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Biomedical subjects

D D Sugrue

Publications and source records attributed to D D Sugrue.

At least 55 records · Page 3Linked to original sources
PubMed1985

Surgical treatment of accessory atrioventricular pathways and symptomatic tachycardia in children and young adults.

Twenty-seven patients aged 21 years or younger (mean 15) with symptomatic tachycardia underwent operation for ablation of an accessory atrioventricular pathway. Six patients had associated Ebstein's malformation of the tricuspid valve. Supraventricular tachycardia had been present for a mean of 5 years. At electrophysiologic study, 4 patients were found to have 2 accessory pathways. Left ventricular free wall pathways were found in 14 patients, right ventricular free wall pathways in 10 and septal pathways in 6. Successful initial ablation of all the pathways was achieved in 26 of the 27 patients. No patient died perioperatively and none had persistent complete heart block. During a mean follow-up of 11 months, no patient had recurrence of an arrhythmia related to the accessory pathway. Thus, the surgical treatment of children and young adults with accessory atrioventricular pathways and symptomatic supraventricular tachycardia is safe and effective. For these patients, unless the tachycardia can be easily controlled with a minimal number of drugs and adverse effects, surgical ablation should be considered early in the clinical course.

Adolescent↗
PubMed1985

Histologic abnormalities of the left ventricle in a patient with arrhythmogenic right ventricular dysplasia.

Right ventricular histologic abnormalities have been described in association with arrhythmogenic right ventricular dysplasia, but the cause of the disease is unknown. Identical abnormalities were noted in endomyocardial biopsy specimens from the right and left ventricles of a 20-year-old male patient with the clinical syndrome of arrhythmogenic right ventricular dysplasia. Left ventricular function was normal at rest and during bicycle exercise. Eighteen months previously, he had shown clinical and serologic evidence of mycoplasmal myocarditis. Arrhythmogenic right ventricular dysplasia may represent predominant involvement of the right ventricle in a generalized cardiomyopathic process, possibly as a consequence of healed myocarditis.

Adult↗
PubMed1985

Refractory supraventricular tachycardia in the neonate: treatment with temporary antitachycardial pacing.

Although intracardiac antitachycardial pacing techniques are frequently used to terminate reentrant supraventricular tachycardia in adults, this approach has rarely been used in neonates. We describe two neonates, both of whom were in circulatory shock due to recurrent paroxysmal supraventricular tachycardia, who were treated with temporary antiatachycardial pacing. This approach allows repeated termination of the tachycardia at the bedside until an adequate therapeutic concentration of an effective drug regimen is achieved and obviates repeated direct-current cardioversion.

Cardiac Pacing, Artificial↗
PubMed1985

Errors in gated equilibrium radionuclide measurements of resting left ventricular ejection and filling.

An assessment was made of the reproducibility (between study differences) interobserver variability and intraobserver variability of 7 radionuclide measurements describing both resting left ventricular ejection (ejection fraction--EF, average ejection rate--AVER, peak ejection rate--PER, time to peak ejection rate--TPER) and filling (average filling rate--AVFR, peak filling rate--PFR, time to peak filling rate--TPFR). Gated blood pool studies were performed one week apart in 42 patients and between study correlation coefficients for these measurements ranged from r = 0.58 (TPER) to r = 0.99 (PFR) but there were spontaneous changes in measurements of up to 82% (AVER). Interobserver variability was determined in 44 studies. Correlation coefficients for measurements obtained by two independent observers in 44 studies ranged from r = 0.87 (AVER) to r = 0.96 (TPFR) but spontaneous changes of up to 52% occurred (AVFR). Intraobserver variability was determined in 53 studies and correlation coefficients ranged from r = 0.95 (AVER) to r = 0.99 (AVFR, PFR). The maximum percentage difference between observations was 46% (AVER). Use of correlation coefficients alone to assess the reproducibility of these measurements fails to highlight the marked spontaneous changes which occur in left ventricular function. Changes in radionuclide indices describing left ventricular function in response to a therapeutic intervention must be interpreted in the light of these findings.

Adolescent↗
PubMed1985

Coronary artery disease and haemostatic variables in heterozygous familial hypercholesterolaemia.

Haemostatic variables were measured in 61 patients with heterozygous familial hypercholesterolaemia, 32 of whom had evidence of coronary heart disease. Age adjusted mean concentrations of plasma fibrinogen and factor VIII were significantly higher in these patients than in the 29 patients without coronary heart disease, but there were no significant differences in serum lipid concentrations between the two groups. Comparisons in 30 patients taking and not taking lipid lowering drugs showed lower values for low density lipoprotein cholesterol, high density lipoprotein cholesterol and antithrombin III, and a higher high density lipoprotein ratio while receiving treatment. The results suggest that hypercoagulability may play a role in the pathogenesis of coronary heart disease in patients with familial hypercholesterolaemia.

Adult↗
PubMed1985

Tachycardia induced myocardial dysfunction. A reversible phenomenon?

