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Biomedical subjects

A D Hagan

Publications and source records attributed to A D Hagan.

At least 37 records · Page 2Linked to original sources
PubMed1981

M-mode and cross-sectional echocardiographic diagnosis of right ventricular cavity masses.

Two patients with metastatic carcinoma (one cervical and one testicular) in whom echocardiography was instrumental in diagnosing a right ventricular cavity mass are presented. In first case the M-mode echocardiogram revealed dense echoes in the right ventricle and right ventricular outflow tract during systole and diastole. Surgical confirmation of the mass lesion was obtained. The second case also revealed abnormal echoes in the right ventricle and right ventricular outflow tract, but they were less dense and distinct. Two-dimensional echocardiography clearly delineated a highly mobile mass of tissue in the right ventricle which corresponded to the necropsy findings.

Adult↗
PubMed1981

Two-dimensional echocardiographic evaluation of discrete subaortic stenosis from the apical long axis view.

M-mode standard two-dimensional (2DE) left parasternal long axis echocardiographic examination of the left ventricular outflow tract (LVOT) was evaluated exclusively with respect to its utility in identifying discrete subaortic stenosis (SUB-AS). Important details of the anatomy of the subaortic area may also be obtained from 2DE apical long axis imaging. According, 18 patients with discrete SUB-AS were prospectively evaluated by M-mode and 2DE. The M-mode findings included narrowing of the LVOT and early systolic closure of the aortic valve. However, these findings were variable and highly dependent upon scan speed, fluid flow dynamics, and beam angulation. 2DE findings varied using the standard long axis view at the left parasternal border, depending upon the type of obstruction present. A discrete membrane produced linear echoes adjacent and parallel to the interventricular septum beneath the aortic valve. Fibromuscular obstruction produced a localized dense ridge of echoes in the LVOT. These findings were not apparent in five patients studied. In these patients, the 2DE apical long axis view was employed to image the subaortic area. From this tomographic corss-section a fibrous membrane was imaged as a linear echo parallel to the aortic valve. The membrane extended across the LVOT from the ventricular septum to the anterior leaflet of the mitral valve. The 2DE apical long axis view therefore provides an additional approach in the evaluation of patients with discrete SUB-AS.

Adolescent↗
PubMed1981

Clinical correlates in hypertensive patients with left ventricular hypertrophy diagnosed with echocardiography.

Seventy-three hypertensive patients were evaluated with M mode and two dimensional echocardiography. Left ventricular hypertrophy was found in 37 patients (51 percent); 29 had concentric hypertrophy and the remaining 8 had disproportionate septal thickening. Factors that did not influence the distribution of patients in the group with left ventricular hypertrophy and normal subjects included (1) duration of hypertension, (2) level of blood pressure, (3) age, (4) body surface area, and (5) race. More of the patients who had a normal left ventricular mass (32 or 89 percent) than of those who had hypertrophy (22 or 59 percent) were receiving two or more antihypertensive drugs. Electrocardiography was very insensitive in identifying left ventricular hypertrophy in these patients. The presence of increased left ventricular mass was associated with a greater incidence of other target organ disease.

Adrenergic beta-Antagonists↗
PubMed1981

Coronary artery disease and ventricular function in angina.

Coronary arteriograms and left ventriculograms of 500 patients with coronary artery disease and angina pectoris were correlated with respect to coronary arterial pattern and left ventricular dyssynergy. We found that the severity of left ventricular dyssynergy was not altered by coronary arterial pattern. The concept of dividing the left ventricle into anterior and posterior zones was validated. Patients with anterior dyssynergy alone or combined anterior and posterior dyssynergy had comparably more severe coronary artery disease in the anterior region than did patients with normal left ventriculograms or posterior dyssynergy alone. Patients with posterior dyssynergy alone or combined anterior anterior and posterior dyssynergy had comparably more severe coronary artery disease in the posterior region than did patients with normal left ventriculograms or anterior dyssynergy alone. Lesions of greater than 90% reduction of coronary arterial luminal diameter best correlated with motion abnormalities of the left ventricular wall.

Angina Pectoris↗
PubMed1981

Correlation of regional myocardial blood flow and function with myocardial infarct size during acute myocardial ischemia in the conscious pig.

