Search PubMed⌕ Search

Biomedical subjects

C L McIntosh

Publications and source records attributed to C L McIntosh.

At least 91 records · Page 5Linked to original sources
PubMed1979

Traumatic cardiac hemolytic anemia: a late complication of a Starr-Edwards mitral valve prosthesis.

Severe, traumatic, cardiac, hemolytic anemia developed in a patient nine years after mitral valve replacement with a Starr-Edwards model 6120 prosthesis. Cardiac catheterization failed to demonstrate a perivalvular leak or prosthetic malfunction. Transfusion on two occasions resulted in accelerated hemolysis and failed to maintain an appreciable elevation of the hemoglobin level. At operation, a perivalvular leak was found. Replacement of the valve led to complete resolution of the hemolytic problem. The case demonstrates that cardiac hemolysis may be a good indicator of valve dysfunction.

Anemia, Hemolytic↗
PubMed1979

Primary osteogenic sarcoma of the heart.

The clinical course of a 17-year-old boy with primary osteogenic sarcoma of the left atrium with partial obstruction of the mitral valve and the right pulmonary veins is described. After operative removal of the tumor, echocardiography documented its rapid recurrence. Despite two subsequent open-heart operations and adjuvant chemotherapy and radiotherapy, the patient died twenty-one months after the initial symptoms. Previous reports of such tumors are reviewed, and technical difficulties of removal are discussed.

Adolescent↗
PubMed1978

Effects of coronary-artery bypass on global and regional left ventricular function during exercise.

To determine the effect of coronary revascularization on exercise-induced abnormalities of left ventricular-ejection fraction and regional contraction, we obtained electrocardiograph-gated 99mTc radionuclide cineangiograms before and after operation in 23 consecutive patients. At rest, their average ejection fraction remained unchanged: 51 +/- 3 versus 54 +/- 4 per cent (+/- S.E.M.). However, 17 of the patients showed improvement of ejection fraction during postoperative exercise (increase of 51 per cent). The remaining six patients had no change or a decreased ejection fraction during exercise. All patients with improved ejection fractions during exercise were symptomatically improved. No improvement of regional function occurred at rest, but improvement did occur in regions of exercise-induced dysfunction. Although coronary revascularization has little effect on left ventricular function at rest, the ejection fraction during exercise and exercise-induced wall-motion abnormalities improve in most patients who experience symptomatic improvement.

Adult↗
PubMed1978

Long-term anatomic fate of coronary-artery bypass grafts and functional status of patients five years after operation.

To assess long-term results, coronary and graft angiography was performed 53 to 84 months after operation in 22 of 30 consecutive patients who had undergone coronary-artery bypass grafting before 1973, and who had at least one graft patent at an early (three to nine months) postoperative study. Of the 33 grafts, 31 were patent at late study. All patients had severe symptoms before operation. Of 16 who became asymptomatic early after operation, angina pectoris later redeveloped in 11. Progression of disease in ungrafted vessels accounted for symptomatic deterioration in nine of these 11 patients. We conclude that most grafts patent several months after operation remain so for at least 4 1/2 years, and that although most patients improve symptomatically after operation, symptomatic deterioration is common in the succeeding years and is most often due to progression of disease in ungrafted vessels.

Angina Pectoris↗
PubMed1978

Evaluation of regional myocardial nutrient perfusion following selective retrograde arterialization of the coronary vein.

The effects of selective coronary vein occlusion (SCVO) and selective retrograde arterialization of the coronary vein (SRACV) on nutritional myocardial blood flow was evaluated in 10 dogs with radioactive microspheres. SRACV was performed with a shunt interposed between the aorta and the great cardiac vein (GCV). Following ligation of the GCV, measurements were performed before and after ligation of the middle portion of the left anterior descending coronary artery (LAD) and then after 15 and 30 minutes of SRACV. The myocardium was divided into three regions: circumflex coronary artery (served as control), high LAD (proximal to arterial occlusion; supplied by both SRACV and coronary flow), and low LAD (distal to arterial occlusion; supplied by SRACV alone). SCVO decreased mean myocardial blood flow with increased distribution to the endocardium. SRACV to normally perfused myocardium did not significantly change myocardial blood flow; however, SRACV to acutely ischemic myocardium restored less than 50% of the decrease in myocardial blood flow. SRACV does not appear to greatly enhance blood flow to ischemic areas of the myocardium and may significantly reduce flow on the basis of venous occlusion alone.

Animals↗
PubMed1978

Delayed cardiac tamponade associated with prophylactic anticoagulation in patients undergoing coronary bypass grafting. Early diagnosis with two-dimensional echocardiography.

Pericardial tamponade occurring late in the hospitalization of a patient who has undergone a heart operation can be life threatening. Recognition of this insidious, but treatable, complication is difficult. Three patients experienced delayed tamponade while receiving warfarin prophylactically following coronary arter bypass. Two-dimensional echocardiography was useful in recognizing the effusion (and thus aided the diagnosis of tamponade) in each patients. The question of whether prophylactic antiocagulatin should be employed for patients undergoing coronary artery bypass procedures is also considered in light of both the present experience and collected reports from the literature.

