A Appelbaum

Publications and source records attributed to A Appelbaum.

At least 37 records · Page 2Linked to original sources
PubMed1986

Exercise performance in patients with impaired left ventricular function following aorto coronary bypass.

We studied 40 patients with preoperative ejection fraction (EF) of 0.35 or less who underwent aortocoronary bypass. An average of 3.1 saphenous vein grafts per patient were inserted and revascularization was considered complete in 33 (82%) of the subjects in the group. Mean follow-up period was 29 months (range 12-65 months). Early mortality was 5% (2 patients) and there were 7 late deaths (3 cardiac and 4 non-cardiac). The 5-year cardiac actuarial survival rate was 74 +/- 13% (+/- SEM). Angina has improved in 29 (94%) of the 31 long-term survivors with 23 (74%) being totally asymptomatic. Twenty-two of the long-term survivors performed an exercise test at the end of their follow-up period. These tests revealed that bypass surgery in such patients results in significantly enhanced myocardial oxygen consumption with concomitant increase in effort level and duration. The exercise ability is probably directly related to the degree of revascularization.

Adult↗
PubMed1986

Emergency coronary artery bypass for acute myocardial ischemia following percutaneous transluminal coronary angioplasty.

Acute myocardial ischemia is a serious complication of percutaneous transluminal coronary angioplasty (PTCA). Between September 1981 and September 1985, 240 patients underwent 260 PTCAs at the Hadassah University Hospital. Thirteen patients (5%) developed signs of acute ischemia during or immediately after the procedure. In 10 patients (4.2%) emergency coronary artery bypass grafting was performed. The left anterior descending artery in nine cases and the right coronary artery in one case were occluded. In eight patients intraaortic balloon counterpulsation (IAB) was begun prior to surgery. On the average 1.8 grafts per patient were performed. Two patients who were transferred to surgery while being resuscitated died from myocardial rupture, one during surgery and the other 4 days postoperatively. Perioperative infarction rate was 50% (5/10). Six patients are angina-free 3 to 46 months postoperatively. Better patient selection, performance by an experienced team, early use of IAB, and immediate surgery might reduce the current periprocedure morbidity and mortality rate of PTCA.

Adult↗
PubMed1985

Pericardial meshing: a new technique to facilitate primary tension-free pericardial closure.

A method is described to facilitate pericardial approximation at the conclusion of open-heart surgical procedures. Before sternal closure, the anterior pericardium is meshed by multiple longitudinal incisions until tension-free closure is possible. The technique was developed by animal experimentation and is now being performed in patients. It has proven to be simple, safe, and effective.

Animals↗
PubMed1985

Symptomatic sinus bradycardia in infants with structurally normal hearts.

Sixteen infants, ages 6 weeks to 23 months, were evaluated because of syncopal attacks (n = 6), apneic episodes (n = 3), or a combination of syncope, apnea, or "convulsions" (n = 7). Comprehensive metabolic and neurologic investigations yielded negative results in 15 infants; in one, an abnormal EEG was recorded. Severe sinus bradycardia, complete sinus arrest, junctional escape rhythm, or ventricular escape rhythm was found in four patients, and permanent multiprogrammable pacemakers were implanted. Follow-up for 6 to 24 months with ventricular demand pacing showed complete cessation of attacks in two infants and marked improvement in two.

Apnea↗
PubMed1985

Pericardial meshing: an effective method for prevention of pericardial adhesions and epicardial reaction after cardiac operations.

Cardiac reoperations, particularly for coronary revascularization, are becoming more frequent and carry increased risk of damage to the heart during resternotomy. We experimentally evaluated a pericardial meshing technique to facilitate primary pericardial closure. In 18 mongrel dogs, an 8 by 5 cm pericardial flap was fashioned through a left thoracotomy. A standardized procedure for induction of pericardial adhesions was carried out in all animals. Animals were divided into three groups of six animals each: Group I (control)--the pericardial flap was primarily resutured; Group II--the flap was meshed and then resutured; and Group III--the flap was replaced by a pericardial substitute. Animals were put to death 8 weeks postoperatively and the pericardial space was examined for adhesions and epicardial reaction. The extent of adhesions and epicardial reaction was graded as: 0--none; 1--minimal; 2--moderate; and 3--severe. Both in Group I and Group III severe pericardial adhesions (grade 2-3) and epicardial reactions (grade 2-3) were formed, which obscured the underlying coronary anatomy. In Group II pericardial adhesions and epicardial reactions were none to minimal (grade 0-1) and the underlying coronary anatomy was not obscured. The meshed pericardium was completely regenerated by normal pericardium within several weeks. This study demonstrates that pericardial meshing facilitates primary tension-free pericardial closure. Free drainage of intrapericardial blood is achieved. A complete anatomic layer between heart and sternum is restored. Pericardial meshing is superior to the pericardial substitutes examined, as adhesions and epicardial reactions are significantly reduced, and the coronary anatomy is readily identifiable.

Animals↗
PubMed1983

Infective endocarditis in Jerusalem. A comparative analysis of native and prosthetic valve endocarditis.