Regional myocardial function and blood flow were determined for 48 hours after permanent occlusion of the left circumflex coronary artery in conscious swine. Systolic wall thickening and end-diastolic wall thickness (EDWTh) were correlated with regional myocardial flow (RMBF) at 15 minutes, 24 and 48 hours after occlusion. Both regional function and blood flow were compared with the extent of myocardial necrosis (determined histologically) after 48 hours in functionally distinct zones. Group 1 (control zones) was characterized by increased systolic wall thickening, EDWTh, RMBF and had no necrosis. Group 2 (marginal zones) had depressed systolic wall thickening (35 +/- 3% [mean +/ SEM] of preocclusion level at 48 hours) and RMBF (64 +/- 6% of preocclusion values), transiently decreased EDWTh and 46 +/- 5% necrosis. In Group 3 (ischemic zones), all values were greatly reduced: systolic wall thickening was 3.6 +/- 1.2%, EDWTh 76 +/- 8% and RMBF 25 +/- 9% preocclusion values; necrosis was 90 +/- 5%. Groups 2 and 3 had increased RMBF at 24 and 48 hours from that at 15 minutes after occlusion; however, in neither case was systolic wall thickening greater than that at 15 minutes after occlusion. We conclude that there is close correlation between RMBF, systolic wall thickening and the extent of necrosis present after 48 hours of coronary artery occlusion in the conscious swine; subsequent increases in RMBF to the marginal zone after occlusion are not accompanied by improved regional function.

Animals↗
PubMed1980

The distribution and severity of coronary artery disease and left ventricular dysfunction among patients with single coronary artery disease and angina pectoris.

The distribution and severity of coronary artery disease and left ventricular dysfunction were evaluated in 103 patients with single coronary artery disease and angina pectoris. The coronary arterial patterns were separated into right (76), mixed (18), and left (9) systems depending upon the blood supply to the inferior surface of the left ventricle. The following relationships were noted: (1) In patients with single coronary artery disease and angina pectoris, coronary arterial lesions are similar among right, mixed, and left systems. (2) In order of frequency, single coronary artery disease occurred most commonly in the left anterior descending coronary artery (55), next most commonly in the right coronary artery (36), and least commonly in the circumflex/obtuse marginal coronary artery (12). (3) Left ventricular wall motion abnormalities were seen in descending order of frequency: patients with right coronary artery (50%), left anterior descending coronary artery (36%), and circumflex/obtuse marginal coronary artery (25%) disease.

Adult↗
PubMed1980

Coronary arterial and left ventriculographic findings in patients with double-vessel disease and angina pectoris.

The distribution and severity of coronary artery disease and left ventricular wall abnormalities are described in 119 patients with double-vessel disease and angina pectoris. The coronary arterial patterns were divided into right (84), mixed (17), and left (18) systems, depending upon the blood supply to the inferior surface of the left ventricle. Patterns of double-vessel disease were separated into those with 50% or greater reduction of luminal diameter involving the left anterior descending and circumflex/obtuse marginal arteries (2-LC), circumflex/obtuse marginal and right coronary arteries (2-CR), and left anterior descending and right coronary arteries (2-LR). The following relationships were noted. (1) Left anterior descending and right coronary artery disease occurs with twice the frequency of 2-LC or 2-CR disease, supporting the thesis that of the three major coronary arteries, the circumflex/obtuse marginal arteries contribute least to angina pectoris. (2) The mid portion of the left anterior descending artery is most commonly involved and the left main coronary artery least commonly involved in patients with double-vessel disease. (3) Left ventricular wall motion abnormalities are found in one-half of patients with double-vessel disease and angina pectoris with hypokinesis usually found in all areas except at the apex where dyskinesis is usually seen.

Angina Pectoris↗
PubMed1980

"Pseudo-tumor" of the right ventricular outflow tract and congenital pulmonary valve regurgitation: a case report.

The M-mode and 2-D echocardiographic features of an unusual case of a "pseudo-tumor" of the right ventricular outflow tract are reported. The unique pathologic findings of the pulmonary valve with congenital fenestrations and the clinical implications of this "pseudo-tumor" are discussed. Whenever calcification is noted at fluoroscopy to exist in a region or structure being evaluated by echocardiography, caution must be taken to avoid overestimating the size. Indistinct, dense reflectances without specific motion or appearance of a mass further helps to distinguish the reflectances from an actual structure of significance. Furthermore, all clinical, angiographic, and echocardiographic information must be interpreted together when either the angiogram or the echocardiogram is confusing and potentially misleading.

Adult↗
PubMed1980

Semiautomated method for evaluation of left ventricular regional wall motion in coronary artery disease.

