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Biomedical subjects

B B Roe

Publications and source records attributed to B B Roe.

At least 37 records · Page 2Linked to original sources
PubMed1978

Cardiac valve replacement in patients over 65 during a 10-year period.

From 1967 through 1976, 754 adult patients were subjected to open heart procedures for acquired valvular disease at the University of California, San Francisco, 104 of whom were 66 years of age or over (mean = 70 years). The operative mortality of 15.0% in the elderly group did not differ significantly from that of 14.3% in the entire adult series for the 10-year period. Mortality was consistently higher in combined procedures (multiple valve replacement and valve replacement with coronary grafting). Since the introduction, in 1973, of hypothermic hyperkalemic coronary washout for intraoperative protection of the ischemic myocardium, the hospital mortality rate has decreased to 8.1% overall, 6.0% for isolated aortic valve replacement and 0% for isolated mitral valve replacement in patients over 65. Moreover, the long-term survival following aortic and mitral valve replacement in this series appears to approximate the survival curve of the normal population of the same age. This experience suggests that cardiac surgery has become safer for all patients during the past 10 years and that operative mortality is related primarily to the type and severity of disease rather than to age.

Age Factors↗
PubMed1977

The application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization.

To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scintigrams and enzymes with negative electrocardiograms. Thirty-four patients with negative electorcardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release.

Adult↗
PubMed1977

Myocardial protection with cold, ischemic, potassium-induced cardioplegia.

A total of 204 patients, ages 3 months to 84 years, underwent open-heart surgery with the aid of cardiopulmonary bypass with moderate hypothermia. For protection of the myocardium, cardioplegia was induced by washing out the coronary arteries with an iced, buffered, isoosmolar, potassium-based infusate. After aortic cross-clamping, the aortic root or individual coronary arteries were perfused with 500 to 2,000 c.c. of an aqueous solution (at zero to 4 degrees C.) containing 20 mEq. of potassium. Periods of ischemic arrest as long as 208 minutes have been well tolerated, with only two of the eleven hospital deaths considered heart related. Defibrillation occurred spontaneously in 41 per cent and after one shock in 47 per cent of patient, without apparent correlation between duration of ischemia and restoration of effective rhythm.

Cardiac Surgical Procedures↗
PubMed1976

Noninvasive diagnosis of a false left ventricular aneurysm with radioisotope gated cardiac blood pool imaging. Differentiation from true aneurysm.

Unlike the true left ventricular aneurysm, false aneurysms have recently been shown to be subject to late rupture. Rarely diagnosed before surgery or autopsy, the false aneurysm has never been identified by noninvasive techniques. We report the first such noninvasive diagnosis employing radioisotope gated cardiac blood pool imaging. Due to the unique and possibly life-threatening clinical course and potential for surgical cure of false left ventricular aneurysm, early noninvasive diagnosis by imaging techniques may be critical. The methods shown here are generally applicable, becoming widely available and may help in evaluation of false left ventricular aneurysm as a cause of sudden death.

Aged↗
PubMed1976

Transaortic cannulation for balloon pumping: report of a patient undergoing closed chest decannulation.

A technique is described for introduction of an intraaortic balloon (for circulatory augmentation) through the transverse aorta using a crimped Dacron arterial graft brought out through a lateral skin incision. When balloon pumping is discontinued, the balloon catheter is withdrawn through the percutaneous graft without reopening the chest. The graft is amputated and buried without ill effect.

Aorta↗
PubMed1976

Prevention of air embolism with intravascular carbon dioxide washout.

Air embolism remains a constant hazard from all operative procedures which involve opening the central cardiovascular system. Standard surgical maneuvers have been developed to prevent embolization by evacuating the air before restoring the circulation. Under certain circumstances these maneuvers may not be effective in removing air from the aortic arch. Introduction of carbon dioxide directly into the aorta to displace blood for adequate visualization has proved to be a simple, safe adjunct to the prevention of air embolization in operations involving the aortic arch.

Adult↗
PubMed1976

Surgical management of severe aortic coarctation and interrupted aortic arch in neonates.

Forty-four infants, 2 to 90 days of age, with severe obstructive lesions of the aortic arch, underwent emergency surgical correction between Jan. 1, 1966, and April 1, 1975. The typical clinical presentation was severe congestive heart failure and acidemia. Resection of an aortic coarctation with end-to-end anastomosis was performed in 31 patients. Eight (26 per cent) died after the operation. Since 1969, the mortality rate has been reduced to 14 per cent (3 of 22 patients) even though the incidence of major associated cardiac lesions has remained essentially constant (56 per cent from 1966 through 1969, 64 per cent from 1970 through March, 1975). This suggests that the higher survival rate has resulted from improved surgical techniques and postoperative care. The mortality rate in the infants operated upon during the second and third months of life was twice as high as that in those operated upon before the age of 1 month. Eight patients with Type A interrupted aortic arch were operated upon and 5 survived. Five patients with Type B aortic arch were operated upon and 3 survived.

Aorta↗
PubMed1975

Calcified postoperative epicardial granuloma.

A sterile calcified granuloma on the external surface of a right ventriculotomy in an 8-year-old boy was identified four years after closure of a ventricular septal defect; He had no symptoms, but a systolic ejection murmur was identified and disappeared after resection of the lesion. Sensitivity to silk suture material is suggested by the operative findings and a history of multiple silk suture sinuses developing in his uninfected original thoracotomy incision.

Calcinosis↗
PubMed1975

Occluder disruption of Wada-Cutter valve prosthesis.

Total detachment and embolization of the hinged, tilting occluder of the Wada-Cutter prosthetic heart valve was the proved cause of death in 2 of 25 patients who had these devices implanted at the University of California, San Francisco, Medical Center in 1969-70. In addition, there were 8 late deaths without postmortem examination, 2 of which were sudden and 4 of which followed rapidly progressive congestive heart failure over a period of hours to days. Prosthetic malfunction appears to be a possible mechanism of death in the majority of these patients. The 2 additional late deaths were unrelated to valve malfunction. Regurgitant murmurs have been identified during follow-up examination in 17 patients. Two patients had prosthetic replacement for hemodynamically significant leaks through the valve mechanism and were found to have no perivalvular leak. Six additional patients had prophylactic replacement of the Wada-Cutter valve. Measurements on 7 available occluders that were removed showed variable degrees of material movement at the hinge. This experience has caused us to recommend elective replacement of remaining Wada-Cutter valves.

Adult↗
PubMed1975

Aorto-pulmonary shunt in the premature infant: technical considerations.

In a 13-day-old, 1,300 gram premature infant with tricuspid atresia, a Potts-Smith anastomosis was successfully performed. We used a neurosurgical vessel clip, smaller than the smallest available vascular clamp, to side-clamp the descending aorta. This report appears to be the first of the construction of a Potts-Smith shunt in an infant of this size.

Aorta↗
PubMed1975

The role of valve replacement in the treatment of fungal endocarditis.

The role of valve replacement in the treatment of fungal endocarditis has not been defined. The diagnosis of fungal endocarditis was made in 11 patients, 8 before death and 3 at autopsy. Nine patients were infected with Candida species, one with Torulopsis glabrada and one with Aspergillus. None of the 8 patients whose disease was diagnosed during life was cured despite up to 160 days of amphotericin B therapy. All required valve replacement for heart failure (1 patient), emboli (1 patient, or both (6 patients). We recommend early valve replacement for fungal endocarditis before the onset of heart failure and emboli.

Adult↗
PubMed1973

Whither in maturity?

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Cardiac Surgical Procedures↗