Thirty patients with prosthetic valve endocarditis (PVE) and 62 patients with native valve endocarditis (NVE) observed during a concurrent period of time (1970-80) were analyzed. Patients with PVE were also compared with 697 patients who underwent cardiac valve replacement in the same period, in an attempt to uncover risk factors for PVE. In the operated patients the overall incidence of endocarditis was 4.3%. There were several significant differences between the NVE and PVE groups. Atrial fibrillation was more prevalent in the PVE group (33.4 vs. 11.5%, P less than 0.05), while infection with gram-positive organisms was more prevalent in the NVE patients (79 vs. 47%, P less than 0.01). The outcome of combined medical and surgical treatment showed a much higher mortality rate (50 vs. 6.4%, P less than 0.01) in the PVE group. Staphylococcal endocarditis resulted in 16% mortality in NVE vs. 100% in the PVE group (P less than 0.01). Careful surveillance may hopefully lead to early detection, treatment and better outcome of PVE.

Adolescent↗
PubMed1982

Hypothesis: new concepts on the pathogenesis of early prosthetic valve endocarditis.

During the years 1970-1980, 697 patients had valve replacement surgery at our institution. Thirty patients subsequently developed prosthetic valve endocarditis (P.V.E.). Reexamination of the native valves of 25 of these patients revealed histopathological evidence of thromboendocarditis in 7, 5 of whom subsequently developed early P.V.E. In 3 out of 25 matched controls in whom P.V.E. was not diagnosed clinically, similar pathological findings were found; these patients all had fever pre- or post-operatively and were treated with a short antibacterial course, but no definite clinical diagnosis was made. We suggest that there is a close relationship between subclinical thromboendocarditis on the native valve and the early development of infective endocarditis on the implanted artificial valve.

Endocarditis, Bacterial↗
PubMed1981

Cardiac rupture and ventricular septal defect in isolated right coronary artery disease.

A patient is described who had both ventricular septal defect and then cardiac rupture with death within 24 hours of the onset of acute posteroinferior myocardial infarction. At autopsy he was found to have single-vessel disease involving the right coronary artery. Isolated disease of the right coronary artery can produce unexpected, fatal mechanical complications.

Aged↗
PubMed1981

Protective effect of hydrocortisone on the myocardium during anoxic arrest.

The protective effect of hydrocortisone on the myocardium during anoxic arrest was investigated in nonworking, isolated rat heart preparations subjected to cardioplegia. In control preparations (no cardioplegia) there was no inotropic effect of hydrocortisone. After both 60 and 120 min of anoxic arrest, recovery of contractility in hearts treated with cardioplegia and hydrocortisone was significantly better than that of hearts treated with cardioplegia only--98 vs. 85%, respectively, at 60 min, and 100 vs. 87% at 120 min. The addition of hydrocortisone to cardioplegia solution apparently results in better protection of the myocardium during anoxic arrest.

Animals↗
PubMed1980

Cardiac contusion in the patient with multiple injuries.

We have treated 20 patients with multiple injuries and concomitant myocardial contusion. The diagnosis of myocardial contusion was based mainly on serial ECG tracings which showed arrhythmias, dynamic ischaemic patterns or conduction disturbances. The clinical and laboratory findings of cardiac contusion are sometimes indistinguishable from those found in multiple injuries. Furthermore, they are overshadowed by the overt manifestation of cerebral, thoraco-abdominal and skeletal injuries. Awareness and prompt diagnostic measures are essential in the diagnosis of cardiac injury. Strict cardiac monitoring following multiple trauma will prevent serious or even fatal outcome of cardiac injury.

Accidents, Traffic↗
PubMed1980

Early calcification and obstruction of a mitral porcine bioprosthesis.

A patient is described in whom severe prosthetic valvular stenosis developed ten months after mitral valve replacement with an Angell-Shiley porcine heterograft. At emergency operation, calcification of the prosthesis was revealed. Early calcification and stenosis of a porcine heterograft valve is a life-threatening complication that must be recognized promptly and treated by emergency valve replacement.

Adolescent↗
PubMed1980

Afterload reduction and cardiac output in patients after mitral valve surgery.

Thirteen patients who had mitral valve surgery were studied within 3 hours after operation. The patients were divided into 2 groups: group A with initial low cardiac index (1.70 +/- 0.25), elevated left atrial pressure (16.5 +/- 6.7) and high peripheral vascular resistance (2623 +/- 789); group B with initial normal cardiac index (3.71 +/- 0.54), normal left atrial pressure (13 +/- 3.5) and normal peripheral vascular resistance (1223 +/- 303). In both groups the mean arterial pressure was elevated (98 +/- 8.8, 96 +/0 15.8). An infusion of nitroprusside to reduce the mean arterial pressure to either 80 mmHg or 10% below the initial value had different effects in each group. In group A, cardiac index (CI) increased by 23%, left atrial pressure (LAP) decreased by 20%, pulmonary artery pressure (PAP) by 35%, and peripheral vascular resistance (PRV) by 32%. In group B, CI decreased by 8%, LAP by 32%, PAP by 30% and PVR by 13%. When LAP returned to initial values after an infusion of blood with continued infusion of nitroprusside, CI increased in both groups (27%, 11%) and the PVR remained lower (40%, 29%). The study demonstrates the favorable effect on cardiac output of vasodilator therapy on patients with elevated blood pressure, impaired by left ventricular function and high LAP, after surgery on mitral valve. The optimal effect is achieved by keeping the LAP within normal limits.

Adolescent↗
PubMed1979

A new method of sternal reclosure.

A new method is described for stabilizing dehiscence or instability of median sternotomy incisions using stainless steel retention sutures. The method has been used successfully in patients who had disruption of the sternum following open-heart surgery and resulted in no complications. It is recommended also as a preventive measure for closure of the sternum in elderly, debilitated patients with a fragile sternum and with prolonged low cardiac output after operation.

Aged↗