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Biomedical subjects

E Glassman

Publications and source records attributed to E Glassman.

At least 37 records · Page 2Linked to original sources
PubMed1984

Use of two-dimensional echocardiography during transseptal cardiac catheterization.

Inadvertent puncture of the intrapericardial aorta is a serious complication of transseptal catheterization. Two-dimensional echocardiography allows delineation and spatial resolution of the aorta and interatrial septum. Thirteen patients underwent transseptal catheterization with simultaneous monitoring of needle and catheter position using fluoroscopy and two-dimensional echocardiography. The interatrial septum was demonstrated in the short-axis and four chamber views, and clearly separated from the ascending aorta. The transseptal needle and catheter were visualized by echocardiography while the needle tip was manipulated into the fossa ovalis avoiding puncture of the aortic root. In some cases, under pressure from the needle tip just before puncture, the interatrial septum appears to bulge toward the left atrium. Saline solution contrast echocardiography helped to confirm the needle position in the right atrium, and in the left atrium after puncture. These data suggest that two-dimensional echocardiography is a useful adjunct to fluoroscopy during transseptal catheterization that may improve its safety and prevent complications.

Adult↗
PubMed1984

The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study.

One hundred twenty-two consecutive patients (104 men; 18 women) were studied to determine the incidence and natural history of pericardial effusion occurring 2, 5, 10, and 20 to 50 days after cardiac surgery. Three patients had pericardial effusions before and 103 patients (91 men; three women) had effusions after surgery. Effusions were first recorded on the second postoperative day in 72 patients, on the fifth postoperative day in 29 patients, and on the tenth postoperative day in two patients. In 96 of these patients, effusions reached their maximum size by postoperative day 10. Of the 103 patients with effusions, 66 (64%) were followed to complete resolution. A specific pattern was observed in most resolving effusions. The echo-free space diagnostic of pericardial effusion became progressively more echo-dense as the effusion diminished in size. As the effusion became echo-dense, the posterior pericardium, which had been motionless, resumed its normal systolic anterior motion. One patient developed cardiac tamponade on postoperative day 3. We conclude that pericardial effusion occurs frequently after cardiac surgery, but that associated complications are rare.

Adult↗
PubMed1983

'Pulsatile' left atrial-femoral artery bypass. A new method of preventing extension of myocardial infarction.

A left atrial-femoral artery (LA-FA) bypass system was designed to deliver synchronous pulsatile blood flow. We compared it with nonpulsatile LA-FA bypass in its effectiveness to limit infarct extension after ligation of the left anterior descending coronary artery at its origin in 35 dogs. Nonpulsatile LA-FA bypass resulted in a 70% reduction in the size of infarct. The addition of synchronous diastolic counterpulsation (P-LA-FA) further reduced the size of infarct, when compared with that in controls (95%) or animals that underwent LA-FA bypass (83%). Both LA-FA and P-LA-FA bypasses limited infarct extension and reduced mortality after acute coronary occlusion through effective unloading of the left ventricle. The addition of diastolic counterpulsation to LA-FA bypass led to further significant infarct reduction, when compared with LA-FA bypass alone. These effects were most likely secondary to improvements in myocardial blood flow distribution.

Animals↗
PubMed1983

The swift increase in alcohol metabolism (SIAM) in four inbred strains of mice.

Ethanol metabolism increases two to three hours after the administration of ethanol. This phenomenon, called the Swift Increase in Alcohol Metabolism (SIAM), has been compared in four inbred strains of mice (DBA/2J; C3H/HeJ; AKR/J; C57BL/6J). Basal rates of ethanol elimination were determined in individual mice after intraperitoneal injections of ethanol. Little variability in this basal rate of ethanol elimination was observed within each strain. Mice were then exposed to ethanol vapor for 4 hours. In both injected and treated mice the dose of ethanol was varied to produce blood ethanol levels ranging from 50 to 250 mg%. Ethanol elimination increased maximally 1.5 to 4-fold in all four strains following 4 hours of vapor treatment at the same blood ethanol level; however, the dose at which the maximal increase occurred differed among the strains. DBA/2J mice exhibited a maximal increase in the rate of ethanol elimination when ethanol concentrations were in the range of 30 to 50 mg%; the increase was smaller as the dose was increased. In contrast, AKR/J and C57BL/6J mice required 100 to 150 mg% ethanol to activate SIAM. These data indicate clearly that the SIAM effect is a common phenomenon, and that dose-response relations differ in various inbred strains of mice.

