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Biomedical subjects

A DeBoer

Publications and source records attributed to A DeBoer.

17 recordsLinked to original sources
PubMed1992

The role of the lymphatic system in coronary atherosclerosis.

Arguments are presented to support the hypothesis that the integrity of the coronary lymphatic system is an important factor in the development of coronary atherosclerosis. It is proposed that the lymphatic drainage of the epicardial coronary arteries is genetically inadequate, and that the flow of lymph from the heart is further impaired by gravitational factors due to man's upright position. Arguments are presented to support the concept that the intramural coronary arteries are protected from atherosclerosis because of a highly effective pericoronary lymphatic and venous capillary system and that the internal thoracic (internal mammary) artery is similarly protected from atherosclerosis because of its close relationship to an extensive lymphatic chain. It is proposed that the failure of the cardiac lymphatic system in the allogenic transplanted heart is a cause of the accelerated atherosclerosis in both epicardial and intramural coronary arteries.

Animals↗
PubMed1992

The efferent cardiac lymphatic pathways in the macaque monkey.

In ten postmortem hearts of the Macaque monkey (M. mulatta), the coronary lymphatics were visualized using an India ink suspension in 2% gelatin. The left coronary lymphatic initially passed to the dorsal surface of the aortic arch. In five hearts, this lymphatic went directly to the cardiac lymph node, whereas in the others, it first ascended to the left superior tracheobronchial node and then interconnected with the cardiac lymph node. The right coronary lymphatic usually passed in front of the ascending aorta and common arterial (brachiocephalic) trunk and entered the cardiac lymph node. In two hearts, however, the right coronary lymphatic first ascended to an anterior transverse mediastinal node and from here lymphatics joined the cardiac lymph node. Those lymphatics that passed cephalad from the cardiac lymph node to the right anterior mediastinal nodes and the right paratracheal nodes ultimately emptied into the right venous angle. Those lymphatics that passed cephalad from the cardiac lymph node to the anterior transverse mediastinal nodes ultimately emptied into the left venous angle. In five other Macaque monkeys (M. mulatta and M. fascicularis) after marker injection (T1824 blue dye and micropulverized barium sulfate) into the living heart or pericardium, lymphatic drainage beyond the base of the heart could not be demonstrated. Whereas postmortem morphologic studies suggest that the monkey coronary lymphatic system is amenable to obstruction by removal of the cardiac lymph node and interruption of its adjacent lymphatic connections, effective methods for visualizing the mediastinal lymphatic collecting system in the living monkey must be developed before experimental cardiac lymphatic ablation can be accomplished in this species.

Animals↗
PubMed1988

The lymphatic drainage of the pericardial space in the dog.

The purpose of this study was to characterize definitively the lymphatic drainage system of the pericardial space in the dog. The reports on this subject, based on dissection experiments and acute dye injections, remain controversial, and our own previous studies have been incomplete. Seventeen dogs were studied using a radiographic technique. Micropulverized barium sulfate instilled into the pericardial sac was followed with serial chest x-rays in seven dogs with intact cardiac lymphatics, in seven dogs after section of the cardiac lymphatic drainage node (the cardiac lymph node) in the right upper mediastinum, and in three dogs after resection of cardiac drainage lymphatic nodes in the left upper mediastinum. These studies revealed that the lymphatic drainage of the pericardial space is via (a) the principal coronary lymphatic which drains from the left ventricular muscle and passes to the right upper mediastinum via the cardiac lymph node, (b) the lesser coronary lymphatic which drains the right ventricular muscle and passes to the left upper mediastinum, and (c) bilateral internal mammary (parasternal) lymphatic chains. These observations are important in planning experimental approaches to the effects of impairment of lymph drainage from the pericardial space. An understanding of the lymph drainage from the pericardial space may prove significant to understanding fibrotic reactions within it and the pathologic mechanisms of such entities as constrictive pericarditis.

Animals↗
PubMed1986

An eight-year experience with porcine bioprosthetic cardiac valves.

A total of 589 porcine bioprostheses were implanted in 509 patients from January, 1976, through December, 1983. Of the valves implanted, 390 were Hancock and 199 were Carpentier-Edwards. A total of 1,633 patient-years was accrued, with a mean follow-up of 38 months per patient. Two hundred eight patients had aortic valve replacement, 209 had mitral valve replacement, and 79 had multiple valve replacements, of which 46 were aortic and mitral replacements. The mortality for isolated aortic valve replacement was 5.8%; for isolated mitral replacement, 8.6%, and for all patients, 10.9%. Late mortality was 3.9% per patient-year. The actuarial survival rate at 5 years was 79% for aortic, 68% for mitral, and 76% for aortic-mitral valve replacement. There were 12 thromboembolic events (0.73% per patient-year). Two episodes occurred in patients with an aortic bioprosthesis, nine in patients with a porcine mitral valve, and one in a patient with mitral and tricuspid bioprosthetic valves. The probability of remaining free of thromboembolism at 5 years was 99% for the group having aortic valve replacement, 93% for those having mitral replacement, and 100% for the group having aortic-mitral valve replacements. Thirteen episodes of endocarditis occurred (0.8% per patient-year). Seven of the 13 patients died as a direct result of endocarditis. The probability of remaining free of prosthetic endocarditis at 5 years was 97% for the aortic valve replacement group, 95% for the mitral group, and 97% for the aortic-mitral group. There were 20 instances of xenograft failure (1.2% per patient-year). The probability of remaining free of valve failure at 5 years was 96% for the aortic valve replacement group, 93% for the mitral group, and 93% for the aortic-mitral replacement group. Primary tissue failure of a prosthesis occurred in seven patients, all with Hancock valves (0.43% per patient-year). As yet there has been no primary tissue failure of the Carpentier-Edwards prosthesis. There also appears to be a lower incidence of thromboembolism (Edwards, 0.3% per patient-year; Hancock, 0.8% per patient-year) and endocarditis (Edwards, 0.6% per patient-year; Hancock, 1.0% per patient-year). The low incidence of complications with the porcine bioprosthetic valve, especially the Carpentier-Edwards, encourages us to recommend its continued use, especially in situations in which anticoagulation is contraindicated.

