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Biomedical subjects

B G Wisoff

Publications and source records attributed to B G Wisoff.

At least 19 recordsLinked to original sources
PubMed1979

Atrial pacing induced left ventricular dysfunction: reversibility after aortocoronary bypass surgery.

Three patients with angina pectoris were studied before and after aortocoronary bypass surgery. Angiographic studies were performed with and without atrial pacing. Preoperative atrial pacing in all three patients resulted in angina and/or ST segment changes accompanied by regional left ventricular contractile abnormalities, decreased ejection fraction, as well as decreased left ventricular end-diastolic and stroke volumes. After surgery with all grafts patent, atrial pacing at similar heart rates did not produce an ischemic response. Left ventricular contractile pattern remained normal, and there was no change in ejection fraction though end-diastolic and stroke volumes decreased. These studies demonstrate that aortocoronary bypass surgery can abolish both the ischemic response and left ventricular dysfunction that accompany atrial pacing.

Angina Pectoris↗
PubMed1979

Late coronary bypass graft flow: quantitative assessment by roentgendensitometry.

Quantitative assessment of the flow in 45 saphenous vein aortocoronary bypass grafts in 30 patients was performed by a roentgendensitometric technique. Detalis of the technique are given. Mean graft flow for all grafts measured in the early postoperative period (two weeks) and again in the late postoperative period (six months to 3 years; average, 1.5 years) significantly decreased (72.6 +/- 34.7 to 57.4 +/- 28.6 ml/min; p less than 0.01). Mean graft diameter also significantly decreased over the same period (3.5 +/- 0.6 to 3.0 +/- 0.6 mm; p less than 0.01). Differences could not be related to graft site or to the time interval between early and late recatheterization. Changes in diameter did not correlate with changes in flow. During a 3-year follow-up, saphenous vein grafts significantly decreased in diameter and flow but still functioned adequately; and vein grafts generally remained larger than the recipient arteries. The determinant of adequacy of flow is the native coronary bed.

Absorptiometry, Photon↗
PubMed1978

Unusual complications of coronary bypass surgery.

Five patients after coronary bypass surgery developed unusual complications. Three developed new apical thrombi which are thought to be due to the trauma of the left ventricular vent or deterioration of the left ventricular contraction. Significant new mitral regurgitation in one patient probably is secondary to papillary muscle dysfunction as the result of stenosis distal to anastomoses. The leakage of angoigraphic material around distal anastomatic site is due to technical error. Although these unusual complications are very rare, however, they should be considered as potential source of morbidity in asymptomatic patients who leave the hospital after bypass surgery.

Adult↗
PubMed1978

Significance of new Q waves after bypass grafting: correlations between graft patency, ventriculogram, and surgical venting technique.

New postoperative electrocardiographic Q waves have been described in eight of 40 per cent of patients undergoing bypass grafting for coronary artery disease. Various theories have been proposed to explain these new Q waves. Correlations of new Q waves to vein bypass occlusion, prolonged pump time or aortic cross-clamping time are controversial. Indeed, whether or not the appearance of new postoperative Q waves means real transmural myocardial infarction is not clear. We report herein our experience with postoperative Q waves in 56 patients with vein bypass grafts and the relationship of new Q waves to ventricular venting, graft patency, and the postoperative ventriculogram. Our observations indicate that: (1) Not all Q waves are due to occlusion of the saphenous bypass grafts (as noted by others). (2) A certain percentage of new Q waves may not reflect true transmural myocardial infarction, especially when all the vein grafts are patent and the postoperative ventriculograms show improvement. (3) Some new Q waves reflect true transmural infarction due to occlusion of grafts or of distal coronary arteries with deteriorated left ventriculograms. (4) The high incidence of new Q waves in patients with ventricular vents is probably due to direct myocardial trauma at the apex of the left ventricle.

Adult↗
PubMed1978

Results of aortocoronary bypass grafting in patients with subendocardial infarction: late follow-up.

Twenty-eight patients with subendocardial infarction (Group A) were compared with 28 patients with unstable angina (Group B) and 28 with stable angina (Group C) matched for age and sex. The three groups did not differ in prevalence of diabetes, hypertension, old infarction or duration of disease. There were no significant differences in number of diseased vessels, coronary score, abnormal left ventricular wall motion or left ventricular end-diastolic pressure. Angiograms performed 2 weeks postoperatively revealed closure of 3 of 31 grafts (16 patients) in Group A, closure of 3 of 34 grafts (17 patients) in Group B and closure of 6 of 50 grafts (22 patients) in Group C (differences not significant). Postoperative angiograms showed improved wall motion in 37 percent of Group A, 53 percent of Group B and 36 percent of Group C (differences not significant). Postoperative new Q waves appeared in one hospital in Group A and in two patients in Groups B and C. There were no hospital or late deaths. In a mean follow-up period of 29 months, 68 percent of patients in Group A, 61 percent in Group B and 54 percent in Group C were asymptomatic. Thus, bypass grafting was performed with similarly low mortality and morbidity in patients with subendocardial infarction and in those with angina; more than one third of postoperative angiograms in the three groups showed improved wall motion; and late follow-up studies demonstrated functional improvement in the majority of patients in all three groups.

