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Biomedical subjects

C R Hatcher

Publications and source records attributed to C R Hatcher.

At least 37 records · Page 2Linked to original sources
PubMed1987

A valveless counterpulsation left ventricular assist pump in the descending aorta: hemodynamic benefit with a reduced risk of cerebral emboli.

Because of valve malfunction and cerebral embolism reported with use of the total artificial heart, the descending aorta was reexamined as a site for a valveless counterpulsation left ventricular assist pump. The pump was introduced into the thoracic aorta at the level of the eight thoracic vertebra in 11 canine right-heart bypass preparations. Heart rate (110 beats per minute), stroke volume (20 ml), and mean arterial pressure (80 or 100 mm Hg) were precisely controlled. The pump ejection volume was adjusted to equal 1 time or 2 times the stroke volume of the dog. A 20-ml ejection led to an 11% reduction in left atrial pressure, an 11% reduction in peak left ventricular pressure, and a 20% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). Systolic shortening (ultrasonic crystals) increased by 5% (p less than .05 at a mean arterial pressure of 80 mm Hg). A 40-ml pump ejection led to an 11% reduction in mean left atrial pressure, a 17% reduction in peak left ventricular pressure, and a 21% reduction in tension time index (all, p less than .05 at a mean arterial pressure of 80 mm Hg). The systolic shortening increased by 15% (p less than .05). To assess the relative risk of cerebral embolism, albumin spheres (40 to 60 micrograms) labeled with technetium-99 were injected into the pump chamber in 5 dogs (40-ml ejection, 2.1 +/- 0.1 times the dog's stroke volume).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function.

Surgical resection is the treatment of choice for non-small cell bronchogenic carcinoma, and it is the only method providing prolonged arrest and chance for cure. From 1974 through 1984, 32 patients with marked impairment of pulmonary function had a limited resection for carcinoma of the lung. Marked impairment is defined as a maximum breathing capacity less than 35 to 40% of predicted, forced expiratory volume in one second less than or equal to 1 liter, and forced expiratory flow (FEV25-75) of less than or equal to 0.6 liter. Limited resection is defined as an operation that is less than a lobectomy, generally a wide wedge or segmental resection. The pathological stage of disease was Stage I in 31 patients and Stage II in 1 patient. Ten patients were treated by segmental resection and 22 by wide wedge resection. Two-year and three-year survival is 84 and 78%, respectively, and 10 patients (31%) have survived for five years. Recurrent disease developed in 8 patients, 5 of whom died. Recurrence was highest when the lesion crossed an intersegmental plane. In 1978, postoperative radiation therapy was added to the treatment of all patients whose lesion crossed an intersegmental plane. Since then, 18 patients have undergone wedge resection and postoperative irradiation with only 2 local recurrences at two years.

Aged↗
PubMed1987

Vasoactive drug effects on blood flow in internal mammary artery and saphenous vein grafts.

The internal mammary artery is a dynamic coronary graft, whereas the saphenous vein graft is passive. Therefore, potential exists not only for beneficial vasodilation but also for catastrophic spasm of the artery. The purpose of this study was to examine blood flow in the internal mammary and saphenous vein grafts during infusion of drugs that are commonly used after cardiac operations. A canine right heart bypass preparation allowed precise control of cardiac output, blood pressure, and heart rate, which were maintained constant during drug infusion. Both the internal mammary and saphenous vein grafts were constructed so that they perfused the same coronary bed: They were anastomosed in a Y fashion to a ligated anterior descending coronary artery. Electromagnetic flow probes measured graft flow (with the other graft occluded) before and after 15 minutes of drug infusion. The order of drug infusion was randomized and changes were compared by tests for paired differences. Phenylephrine (2 micrograms/kg/min) decreased flow in both the internal mammary and saphenous vein grafts, whereas norepinephrine (0.1 microgram/kg/min) increased flow in both grafts. Epinephrine (0.05 microgram/kg/min) increased mammary artery flow 16% +/- 6% but decreased saphenous vein graft flow 9% +/- 7%. Nitroglycerin (1 microgram/kg/min) significantly increased internal mammary flow (36% +/- 13%), from 47 +/- 7 to 59 +/- 7 ml/min (p less than 0.01), whereas flow decreased significantly in the saphenous vein graft 14% +/- 3%, from 64 +/- 9 to 59 +/- 8 ml/min (p less than 0.01). Nitroprusside (1 microgram/kg/min) decreased mammary artery flow 12% +/- 2%, from 50 +/- 7 to 44 +/- 7 ml/min (p less than 0.01), but increased saphenous vein graft flow 25% +/- 8%, from 64 +/- 9 to 77 +/- 7 ml/min (p less than 0.01). All hemodynamic variables were unchanged, except for norepinephrine, which significantly increased the first derivative of left ventricular pressure. The results suggest that flow through the canine internal mammary artery is changed by the drugs commonly used in perioperative management. Epinephrine and nitroglycerin increased internal mammary artery flow and decreased saphenous vein graft flow, whereas nitroprusside had the opposite effect. The vascular reactivity of the internal mammary artery must be considered when these drugs are used after coronary revascularization.