Animals↗
PubMed1983

Late functional and hemodynamic status of surviving patients following insertion of the left heart assist device.

Since July, 1978, we have inserted a roller pump type of left heart assist device between the left atrium and ascending aorta in 35 patients. There were no significant complications related to use of the device. Seventeen patients recovered sufficiently to have the device removed. There were four early deaths, 60 to 120 days following removal of the device. Three of these patients died of septic complications and one patient died as a result of a cardiac arrest. Of the 13 long-term survivors, seven are working and six are retired. Five patients have mild to moderate cardiac symptoms, whereas eight others are completely asymptomatic. In three patients the ejection fraction was significantly lower than preoperatively; however, in all other patients the ejection fraction either stayed the same or improved postoperatively. We conclude that this type of left heart assist device can provide adequate cardiac support in patients with profound left ventricular dysfunction following cardiac operations. Furthermore, surviving patients generally have satisfactory long-term cardiac function and are leading productive lives.

Adult↗
PubMed1983

Left atrium-to-femoral artery bypass: effectiveness in reduction of acute experimental myocardial infarction.

The effects of prompt institution of left atrium-to-femoral artery (LA-FA) bypass on myocardial infarct area (AI) as a percentage of myocardial area at risk for infarction (AR) during a 4 hour period following ligation of the left anterior descending coronary artery (LAD) were studied in 26 dogs. Following LAD ligation, baseline measurements of myocardial tension-time index (TTI) and regional myocardial blood flow (RMBF) were obtained. Group I (controls, n = 16) received no further support. Group II (LA-FA bypass, n = 10) underwent left ventricular unloading via LA-FA bypass beginning 15 minutes after coronary occlusion. Four hours after LAD occlusion, measurements of TTI and RMBF were repeated in both groups. Just before sacrifice, gentian violet was injected into the aortic root to delineate the AR. The hearts were then removed and sectioned transversely through the left ventricle (LV) and septum. The AR (that ventricular area not perfused by gentian violet) was measured by planimetry and compared to the AI as identified by incubation of heart slices in triphenyltetrazolium chloride dye. In comparisons of control versus LA-FA bypass groups, both AI/LV (21.6% versus 10.4%) and AI/AR ratios (73.7% versus 21.8%) were significantly reduced in the bypass group (p less than 0.005). Mortality in the control group (5/16, 31.2%) was significantly greater (p less than 0.005) than in the bypass group (0/10, 0%). Mean TTI over the 4 hour ischemic period was essentially unchanged in the control group as compared to a reduction of 62.8% in the bypass group (p less than 0.005). Furthermore, RMBF at 4 hours was significantly improved in all regions of the LV in hearts undergoing LA-FA bypass when compared with control hearts (p = 0.025). These results demonstrate by a consistent method that prompt institution of LA-FA bypass significantly reduces the mortality associated with acute coronary artery occlusion, as well as the total AI and AI/AR. The protective mechanisms provided by LA-FA bypass probably include the highly significant reduction of LV work and the opening of new bridge collateral blood vessels with redistribution of blood flow to the ischemic region.

Animals↗
PubMed1982

Long-term survival with partial left heart bypass following perioperative myocardial infarction and shock.

During the period from July 1, 1978 to Dec. 31, 1980, we employed a partial left heart bypass (left atrium to ascending aorta) in 16 patients who could not be weaned from cardiopulmonary bypass with inotropic agents and the intra-aortic balloon pump. Flow rates up to 3,500 ml/min could be obtained with this device. Eight of the 16 patients survived and left the hospital. One patient died of a cardiac arrest 4 months postoperatively and one has recurrent angina and moderate congestive heart failure 24 months postoperatively. Six patients are well 5 to 17 months after discharge. Seven of the eight deaths were characterized by progressive myocardial failure. One patient died of ventricular fibrillation 18 hours after discontinuation of the left heart bypass. All survivors had significant improvement in ventricular function 12 to 24 hours afer institution of the left heart bypass, which was continued for 16 to 68 hours. These results indicate that early institution of left heart bypass in seriously ill patients can provide satisfactory long-term results.