Angina Pectoris↗
PubMed1978

Survival after coronary surgery.

A 4.4 year follow-up study has been done on a previously reported group of 200 consecutive patients who underwnet coronary bypass. The yearly mortality rate has been 1% (8/200 in 4 years). Our total group of 1,038 surgically treated patients has had an operative mortality rate of 1.3%, and an early graft patency rate of 89.6% has been recorded in the 60% of patients consenting to restudy. These results are compared to natural history studies with and without angiography. Comparison with recent prospective randomized studies of patients with chronic stable angina and those with unstable angina suggests that a low operative mortality rate and optimal technical performance are necessary to improve the survival rate of patiens with symptomatic obstructive coronary disease.

Adult↗
PubMed1977

Comparative study of the postoperative flow in the saphenous vein and internal mammary artery bypass grafts.

Postoperative coronary bypass flow was evaluated in two groups of randomly selected patients with grafts to the left anterior descending artery (LAD). Saphenous vein bypass grafts were placed in 27 patients and internal mammary artery grafts in 25 patients. Postoperative flow studies were performed in both groups with roentgendensitometric methods based on the transit time of radiopaque media along the graft plus the mean graft diameter. There was no significant difference between the two groups of patients for age, duration of symptoms, or the frequency of hypertension, diabetes mellitus, prior myocardial infarction, or cardiomegaly. Intraoperative bypass flows were 75+/-27 and 77+/-24 ml. per minute for the saphenous vein group (SVG) and internal mammary artery group (IMAG), respectively. There was no significant difference in the heart rate or mean aortic pressure at the time of the roentgendensitometric flow study. The mean graft diameters were 3.0+/-0.5 and 1.9+/-0.3 mm. for the SVG and IMAG, respectively (p less than 0.001). The ratios of graft diameter to LAD diameter were 1.9+/-0.3 and 1.2+/-0.2 for the SVG and IMAG, respectively (p less than 0.001). The roentgendensitometric postoperative flows were 68+/-27 ml. per minute in the SVG and 46+/-16 ml. per minute in the IMAG (p less than 0.01). The present study indicates that flow in significantly higher in saphenous vein than in internal mammary artery bypasses and that the difference in flow may in part be explained on the basis of the graft diameter.

Angina Pectoris↗
PubMed1977

Isolated aortic valve stenosis in the eighth decade.

Aortic valve stenosis was evaluated in 26 patients in the eighth decade of life, representing 20% of all patients referred for aortic valve stenosis. There were no clinical features which distinguished this older group from younger patients. Coronary artery disease was present in 46% of the older group, 30% in the younger. Angina pectoris or an infarction pattern on the electrocardiogram was not useful in predicting coronary artery disease in either group. A dominant left coronary circulation was more frequent (22%) in the younger than the older group. This was related to the higher incidence of congenitally deformed aortic valves (55%) found in the younger, compared in the advanced age group (5%). The surgical mortality in the younger and advanced age group was 8 and 20%, respectively. Mortality in both groups was related in more than half the patients to coronary artery disease.

Age Factors↗
PubMed1976

Analogical reasoning and postoperative outcome. Predictions for patients scheduled for open heart surgery.

We investigated whether postoperative outcome of open heart surgery is related to preoperative cognitive dysfunction. Patients ill enough to require open heart surgery frequently have gravely compromised circulation and, hence, possible brain damage. The Conceptual Level Analogy Test (CLAT), a new, rigorously constructed analogy test, was used to measure cognitive dysfunction. The results indicated that the CLAT, aministered preoperatively to open heart surgery patients, differentiated between patients having different types of postoperative outcome. A significant relationship between type of surgical procedure and poor postoperative outcome was also found; cardiac valvular surgery patients had significantly worse outcome than coronary bypass surgery patients. The incidence of good outcome (survival with no psychiatric complications) was 28% for cardiac valvular surgery patients with extremely poor preoperative CLAT scores, but 74% for valvular surgery patients with higher preoperative CLAT scores.

Cardiac Surgical Procedures↗
PubMed1976

Should the pericardium be closed after an open-heart operation?