Animals↗
PubMed1987

Emergency coronary bypass for cardiogenic shock.

Emergency coronary bypass for cardiogenic shock has been associated with a high operative mortality. From January 1983 through March 1986, 69 patients at Crawford W. Long Hospital underwent emergency coronary artery bypass. Seventeen of 69 were in shock, 15 with hypotension requiring treatment (intra-aortic balloon pump in 10; catecholamines in six). The other two patients had a low cardiac index and a pulmonary capillary wedge pressure greater than 25 mm Hg. Of these patients, nine presented with acute infarction, four with failed angioplasty, and four with uncontrollable angina. Four patients required cardiopulmonary resuscitation. After operation, 94% of the patients required catecholamine support and 71% were treated with an intra-aortic balloon pump. There were two hospital deaths (12%). The median postoperative stay for survivors was 9 days. Major complications occurred in 47%. Follow-up (100%, mean 20.5 months) revealed no late deaths, a 3 year survival of 88 +/- 8%, and a functional class of I in six patients, II in seven patients, and III in two patients. The nine patients who were working before operation all returned to work. Of the 52 emergency coronary bypass patients without shock, one patient died in the hospital (2%), 52% required catecholamines (p less than .05 vs shock group by chi-square analysis), and 12% required an intra-aortic balloon pump after operation (p less than .05 vs shock group by chi-square analysis). Median stay was 8 days. Complications occurred in 13% (p less than .05 vs shock group by chi-square analysis). Three year survival was 91 +/- 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Alfred Blalock.

Explore the source record for details and available documents.

Cardiology↗
PubMed1986

Importance of coronary artery anomalies in operations for congenital heart disease.

A congenital coronary artery anomaly influenced operative management of 21 children (34 operations) during a recent 8-year interval. This group represented 1.3% of cardiothoracic operations performed. Survivors included 5 of 10 children having correction of the left coronary artery from the pulmonary artery and 11 children having correction of intracardiac defects associated with major coronary arteries crossing the right ventricular outflow tract. Two children survived primary repair of injured major coronary arteries. Isolated coronary artery anatomy must be considered during management of intracardiac defects. Intraoperative injury to a major coronary artery requires meticulous repair.

Adolescent↗
PubMed1986

Reoperation for prosthetic valve degeneration after Konno aortoventriculoplasty.

Since the introduction of the aortoventriculoplasty procedure by Konno in 1975, 16 patients have undergone aortic root augmentation by this method at the Woodruff Medical Center of Emory University. In four patients bioprosthetic valve degeneration 2 to 5 years after the Konno procedure has necessitated repeat operation and replacement of the prosthetic aortic valve. Modification of the septal patch or repeat right ventriculotomy has not been required. One patient required an additional lateral anulus-enlargement procedure (Manouguian) whereas the other three have demonstrated stability or growth of the aortic anulus. We have not observed recurrent subvalvular stenosis or problems with the right ventricular outflow tract. Repeat operation after aortoventriculoplasty has been relatively simple and has usually involved only the supra-annular aorta.

Adult↗
PubMed1985

Avoidance of transverse midventricular disruption following mitral valve replacement.