Four patients with myocardial dysfunction related to tachycardia underwent electrophysiological studies, which showed a re-entrant supraventricular tachycardia using an accessory atrioventricular connexion. Serial assessment of left ventricular function by echocardiography before and after control of the tachycardia indicated a variable degree of reversibility. Endomyocardial biopsy in two patients detected non-specific histological changes. Because of the possible role of ischaemia in this condition effective control of prolonged tachycardia is needed to prevent deterioration of myocardial function.

Adolescent↗
PubMed1984

Effect of amiodarone on left ventricular ejection and filling in hypertrophic cardiomyopathy as assessed by radionuclide angiography.

Left ventricular (LV) function at rest was assessed by radionuclide angiography in 30 patients with hypertrophic cardiomyopathy (HC) before and during treatment with amiodarone (600 to 800 mg for 1 week, 200 to 400 mg/day thereafter) for an initial maintenance period of 1 month in 30 patients and 6 months in 12 patients. The reproduciblity of the measurements was assessed by performing control studies within 24 hours in 13 patients and at 1 to 6 months in 6 patients, and 95% confidence limits for spontaneous change were determined. There was a significant decrease in heart rate at 1 month (from 67 +/- 9 vs 61 +/- 9 beats/min, p less than 0.004) with no further decrease at 6 months. Systemic blood pressure did not change. After amiodarone therapy, for each of the measurements of LV function except peak ejection rate, there was no mean change and the number of patients in whom the values increased and decreased by more than the 95% confidence limits were approximately equal. Peak ejection rate showed a significant decrease at 1 month, but this effect was not maintained at 6 months; 4 of 6 patients who showed a significant decrease at 1 month were reevaluated at 6 months, and in all 4 the values had returned to control levels. These findings suggest that the 95% confidence limits for spontaneous change were not wide enough and that chronic oral amiodarone therapy does not alter radionuclide indexes of LV function at rest in patients with hypertrophic cardiomyopathy.

Adolescent↗
PubMed1984

Carotid sinus hypersensitivity and syncope.

The patient with a hypersensitive carotid sinus reflex and syncope may pose special challenges in evaluation and treatment. Specifically, although the finding of carotid sinus hypersensitivity may indeed indicate an exaggerated vagal tone that causes syncope, it may also be a chance association in a patient with syncope due to another cause. Careful clinical and electrophysiologic testing may be needed to distinguish these two possibilities. Furthermore, the need for drug therapy or cardiac pacing (or both) must be determined on an individual basis, depending on the relative contributions of cardioinhibitory and vasodepressor components to the patient's symptoms and also on the degree of patient limitation.

Aged↗
PubMed1984

Cardiac histologic findings in patients with life-threatening ventricular arrhythmias of unknown origin.

Percutaneous endomyocardial biopsy (right ventricle in 10, left ventricle in 2) was performed in 12 patients, aged 9 to 57 years, with serious ventricular arrhythmias occurring in the setting of normal cardiac anatomy and mechanical function. Light microscopic examination of tissue revealed histologic abnormalities in 11 patients, including myocardial cellular hypertrophy in 7, interstitial fibrosis in 5, endocardial fibrosis in 2, myocardial degenerative changes in 1 and increased interstitial cellularity in 1. One patient had histologic evidence of acute lymphocytic myocarditis. Thus, a majority of patients with serious ventricular arrhythmias and normal cardiac anatomy had histologic abnormalities, bringing into question the concept of primary electrical heart disease or idiopathic ventricular tachycardia.

Adolescent↗
PubMed1984

Electrophysiologic testing in the upright position: improved evaluation of patients with rhythm disturbances using a tilt table.

Patients are traditionally evaluated in the supine position in the electrophysiology laboratory, although symptoms due to a cardiac rhythm disturbance are often maximal clinically during standing. The assumption of the upright position results in dependent displacement of blood, followed by prompt vasoconstriction to maintain arterial pressure. This normal response may aggravate tachyarrhythmias by increasing catecholamine levels or may precipitate vasodepressor syncope if the vasoconstrictor response is absent. The use of a tilt table during electrophysiologic testing was evaluated over a 12 month period in 104 patients having a mean age of 60 years (range 37 to 81): 59 with supraventricular tachycardia, 6 with vasovagal syncope and 39 with carotid sinus hypersensitivity. Twenty-three patients (22%) had significant abnormalities when upright that were not present when supine: eight patients with supraventricular tachycardia who had their clinical syndromes of palpitation and syncope reproduced when upright, but only minimal symptoms when supine; two patients with supraventricular tachycardia who had sustained atrioventricular reentry when upright, but only two to eight beats of tachycardia when supine; six patients with syncope and a normal cardiac evaluation before electrophysiologic testing who had their typical spells only after being placed upright during a vasovagal event and seven patients with carotid sinus hypersensitivity who had their clinical syndromes reproduced with carotid sinus massage only when upright, developing hypotension despite maintaining their heart rate with sinus rhythm or pacing (vasodepressor response). In 22% of patients, electrophysiologic testing in the upright position provided clinically important information that was not evident during standard testing in the supine position.

Adult↗
PubMed1984

Right ventricular dilated cardiomyopathy.