Adult↗
PubMed1986

Comparative study of warfarin versus antiplatelet therapy in patients with a St. Jude Medical valve in the aortic position.

To determine the necessity of long-term warfarin anticoagulation after St. Jude Medical aortic valve replacement in adults, we evaluated the risks of thromboembolism, valve thrombosis, anticoagulant hemorrhage, and sudden cardiac death in two groups of patients. Group I consisted of 41 patients treated with conventional long-term warfarin therapy. Forty-two patients in Group II were treated primarily with antiplatelet therapy (aspirin, dipyridamole, or both); 17 of these patients received warfarin for a short time postoperatively and seven others received it intermittently during the study period. The groups were similar with respect to age, sex, associated cardiovascular disease, and length of follow-up (mean 29 months per patient). In the warfarin-treated group, three late sudden deaths occurred, one of which was preceded by a cerebrovascular accident, for a cardiac mortality of 2.7% per patient-year. There were eight major nonfatal complications (7.3% per patient-year), of which four were hemorrhagic and four embolic. In Group II, there was one sudden cardiac death (1.1% per patient-year) and four major complications occurred (3.2% per patient-year). Two of the complications were embolic and two were episodes of valve thrombosis, both necessitating reoperation. Although the incidence of serious morbidity in the warfarin-treated group was twice that of patients treated with antiplatelet therapy, there were no statistically significant differences in the rates of sudden death or major complications. These data suggest that antiplatelet therapy may be as effective as warfarin in preventing embolism from the St. Jude Medical valve in the aortic position. Valve thrombosis occurred in two patients, both receiving antiplatelet therapy (2.2% per patient-year). Whether this type of valve failure can be prevented by warfarin remains in question.

Adolescent↗
PubMed1979

Taussig-Bing anomaly with straddling mitral valve.

Five patients with the left-sided or intermediate type (Lev) of the Taussig-Bing anomaly were found to have an associated straddling of the mitral valve. In four patients the anomaly of the mitral valve was not recognized preoperatively, and all four died postoperatively. The persistent subpulmonic obstruction caused by the abnormal attachment of the anterior mitral leaflet is considered a significant factor in the poor operative outcome. Retrospective study of angiograms in these four patients revealed diagnostic clues of straddling mitral valve which enabled us to diagnose a fifth patient angiographically and confirm the diagnosis by cross-sectional echocardiography. A surgical approach to correct this association of abnormalities is proposed which avoids operating upon the mitral valve. Its function is thereby preserved, yet the hemodynamic problem caused by the straddling is bypassed. The fifth patient in this series was successfully treated by the proposed operative method.

Adolescent↗
PubMed1977

A case of myocardial abscess evaluated by radionuclide techniques: case report.

A patient with infective endocarditis was evaluated by Ga-67 citrate imaging, Tc-99m pyrophosphate imaging, equilibrium gated blood pool imaging, and Tl-201 imaging of the chest. The diagnosis of ventricular abscess was first suggested by an abnormal gallium scan. At surgery, an abscess was identified in the area where the scan was abnormal, and postoperatively a repeat scan was normal.

Abscess↗
PubMed1976

Postperfusion coronary ostial stenosis: incidence and significance.

In a study of 117 consecutive aortic valve replacements in which selective coronary perfusion was routinely employed, four patients developed coronary ostial stenosis (3.5 per cent). Continuous selective coronary perfusion was performed by use of Mayo balloon catheters with individual measuring of pressure and flow. All 4 patients developed progressive symptoms of angina pectoris within 6 months of the original operation, after uneventful recoveries. All 4 were found to have lesions in the left main coronary ostium and required a coronary bypass. Two made uneventful recoveries and are presently asymptomatic, whereas 2 died in the immediate postoperative period. The literature indicates that the reported incidence of this complication varies from 1 to 5 per cent. Furthermore, the mortality rate for reoperation in these patients is higher than that for those undergoing uncomplicated coronary bypass without an antecedent procedure. Our experience confirms the lethal nature of this complication and the necessity for reoperation once the diagnosis is established. The development of these dangerous lesions must be taken into account in the prevailing controversy between the most effective methods of myocardial protection during aortic valve replacement.

Adult↗