From 1974 through 1977 when our hospital mortality for aortic valve replacement and myocardial revascularization was 3.5% and 1.1%, respectively, hospital mortality for mitral valve replacement (MVR) was 8.3% (13/156)--as high as 14.9% in 1976. Transverse midventricular disruption (TMD) was present in 7 of 10 patients on whom an autopsy was done and was clinically diagnosed in 3 others without postmortem examination. Transverse midventricular disruption presented as refractory myocardial failure immediately on termination of bypass or later (1 to 5 days) after an initial period of good hemodynamics. It appeared to result when volume loading or afterload pressure was returned to the untethered ventricle after MVR performed with potassium-induced, cold cardioplegia and ischemic arrest. Operative techniques were modified to preserve a portion of the mitral suspensory mechanism, to extend the reperfusion interval following cardioplegia and ischemic arrest, and to control strictly ventricular volume and pressure loading following bypass. By utilizing these methods, TMD was avoided from 1978 through 1982, and hospital mortality for MVR was 3.7% (9/241). The improved hospital mortality and avoidance of TMD did not result from patient selection. Allowing adequate time for recovery of the myocardium after cardioplegia plus ischemic arrest prior to ventricular loading, preservation of mitral suspensory function, and strict control of preload and afterload pressures have been effective in lowering hospital mortality for MVR and have eliminated TMD in a 5-year period.

Aged↗
PubMed1985

Combined treatment approach in surgical management of carcinoma of the esophagus: a preliminary report.

Surgical management of squamous cell carcinoma of the esophagus continues to be a controversial area in thoracic surgery. In a series of 20 patients, 15 received preoperative chemotherapy with cis-platinum (cisplatin), 2 received cisplatin plus 5-fluorouracil, and 3 received cisplatin plus vinblastine sulfate. Eighteen patients underwent en bloc esophagogastrectomy and postoperative radiation therapy. All patients were staged preoperatively by thoracoabdominal computed axial tomographic scan, bone scan, bronchoscopy, esophagoscopy, and barium swallow. Patients with liver or bone metastasis were excluded. The majority of patients received preoperative enteral hyperalimentation. Eighteen of the 20 patients completed the study with a follow-up of 12 to 24 months. There was 1 operative death, and 3 patients were in the hospital for more than three weeks after operation before they were discharged. Fourteen of the 18 patients survived for a year, and 11 survived for 12 to 24 months. Substantial reduction in mucosal disease and tumor burden based on preoperative barium swallow and endoscopy was evident in 11 of 18 patients, but in no patient was the tumor completely eradicated by preoperative chemotherapy. Although follow-up is short, this treatment regimen involving a combined treatment offers hope in the palliation of this disease.

Adult↗
PubMed1985

Management of the infected pacemaker: explantation, sterilization, and reimplantation.

From January, 1970, through December, 1984, nineteen infected or eroded pacemaker units were reimplanted in 17 patients. Characteristics of the patients, types of infecting organisms, surgical management, and complications are described. Optimal treatment of the infected generator pocket requires explantation of the generator unit with utilization of the in situ leads for pacing by an external-demand pacemaker unit. The generator unit is sterilized, and new leads are placed with relocation of the pocket. The old leads are then removed. This technique has been used safely and with excellent results for the past fourteen years.

Adolescent↗
PubMed1985

Myopotential inhibition of unipolar pacing in children.

Myopotential inhibition of unipolar demand pacing systems has been shown to be a frequent occurrence in adults with transvenous pacing systems in which the pulse generators are implanted adjacent to the pectoralis muscle. To evaluate this problem in children, most of whom have epimyocardial systems and abdominal wall generator implants, 50 patients underwent electrocardiographically monitored exercise and 24-hour ambulatory electrocardiograph monitoring. Patients' ages at the time of study ranged from less than one year to 18 years, and weights ranged from less than 5 kg to 63 kg. Sixteen different models of pulse generators from five manufacturers were involved. Pacing modes were VVI, DVI, AAI, VDD, and DDD. Forty-seven patients had epimyocardial systems. None of the patients was symptomatic as a result of myopotential inhibition. Only three patients (6%) had any evidence of myopotential inhibition and all three demonstrated this inhibition on both monitored exercise and ambulatory electrocardiograph. The inhibition was eliminated by reprogramming the sensitivity levels of the three generators without compromising R-wave sensing. Thirteen of the remaining 35 patients with multiprogrammable generators had induction of myopotential inhibition when exercised after temporary programming to maximal sensitivity settings. Myopotential inhibition of unipolar demand pacing appears to be less frequent and less problematic in the pediatric population, even though they are physically quite active. It is not clear whether this is a function of patient size or the abdominal wall position of the pulse generator.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1985

Improved myocardial recovery after cardioplegic arrest with an oxygenated crystalloid solution.