Adult↗
PubMed1977

Aortic valve replacement in the elderly. Encouraging postoperative clinical and hemodynamic results.

Seventy-three patients aged 60 and over and 277 patients under 60 years of age underwent isolated aortic valve replacement (AVR) for aortic stenosis, regurgitation, and mixed disease from 1966 through 1975. Cardiac catheterization was performed five to nine months following operation in 77% of these patients. Follow-up averaged 55 months per patient. The hospital mortality in the elderly group was 2.7%, compared to 5.8% in the younger group. The late cardiac mortality was 21% and 19%, respectively. There was significant improvement (P less than .001) in the left ventricular end-diastolic pressure, cardiac index, and functional class in each of the three disease groups in the younger as well as the elderly patients. More important, the magnitude of improvement in each of these variables in patients over and under 60 years of age was not significantly different. Increasing longevity will make cardiac operations more common in the older population. These findings indicate that AVR carries the same low risk and brings about a similar improvement in left ventricular pump function in patients older and younger than 60.

Aged↗
PubMed1977

Evaluation of hemolysis following replacement of atrioventricular valves with procine xenograft (Hancock) valves.

Twenty-two patients who had undergone valve replacement with the porcine xenograft were studied 6 to 62 months postoperatively (mean 30.5 months) for evidence of intravascular hemolysis. Hemolysis was not detected in any patient and postoperative red cell indices and iron studies were normal for the majority of patients. Five patients had significantly elevated serum lactic dehydrogenase (LDH) values preoperatively which returned to normal following operation. Our evidence suggests that the glutaraldehyde-fixed porcine xenograft valve does not cause detectable hemolysis.

Anemia, Hemolytic↗
PubMed1977

Clinical and hemodynamic results following triple valve replacement: mechanical vs porcine xenograft prostheses.

This study summarizes the results in 26 patients of triple valve replacement (TVR) performed between 1967-1975. The first ten patients (group I) received all-mechanical valves, but the last 16 (group II) received porcine xenograft atrioventricular and porcine or mechanical aortic valves. Preoperatively, all patients were functional class II or IV with pulmonary arterial and venous hypertension. Early mortality was 30% group I and 18.8% group II; late mortality has been 30% group I and 6.3% group II. Total operative and bypass time, and duration of postoperative respiratory support was less (P less than 0.025) in group II than in group I. Postoperative catheterization performed in 16 of 26 patients demonstrated significant reduction (P less than 0.05) in pulmonary arterial and venous hypertension, and aortic and mitral gradients in group II. There have been no late complications or valve malfunctions in group II. An improvement of at least two functional classes was seen in 4/6 group I and 12/13 group II operative survivors. The results of TVR with porcine xenografts compare favorably with those of all-mechanical replacements and deserve further evaluation.

Adult↗
PubMed1976

Tricuspid regurgitation. A comparison of nonoperative management, tricuspid annuloplasty, and tricuspid valve replacement.

The best means of managing tricuspid regurgitation associated with mitral or mitral and aortic valve disease is still to be determined. During the period 1972 to 1974, we treated 76 patients who had tricuspid regurgitation along with associated valvular dysfunction. Patients with mold regurgitation were treated conservatively, those with moderate regurgation underwent annuloplasty, and those with severe regurgitation had tricuspid valve replacement. We found the results to be less satisfactory in the group treated by annuloplasty than in the other two groups. We still manage conservatively those patients with mild regurgitation, but we believe it appropriate to replace the valve in an increasing number of subjects who have tricuspid regurgitation of moderate severity.

Animals↗
PubMed1975

Measurement of mitral orifice area in patients with mitral valve disease by real-time, two-dimensional echocardiography.

A quantitative assessment of mitral valve orifice area can be achieved in patients with pure mitral stenosis by cardiac catheterization. In the presence of mitral regurgitation, however, accurate measurement often is impossible because total diastolic flow through the mitral valve frequently is unknow. Using a recently developed real-time, two-dimensional echocardiography system, we are able to obtain cross-sectional images of the mitral valve by scanning the heart perpendicular to its long axis at the level of the tip of the mitral leaflets. Twenty consecutive patients undergoing operation for mitral valve disease were studied during the week prior to operation. In 18 of 20 (90%) the mitral orifice was imaged successfully in early diastole by two-dimensional echocardiography so that mitral valve orifice area could be measured directly in square centimeters. In 14 patients (ten with associated mitral regurgitation), mitral orifice area was measured both by echocardiography and directly at time of operation. In 12 of 14 (86%) patients, mitral orifice area by two-dimensional echocardiography was within 0.3 square centimeters of that measured at operation (correlation coefficient for all 14 patients equals 0.92). We conclude that two-dimensional echocardiography is extremely useful in the evaluation of patients with mitral valve disease because it provides a noninvasive method for directly measuring the mitral valve orifice area that is accurate even in the presence of mitral regurgitation.

Calcinosis↗