Aged↗
PubMed1982

Swift increase in alcohol metabolism (SIAM) in the mouse: comparison of the effect of short-term ethanol treatment on ethanol elimination in four inbred strains.

Ethanol metabolism increases 2 to 3 hr after the administration of ethanol. This phenomenon, called the swift increase in alcohol metabolism, has been compared in four inbred strains of mice (DBA/2J, C3H/HeJ, AKR/J and C57BL/6J). Basal rates of ethanol elimination were determined in individual mice after an i.p. injection of ethanol (2 g/kg). Little variability in this basal rate of ethanol elimination was observed within each strain. Mice were then exposed to ethanol vapor (20--22 mg/l) and rates of ethanol elimination were determined every 2 hr for 8 hr. By 2 to 3 hr, the rates of ethanol elimination initially increased 2- to 3-fold and then declined toward basal rates over the 8-hr interval in all strains studied. In another experiment, the dose of ethanol was varied to produce blood ethanol levels ranging from 50 to 250 mg/100 ml in both basal- and ethanol vapor-treated mice. Ethanol elimination increased greater than 1.5-fold in all four strains studied when basal rates were compared to rates observed after 4 hr of vapor treatment at the same blood ethanol level; however, the dose at which the maximal increase occurred differed among the strains. DBA/2J mice exhibited a maximal increase in the rate of ethanol elimination when ethanol concentrations were in the range of 30 to 50 mg/100 ml; the increase was smaller as the dose was increased. In contrast, AKR/J and C57BL/6J mice required 100 to 150 mg/100 ml of ethanol to activate the swift increase in alcohol metabolism effect. These data indicate clearly that the swift increase in alcohol metabolism effect is a common phenomenon and that dose and time relations differ in various inbred strains of mice.

Animals↗
PubMed1981

Transvenous intracardiac echocardiography.

A specially designed ultrasonic transducer, 0.2 mm in length and 0.75 mm in diameter, operating at 7.5 megahertz and mounted on a thin flexible coaxial cable was advanced to the distal tip of a right heart or transseptal catheter in 20 patients during cardiac catheterization. Left atrial, aortic root and right atrial cavity size, pulmonary arterial diameter at various sites, right ventricular wall thickness and the width of a pericardial effusion were demonstrated. Tricuspid, pulmonary, and aortic valves were seen and their motion displayed. With the transducer positioned at the tip of a transseptal needle it could be recognized when it made contact with the interatrial septum. Puncture into the left atrium, avoiding such structures as the aorta, was facilitated in this fashion. No complications were encountered in any patient. Intracardiac echocardiography appears to be a safe, valuable adjunct to both conventional echocardiography and cardiac catheterization. Furthermore, recordings of structures that may be difficult or impossible to obtain with routine external echocardiography may be made possible.

Aortic Valve↗
PubMed1979

Mechanism of relief of angina after coronary bypass surgery: an angiographic study.

Coronary angiography was performed before and after coronary revascularization in 67 patients. The interval between studies ranged from 1 to 38 months (average 9.9). The patients were separated into four clinical groups on the basis of their symptoms at the time of restudy; Group I, 13 asymptomatic patients; Group II, 19 patients with nonanginal chest pain (18 cases) or dyspnea (1 case); Group III, 12 patients whose angina was relieved but not eliminated; and Group IV, 23 patients whose angina was not alleviated. The graft patency rate was 72 percent in Group I, 78 percent in Group II, 61 percent in Group IIII and 34 percent in Group IV. The sum of diseased, but not bypassed and unsuccessfully bypassed arteries per patient was 1.6 in Groups I and II. 2.9 in Group III and 4.0 in Group IV. The incidence of perioperative myocardial infarction, defined using enzymatic and electrocardiographic criteria, was 8 percent for Group I, 26 percent for Group II, 25 percent for Group III and 52 percent for Group IV. Anginal relief after coronary bypass surgery is achieved by successful and complete revascularization rather than by perioperative myocardial infarction.

Angina Pectoris↗
PubMed1977

Left internal mammary--left ventricular fistula after Vineberg operation.

This communication presents an unusual complication in a patient who underwent the Vineberg procedure with the formation of an internal mammary to left-ventricular fistula, which caused a new apical diastolic murmur. This represents a previously unreported etiology for the appearance of an apical blowing diastolic murmur.

Coronary Disease↗