Possible enhancement of myocardial protection by oxygenation of a crystalloid cardioplegic solution was evaluated in a three-part study. In Part I, canine hearts underwent ischemia followed by heterogeneous cardioplegic arrest for 45 to 60 minutes. Oxygenation led to improved recovery in the left anterior descending region (47% versus 86% recovery, p less than 0.05) (15 minutes of ischemia) and in the circumflex region (9.5% versus 52% recovery, p less than 0.05) (30 minutes of ischemia). Part II was a blind prospective randomized study in 12 patients. It examined creatine kinase, myoglobin, and lactate as well as coronary sinus flow, oxygen consumption, and cardiac work 1 hour after aortic cross-clamping during atrial and during ventricular pacing. No significant difference was demonstrable between control and oxygenated solutions. In Part III, 57 coronary bypass patients were protected with a nonoxygenated solution while 94 patients received an identical oxygenated solution. Twelve-hour creatine kinase levels were similar in the nonoxygenated (9.5 +/- 16 IU, +/- standard deviation) and oxygenated (11 +/- 22 IU) groups if the cross-clamp interval was 28 minutes or less. In patients subjected to longer than 28 minutes of arrest, the 12 hour creatine kinase MB levels were more than twice as high in the nonoxygenated group (26.5 +/- 26 IU) compared to the oxygenated group (9.9 +/- 14 IU, p less than 0.05). In this canine model of heterogeneous cardioplegia and in the routine conduct of coronary bypass operations, oxygenated crystalloid cardioplegia is superior to an identical nonoxygenated solution.

Animals↗
PubMed1985

Right heart assist by intermittent abdominal compression after surgery for congenital heart disease.

Right heart assist after open heart surgery in children can be accomplished by inflation of a balloon beneath a tight cloth wrap on the abdomen. This device can be inexpensively constructed of ordinary equipment found in the intensive care unit. This is a review of the use of intermittent abdominal compression in 14 children (mean age 19 +/- 15 months, mean weight 8 +/- 4 kg) after operation at Henrietta Egleston Hospital. Primary diagnoses were tricuspid atresia physiology in five, atrioventricular canal in four, truncus arteriosus in one, tetralogy of Fallot in one, ventricular septal defect (VSD) in one, D-transposition of the great arteries in one, and aortic-left ventricular tunnel with VSD in one. Compression was used for an average of 16.3 +/- 11.4 hr. Displacement of blood from the abdominal viscera to the central circulation by balloon inflation led to elevation of right atrial pressure by 3.6 +/- 1.8 mm Hg (p less than .001) and consequent elevation of mean arterial pressure by 9.8 +/- 5 mm Hg (p less than .001). Urine output was improved in almost every instance. In 11 surviving children, the net fluid intake and output balance in the first 12 hr after application of intermittent abdominal compression was -154 +/- 219 ml (p less than .05). This simple method of intermittent abdominal compression was effective after a variety of operations for treatment of congenital heart disease and was especially useful after the Fontan procedure.

Cardiac Output↗
PubMed1985

Mediastinitis after cardiac valve operations. Impact upon survival.

Mediastinitis after cardiac valve replacement is a dreaded complication with consequent mortality estimated as high as 70%. We have reviewed 2,491 patients with cardiac valve operations to assess the impact of mediastinitis upon mortality in our institution in the past 10 years. Mediastinitis developed after valve replacement in 36 patients (1.4%). All patients required operative intervention for mediastinal infection with positive bacterial cultures. Twelve of these patients had other perioperative problems associated with a high mortality independent of mediastinitis: bacterial endocarditis not cured by valve replacement (three), recent preoperative myocardial infarction (four), triple valve disease with biventricular failure (one), and severe perioperative cerebral damage (four). Ten of these high-risk patients died (83.3%). The impact of mediastinitis upon survival is best evaluated in the remaining 24 patients without high-risk perioperative problems. Eight of these patients were managed before 1980 with débridement and irrigation as the primary treatment, with two hospital deaths (25%). Pectoral or rectus muscle flaps were frequently used after 1980 (flaps in 11 of 16 patients), leading to a significantly shorter time between diagnosis of infection and hospital discharge free of infection (62 versus 385 days, p less than 0.05). Only one of these 16 patients died. Valve re-replacement for endocarditis was performed in three of these 24 patients although 13 of 24 had positive blood cultures. Mediastinitis after valve operations in the absence of other high-risk perioperative problems can be successfully managed. Early débridement and muscle flap closure has led to a 94% survival rate in 16 patients during the past 4 years.

Adult↗