Regional left ventricular wall motion was independently assessed in 436 patients using both subjective visual inspection of ventriculograms and objective computer-determined percent change in the square root of the area between systolic and diastolic outlines. Agreement between subjective and objective techniques was greatest at the ventricular apex and least at the base and partly dependent on the number of abnormal segments present. Objective analysis of regional wall motion provides a permanent quantitative record of wall motion and shows good agreement with meticulous subjective inspection of ventriculograms. As such, it has potential as an adjunct to ventriculography.

Coronary Disease↗
PubMed1979

Distribution and severity of coronary artery disease in 500 patients with angina pectoris.

The distribution and severity of coronary disease in 500 patients with angina pectoris and at least one area of 50% or greater reduction of luminal diameter in a major coronary artery were compared with respect to patients' age and coronary arterial pattern. The coronary arterial patterns were separated into right (360 patients), mixed (89 patients), and left (51 patients) systems, depending upon the blood supply to the inferior surface of the left ventricle. The following relationships were noted: 1) In patients with angina pectoris, the distribution and severity of coronary artery disease is similar from the third to eighth decade. 2) Coronary arterial stenoses of 50-70% of greater reduction of luminal diameter involve most frequently the proximal portion of the major vessels. Coronary artery disease is multivessel in nature in 80% of cases. In single vessel disease the left anterior descending artery is involved most frequently. 3) The left main coronary artery is moderately to severely obstructed less frequently in individuals with left (2%) as compared to right (8%) and mixed (10%) systems. Otherwise, the distribution of coronary artery disease is similar in right, mixed, and left systems. 4) Coronary artery disease is a diffuse rather than a focal process. As demonstrated by coronary arteriography, patients with coronary artery disease have smaller vessels throughout the arterial tree as compared with individuals free of evident coronary atherosclerosis.

Adult↗
PubMed1979

Two dimensional echocardiographic characteristics of double outlet right ventricle.

The reliability was evaluated of two dimensional echocardiography in distinguishing double outlet right ventricle from other anomalies of the great arteries. Accordingly, a combined retrospective and prospective study was conducted in 13 children with double outlet right ventricle, 12 with tetralogy of Fallot, 13 with complete d-transposition of the great arteries, 5 with congenitally corrected I-transposition and 2 with truncus arteriosus. Echographic findings using a standard long axis view in all subjects with double outlet right ventricle included (1) inability to identify a great artery arising from the left ventricle, and (2) lack of continuity between the anterior mitral leaflet and any semilunar valve. In the short axis view constant findings were (1) simultaneous imaging of both great arteries in an anterior location with the ventricular septum identified posteriorly on sweeping into the left ventricle, and (2) lack of a clockwise wraparound of the aorta by the right ventricular outflow tract. Imaging revealed that the great arteries were side by side in seven patients d-malposed in three and l-malposed in two. A modified left precordial tomographic view demonstrated both great arteries arising from the right ventricle in four of nine patients not treated surgically. In four patients with surgically repaired double outlet right ventricle, the left ventricular outflow tract had a tunnel-like configuration in the long axis view. These findings were diagnostic of double outlet right ventricle in all patients and accurately differentiated the malformation from other anomalies of the great arteries.

Adolescent↗
PubMed1979

Influence of pharmacologic intervention and valvular heart disease on left ventricular ejection phase indices: a review.

Echocardiography represents an established noninvasive technique to evaluate left ventricular (LV) performance. The LV ejection phase indices may be divided into three categories: (1) volume-dependent, (2) circumferential, and (3) wall thickening. Since the latter two are not volume dependent, they are clinically more useful in patients with dilated left ventricles. These parameters have limited clinical value in the presence of left-sided volume overload conditions (e g, mitral regurgitation and aortic regurgitation) since significant LV dysfunction may exist in the presence of normal ejection phase indices by echo. The echocardiogram is also a sensitive procedure to detect subtle alterations in LV function following acute or chronic interventions with various types of vasoactive and inotropic drugs.

Adolescent↗
PubMed1978

Transmural myocardial infarction in the absence of coronary arterial luminal narrowing in a young man with single coronary arterial anomaly.

Reported is a case of single coronary arterial anomaly (SCAA) with its origin from the right sinus of Valsalva as demonstrated by selective coronary arteriography. No branches coursed between the great vessels. Electrocardiography and vectorcardiography were consistent with inferior wall myocardial infarction, although subsequent coronary arteriograms were free of luminal narrowing. While this is an infrequently recognized isolated coronary anomaly, it may carry significant risk of myocardial ishcemia. This risk may not depend alone upon the passage of a branch of SCAA between the great vessels. Evidence of precocious ischemic heart disease should alert the angiographer to look for anomalous coronary anatomy.

Adult↗