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Biomedical subjects

A F Parisi

Publications and source records attributed to A F Parisi.

At least 127 records · Page 7Linked to original sources
PubMed1978

Aortic valve replacement for ochronosis of the aortic valve.

A patient with generalized ochronosis developed severe cardiovascular symptoms related to ochronotic deposits on the aortic valve and in the coronary arteries. A transvalvular gradient of 100 mm Hg and obstruction of the left anterior descending coronary artery were found by catheterization. Aortic valvular replacement and aortocoronary bypass were performed successfully, and the patient has been well two years since operation. This represented the first reported case of aortic valve replacement for this rare metabolic condition. With increased mobility of these patients due to aggressive orthopedic joint treatment, more patients with this syndrome may require surgery for cardiovascular symptoms.

Aortic Valve↗
PubMed1977

Pseudoaneurysm of the left ventricle: an unusual echocardiographic presentation. Review of the literature.

Echocardiography showed a large anterior chamber communicating with the left ventricle cavity through the interventricular septum in a patient with a previous left ventricular aneurysmectomy. At postmortem examination this chamber proved to be an 11-cm diameter pseudoaneurysm that opened into the left ventricle through a 3-cm orifice. A review of the literature showed 67 cases of histologically proven left ventricular pseudoaneurysm, most of which occurred after myocardial infarction and cardiac surgery. Twenty-six of 32 left ventricular pseudoaneurysms were successfully operated upon. Among 35 patients with pseudoaneurysms not operated upon, rupture was a cause of death in 11.

Autopsy↗
PubMed1977

Diagnosis of acute myocardial infarction in patients undergoing open heart surgery: a comparison of serial myocardial imaging with cardiac enzymes, electrocardiography, and vectorcardiography.

In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patients imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery.

Cardiac Surgical Procedures↗
PubMed1976

Clinical appraisal of current nuclear and other noninvasive cardiac diagnostic techniques.

At a time of rapid increases in the cost of medical care and the application of complex invasive procedures to cardiovascular diagnosis, the use of noninvasive methods has aroused interest. This report discusses the usefulness and limitations of various noninvasive diagnostic methods including nuclear medicine techniques, echocardiography, exercise electrocardiography and determination of systolic time intervals. Emphasis is placed on the applicability of these methods to specific disease processes (such as ischemic heart disease, cardiac valve disease, pulmonary embolic disease), their relative merits, future potential and present shortcomings.

Aortic Aneurysm↗
PubMed1976

The influence of left ventricular stroke volume on aortic root motion: an echocardiographic study.

Aortic root motion was studied in 24 normal volunteers at rest and during the Valsalva maneuver, isometric exercise, and amyl nitrite inhalation. In addition root motion was correlated with the stroke volumes determined at cardiac catheterization in 24 patients. The root has distinct systolic movement, the amplitude and duration of which were easily measured both at rest and during the interventions. At rest,the mean (+/-1 SE) systolic amplitude of the anterior aortic wall was 11.2 +/- 0.5 mm and that of the posterior wall 9.5 +/- 0.3 mm. During the strain phase of the Valsalva maneuver anterior wall amplitude fell to 8.2 +/- 0.4 mm and the posterior wall to 7.3 +/- 0.5 mm (P less than 0.001). With release, anterior wall amplitude rebounded to 12.5 +/- 0.8 mm and the posterior wall to 10.8 +/- o.5 mm, values greater than control (P less than 0.01). With isometric exercise there was no change in amplitude compared to rest; however, amyl nitrite caused an increase in the anterior wall to 13.5 +/-0.8 mm and posterior wall to 11.9 +/-0.6 mm (P less than 0.01). In the patient group the amplitude of posterior wall motion correlated weakly with cardiac index (r = 0.63) and stronger with stroke index (r = 0.78). This study quantifies the echocardiographic pattern of normal aortic root motion. The findings indicate that the aortic root motion is an index of stroke volume; they further suggest that root motion is acutely sensitive to variations in stroke volume since its amplitude changed in accord with the documented effects of the employed maneuvers on stroke volume.

Adult↗
PubMed1976

Noninvasive detection of intracardiac thrombosis: 131-I fibrinogen cardiac survey.

