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Biomedical subjects

A G Adelman

Publications and source records attributed to A G Adelman.

At least 55 records · Page 3Linked to original sources
PubMed1976

Increasing operability and survival with intra-aortic ballon pump assist.

Intra-aortic ballon pump assist (IABPA) was used over a 12-month period in the management of 41 patients: 5 patients with complications of myocardial infarction in shock whose circulation was supported by IABPA before operation immediately after angiographic and hemodynamic study (group 1); 14 patients with postcardiotomy low-output state who could not be weaned from cardiopulmonary bypass and required IABPA circulatory support either in the operating room or in the intensive care area (group 2); 19 patients with severe myocardial ischemia and unstable circulation in whom IABPA was instituted either before angiography or before saphenous vein bypass operation (group 3); and 3 patients with severe left ventricular dysfunction and left ventricular hypertrophy due to aortic valve or coronary artery disease, or both, in whom IABPA was used before, during and after cardiopulmonary bypass and a corrective operative procedure (group 4). Survival rates for patients in these groups were 2/5,8/14,18/19 and 2/3 respectively (overall survival, 73%). IABPA may increase the postoperative survival of certain high-risk patients with poor left ventricular function due to valvular disease or coronary artery disease, or both. The survival of patients with severe myocardial ischemia and complicated myocardial infarction is improved by IABPA, early angiography and appropriate surgical correction. Left ventricular ejection fraction and the estimate of subendocardial coronary flow by the ratio of the diastolic pressure time index to the tension time index appear to be significant in identifying patients who may benefit from the use of IABPA.

Adult↗
PubMed1976

Intra-aortic balloon pump assist: adjunct to surgery for left ventricular dysfunction.

Intra-aortic balloon pump assist (IABPA) was used intraoperatively and postoperatively in 34 patients with severe left ventricular dysfunction: the mean ejection fraction was 0.29 and all patients had angiographic grade IV left ventricular contractility. There were three groups of patients: 11 patients with acute coronary artery insufficiency--10 of whom survived vein bypass surgery (group 1); 16 patients with crescendo-type unstable angina--of whom 15 survived surgery (group 2); 7 patients with single (6) or multivalvular (1) replacement (combined with vein bypass in 3)--of whom 5 survived (group 3). Overall survival was 88%. The mean duration of 1:1 IABPA was 40 hours. Inotropic support was not required, hemolysis was insignificant and hemostasis remained secure. Two patients required tracheostomy and one required dialysis. One patient had a peripheral embolus in the leg used for IABPA. IABPA improves subendocardial perfusion during induction of anesthesia, during cardiopulmonary bypass and into the postoperative period; left ventricular work is decreased with a concomitant increase in coronary artery and vein graft blood flow. Use of IABPA may also improve survival and lessen morbidity in patients with left ventricular dysfunction due to the beneficial effects on myocardial performance and is thus a valuable adjunct to cardiac surgery in high-risk patients.

Adult↗
PubMed1975

Saphenous vein bypass grafting. Changes in native circulation and collaterals.

One hundred patients were evaluated 12 to 43 months after saphenous vein bypass surgery. The rate of progression of obstructive disease in the native vessels and changes in collateral circulation were analyzed in detail. Fifty-five per cent of preoperatively patent vessels showed progression proximal to the site of graft insertion, 40% proximal to patent grafts; there was distal progression in only 7% of grafted vessels. The progression rate for nongrafted vessels was 14%. Patent grafts were associated with a high rate of disappearance of collaterals to the grafted vessels, while occluded grafts were associated with preservation of collaterals or appearance of new collaterals. Progression of obstructive disease in the native circulation and changes in collaterals did not prevent symptomatic improvement (93% of patients were symptomatically improved).

Adult↗
PubMed1970

Long-term propranolol therapy in muscular subaortic stenosis.

Twenty-one patients with muscular subaortic stenosis were treated with oral propranolol for periods of 6 to 34 months for a total of 42.5 patient years. The average follow-up was 2 years. Four patients with latent obstruction became asymptomatic on propranolol therapy. Of the 17 patients with resting obstruction, 7 improved, 2 were unchanged, 5 deteriorated, and 2 died during the period of treatment. The 7 patients with resting obstruction who are still improved on propranolol have had relatively short periods of treatment (average 15 months), and none experienced the degree of improvement that occurred in the patients with latent obstruction. This study indicates that propranolol is most effective in patients with muscular subaortic stenosis who have latent obstruction. It is of limited value in patients with resting obstruction because the benefit of propranolol therapy in the majority of these patients is eventually overtaken by progression in the disease.

Adult↗