A controlled clinical study was carried out to decide whether the pericardium should be left open or closed after open-heart operations. One hundred patients had the pericardium closed with interrupted silk, another 100 had the pericardium left open. Complications were alike except for the more frequent occurrence of a pericardial rub in the closed group (14 vs 3 patients), though the incidence of post-pericardiotomy syndrome was equal. There was no late tamponade. Two early reexplorations for bleeding were done in the open group, none in the closed. There were no postoperative deaths. In the patients who consented to postoperative angiography following revascularization procedures, the incidence of graft failure was equal in both groups. The pericardium should be closed after an open-heart operation. Morbidity and mortality are unchanged, and repeat cardiac exploration is safer.

Aortic Aneurysm↗
PubMed1976

New Q waves after bypass grafting: correlations between graft patency, ventriculogram and surgical venting technique.

New Q waves were observed in 35 (11%) of 321 patients undergoing saphenous vein bypass grafting with an overall mortality rate of 1.1%. Twenty-eight (80%) had postoperative arteriograms and ventriculograms and are reported. Ventricular venting was used intra-operatively in 17 patients and atrial venting in 11. The incidence of new Q wave was 22% in patients with ventricular venting and 5.5% in those with atrial venting (p less than 0.05). Complete or incomplete revascularization did not affect the incidence of new Q waves. New Q waves appeared in a zone of myocardium supplied by a grafted artery in all except two patients with ventricular venting in whom Q waves occurred within the zone of myocardium supplied by diseased ungrafted vessels. In the ventricular venting group, seven (41%) demonstrated an improved or unchanged postoperative ventriculogram and ten (59%) had deteriorated ventriculograms. In 11 patients with atrial venting, nine (82%) showed improved or unchanged postoperative ventriculograms and two (18%) had deteriorated ventriculograms. Ventricular venting patients with improved or unchanged postoperative ventriculograms had 7% graft closure as compared to 5% of those with atrial venting (pNS). Graft closure rate was 44% in ventricular venting and 20% (pNS) of patients with atrial venting who had deteriorated left ventriculograms. These findings indicate poor correlation between new Q waves and graft closure. Improved postoperative ventriculograms corrleated well with graft patency despite new Q waves. The etiology of new post bypass graft Q waves are varied. They include ventricular trauma and conduction delays resulting from surgery or venting, as well as infarction. This may be due to compromised arterial inflow either in nonoperated vessels or in the vessels distal to the anastomosis with patent grafts, or due to occluded grafts.

Coronary Artery Bypass↗
PubMed1976

Results of open heart surgery in the septuagenarian.

Open heart surgery has been extended to the septuagenarian. At the Long Island Jewish-Hillside Medical Center, 42 patients 70 to 79 years old underwent 43 open heart procedures in the past 7 years. Their average age was 73 years and 62% were male. Eighteen underwent aortic valve replacement; 7 had mitral valve replacement; 18 had coronary bypasses (3 with valve replacement); exploration for pulmonary embolism was done in 1; 1 patient had tricuspid replacement with mitral commissurotomy; 17% (7/42) died during hospitalization or within 30 days of surgery. Mean follow-up is 25 mo., and an additional 19% (8/42) have died at an average of 27 mo. after surgery. Open heart surgery is feasible for the elderly, but at an increased risk when compared to the younger patient submitted to the same procedure.

Age Factors↗
PubMed1976

Patent ductus arteriosus with hypoplastic lung.

A median sternotomy approach was used for closure of patent ductus arteriosus associated with a hypoplastic right lung. The anterior approach to the left ductus is indicated if left thoracotomy is contraindicated.

Child, Preschool↗
PubMed1976

Medical-surgical aspects of left main coronary artery disease.

Disease of the left main coronary artery compromises circulation to the major part of the left ventricle and thus threatens massive myocardial infarction and sudden death. Cardiac catheterization and coronary bypass surgery, in previous reports, have been associated with high mortality and morbidity rates. We report 50 patients with over 50 per cent narrowing of the left main coronary artery. The clinical pattern in these patients was variable and a left main coronary artery lesion could not be predicted before coronary angiography. There was only one death during cardiac catheterization. One patient died while waiting for elective surgery. Coronary bypass surgery was performed in 42 patients; one died during surgery. Forty-one patients are alive at 2 to 39 months follow-up (mean, 19 months). Thirty-six patients are asymptomatic or have minimal symptoms. Compared to the prognosis in patients with left main coronary artery stenosis treated medically, coronary bypass surgery performed on urgent basis offers a much better prognosis. Both coronary angiography and bypass surgery can be performed in these patients with a very low risk.

Adult↗