Cardiac survey following administration of 131-1 autologous fibrinogen is a noninvasive technique for the detection of intracardiac thrombosis. Fibrinogen is isolated from plasma by a rapid salting-out method with ammonium sulfate and is iodinated with chloramine T. The purity of 131-fibrinogen, expressed as clottable radioactivity, is greater than 90%. Cardiac survey consisting of serial gamma camera imaging or rectilinear scanning after intravenous administration of 131-I fibrinogen was conducted in dogs with freshly induced thromobosis of the left atrial appendage. An accumulation of radioactivity was detectable in the area of the left atrium and confirmed in each of nine dogs sacrificed. Similarly, 20 patients with heart disease predisposing to intracardiac thrombosis were surveyed. Eight of nine patients with positive studies and 11 of 11 with negative studies were confirmed subsequently at surgery or autopsy. Cardiac survey with 131-I fibrinogen is a simple and noninvasive method of detecting intracardiac thrombosis.

Animals↗
PubMed1976

Echocardiographic evaluation of the Valsalva Maneuver in healthy subjects and patients with and without heart failure.

The Valsalva maneuver was evaluated by echocardiography in three groups: A) 10 normal volunteers, B) 10 patients with no history of heart failure and normal ejection fractions, and C) 10 patients with heart failure and depressed ejection fractions. Groups A and B had a significant fall in left ventricular internal dimensions and calculated stroke volume by end strain which returned rapidly to baseline in recovery without significant overshoot. Arterial pressure showed a signoidal strain pattern with a normal overshoot in early recovery in all group B patients. In group C ventricular dimensions did not diminish during strain; arterial pressures showed a "square wave" pressure elevation during strain without an overshoot in recovery. Echocardiography allows a new approach to evaluate further the left ventricular response to the Valsalva maneuver. Patients with severely depressed ejection fractions, unlike those with normal ventricular function, are unable to alter stroke output in response to acutely increased intrathoracic pressure. A square wave pressure response is a likely consequence of a fixed stroke output during the strain maneuver.

Adult↗
PubMed1976

Propranolol as primary therapy for thyrotoxicosis.

It has been suggested that propranolol hydrochloride alone is effective in the treatment of thyrotoxicosis. To test this hypothesis, eight mildly thyrotoxic individuals were prospectively studied for an average of eight months, during which propranolol alone was administered and thyroid function tests, cardiac systolic time intervals, and body densities were sequentially measured. Two patients became euthyroid. The others had adequate but incomplete symptomatic control. Weight loss was not corrected, but no changes in lean body mass were induced. The augmented myocardial contractility of thyrotoxicosis, as determined by systolic time intervals, improved but failed to return completely to normal. Thus, systolic time intervals are a practical means of following the peripheral response to chronic beta-adrenergic blockage in thyrotoxic patients. However, these observations do not support the use of propranolol alone as the first choice of therapy for thyrotoxicosis.

Adult↗
PubMed1975

Assessing left ventricular filling pressure with flow-directed (Swan-Ganz) catheters. Detection of sudden changes in patients with left ventricular dysfunction.

The accuracy with which pulmonary pressures reflect sudden changes in left ventricular (LV) pressures was studied in 15 patients without mitral disease. Mean pulmonary artery (PA), pulmonary artery end-diastolic (PAd), mean pulmonary capillary (PC), and pulmonary capillary "a" wave (PCa) pressures were compared with simultaneous LV diastolic pressures measured before (LV pre "a") and after atrial systole (LVEDP). Recordings were made at rest and after angiography. There were significant correlations (r greater than 0.75, P less than 0.01) between LV diastolic pressures and each of the pulmonary pressures. The LVEDP and PCa related most closely (r = 0.98). Differences of 5 mm Hg or more between LVEDP and either PAd or PC occurred in more than 50 percent of the observations and were due to large LV "a" waves. The PC, and to a lesser degree the PAd, were more closely related to LV pre "a" than to LVEDP. Changes (delta) in PCa after LV angiography approximated deltaLVEDP, whild deltaPAD and deltaPC reflected deltaLV pre "a" more closely than deltaLVEDP. In conclusion, PCa reflects the LV "a" wave and, thus, is the most accurate index for LVEDP and deltaLVEDP in patients with LV dysfunction. The PC reflects LV pre "a" (mean LV filling pressure) but is an unreliable index of LVEDP. The PC is more easily measured than PCa and, with proper interpretation, should remain the most useful measurement for patient monitoring.

Adult↗