Fourteen patients with predominantly right sided dilated cardiomyopathy were studied, of whom five died suddenly. The condition is characterised by male preponderance, syncope, ventricular tachycardia, which typically has a left bundle branch block pattern on the surface electrocardiogram, and right heart failure. The diagnosis should be considered in patients presenting with otherwise unexplained ventricular tachycardia or syncope; the diagnosis may be readily missed because of the nonspecific nature or absence of signs.

Adolescent↗
PubMed1984

Prevalence of coronary artery disease in patients with isolated aortic valve stenosis.

The prevalence of significant coronary artery disease (reduction in luminal diameter by more than 50%) among 88 consecutive patients with aortic stenosis requiring aortic valve replacement at Hammersmith Hospital was examined. Twenty two (34%) patients had significant coronary disease. Nineteen of 42 (45%) patients with typical angina had coronary disease; three of 20 (15%) patients with atypical chest pain had coronary disease, while none of 26 patients free of chest pain had significant coronary disease. Risk factors for coronary disease were equally distributed among patients with and without significant luminal obstruction. Because of the small, but definite, hazard of coronary arteriography and in the interest of cost containment it is suggested that patients with aortic stenosis who are free of chest pain do not require routine coronary arteriography. This applies particularly to patients requiring urgent aortic valve replacement.

Adult↗
PubMed1984

Relation between left ventricular gradient and relative stroke volume ejected in early and late systole in hypertrophic cardiomyopathy. Assessment with radionuclide cineangiography.

Hypertrophic cardiomyopathy is characterised by hyperkinetic left ventricular function, but the effect of an outflow tract gradient on the haemodynamics of ejection remains controversial. To determine the functional importance of left ventricular gradients in hypertrophic cardiomyopathy technetium-99m gated equilibrium radionuclide angiography was performed in 18 normal subjects and 57 patients, 26 with and 31 without left ventricular gradients. Time activity curves were generated from list mode data, and the proportion of stroke volume ejected during various phases of systole was computed. The proportion of stroke volume ejected during the initial third, the initial 50%, and the initial 80% of systole was greater in patients with hypertrophic cardiomyopathy than in normal subjects but was identical in patients with and without left ventricular gradients. The duration of systole was similar in the three groups. These findings favour the interpretation that a left ventricular gradient does not represent true obstruction and are consistent with previous observations that clinical features and prognostic indicators do not relate to gradients in this disease.

Adolescent↗
PubMed1984

A review of thyroid disease in pregnancy.

Goitre is common and alterations in biochemical indices of thyroid function are invariable during pregnancy , but thyroid disease, of which hyperthyroidism is the most frequent (0,05% of 72,257 pregnancies at three Dublin Maternity Hospitals, 1979-81) is rare. Good results in terms of perinatal loss (4/112, 3.57%) has been achieved by one of us (MID) in 109 pregnancies using antithyroid drugs alone. Neonatal thyrotoxicosis occurs in one to two percent of babies born to mothers with thyroid disease. The condition is usually transient but a prolonged course may occur in up to 20 percent. Successful pregnancy is possible despite maternal hypothyroidism; three such pregnancies have been managed by one of us (MID). Clinical hyperthyroidism due to trophoblastic disease is very rare and is cured by evacuation of molar tissue. The course of thyroid cancer is not affected by pregnancy.

Antithyroid Agents↗
PubMed1983

Long term follow-up of hyperthyroid patients treated by subtotal thyroidectomy.

The early and long term complications of subtotal thyroidectomy in 306 hyperthyroid patients (multinodular goitre and diffuse hyperplasia) followed for up to 30 yr are reviewed. There were no perioperative deaths. Sixteen patients (5.2 per cent) had transient symptomatic hypocalcaemia, while 9 (2.9 per cent) had permanent hypocalcaemia. Permanent unilateral vocal cord paralysis occurred in 11 (3.6 per cent) patients (1.8 per cent of nerves at risk). Cumulative per cent (+/- s.e.m.) relapse and hypothyroid rates at 30 yr (life-table analysis) were 15.6 +/- 2.4 per cent and 20.5 +/- 2.1 per cent, respectively. Lifelong follow-up of post-thyroidectomy patients is mandatory because of the risk of relapse of hypothyroidism.

Adolescent↗
PubMed1983

Assessment of right ventricular function and anatomy using peripheral vein infusion of krypton 81m.

A method for imaging the right side of the heart (atrium, ventricle and main pulmonary artery) and for assessment of RV systolic function (ejection fraction and ejection rate) is described. An ultra-short-lived isotope (81Krm) is continuously eluted in 5% dextrose and infused into an ante-cubital arm vein; standard multigated images are acquired using a gamma camera and commercially available software. Preliminary evaluation of the method in 55 subjects (20 with repaired tetralogy of Fallot, 14 with dilated cardiomyopathy and 21 normal volunteers) showed that the technical success rate was 100%; that RV boundaries free from LV overlap can be clearly visualised due to efficient exhalation of 81Krm through the lungs and that 81Krm measurements of RVEF are reproducible. The technique offers considerable potential for serial non-invasive assessment of RV function.

Cardiomyopathy, Hypertrophic↗