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Biomedical subjects

E Sivertssen

Publications and source records attributed to E Sivertssen.

At least 37 records · Page 2Linked to original sources
PubMed1982

Myocardial protection during aortocoronary bypass operations. Comparison of two different operative procedures: cold chemical cardioplegia versus intermittent cross-clamping of the aorta.

Myocardial injury was studied in 40 randomized coronary patients operated on electively with coronary bypass grafting using two different techniques, (A) cardioplegic arrest and continuous cross-clamping of aorta, and (B) ischaemic arrest and intermittent cross-clamping of aorta. The released quantity of the MB isoenzyme of creatine kinase was used as an indicator of myocardial injury. Of the whole group, 3 patients (8%) suffered a myocardial infarction as judged by ECG. The CK-MB release was not significantly different in the two groups. The total period of aortic cross-clamping was markedly longer in the cardioplegic group than in the intermittent clamping group. A significant correlation between the duration of aortic clamping and the amount of CK-MB release was found in the cardioplegic group. Our results indicate that the beneficial effects of cardioplegic arrest are outweighed by an unavoidable longer period of total aortic clamping as compared with the intermittent clamping technique.

Aorta↗
PubMed1982

Doppler ultrasound in mitral stenosis. Assessment of pressure gradient and atrioventricular pressure half-time.

In 16 patients with mitral stenosis (MS), alone or in combination with either mitral insufficiency (2 pats.) or aortic valve disease (3 pats.), the mean diastolic pressure gradients across the mitral valve calculated by Doppler ultrasound were significantly correlated to the catheterization data. The average mean pressure drop by Doppler was 11.8 mmHg and by catheterization at rest 16.7 mmHg. A significant correlation between gradients was also found in 5 patients who exercised supine on a bicycle. Atrioventricular pressure half-time (T1/2), i.e. the time during which the pressure drops from the peak value to half of its initial value by the Doppler technique, was significantly correlated to mitral valve area (MVA) determined from catheterization data. Increasing T1/2 reflected decreasing MVA. It is concluded that Doppler ultrasound is a useful method in the evaluation of patients with MS.

Adult↗
PubMed1981

Detection of mitral regurgitation by Doppler ultrasound. A comparison with left ventricular angiography.

Sixty-four patients with various heart diseases were evaluated for mitral regurgitation (MR) by left ventricular angiography and pulsed Doppler ultrasound within 2-3 days. Adequate Doppler recordings were obtained from 60 patients. The sensitivity of Doppler in detecting MR was 94%, specificity 90% and predictive value for a positive and a negative Doppler examination 90 and 93%, respectively. Two of the 3 false positive Doppler recordings were from patients with coronary heart disease, ischemic papillary muscle dysfunction may have caused MR inconsistently. Two false negative Doppler recordings may be related to problems in placing the ultrasonic sample volume at the systolic retrograde blood stream in the left atrial cavity. It is concluded that pulsed Doppler ultrasound, being a transcutaneous, non-invasive method, is a valuable tool in detecting MR. So far, we have not been able to quantitate the regurgitation.

Adolescent↗
PubMed1980

Functional evaluation of aortocoronary bypass surgery by exercise testing.

Exercise stress test was performed prior to and after aortocoronary bypass surgery in 91 male patients in an attempt to quantitate the change of physical capacity after operation and to correlate this to clinical improvement and late shunt angiography. The mean maximal work load was significantly higher after than prior to surgery in all groups. In average the maximal work load increased 65%. No difference was found between patients who were operated on for stable angina pectoris and those with unstable angina or impending myocardial infarction. Patients, who subjectively were without symptoms or much better after surgery, had a higher maximal work load after operation than those who were subjectively less improved or worse. In a sub-group of patients the maximal oxygen consumption was calculated in per cent of normal values for the age. The mean maximal oxygen consumption increased from 59% prior to surgery to 76% of normal values after surgery.

Angina Pectoris↗
PubMed1979

Escape rhythm in complete A-V block. The recovery phase after overdrive suppression from artificial ventricular suppression from artificial ventricular pacing.

In 60 patients with third degree A-V block, recovery of escape rhythm from overdrive suppression after ventricular pacing has been studied. Implanted unipolar VVI pacemakers were inhibited by chest wall stimuli. A total of 165 rhythmograms were studied. In 37, the rate was irregular, in the other 128 the escape rate increased gradually, following an exponential curve until stabilization after 3 minutes. In 29 of these rhythmograms, a possible exit block of the first escape impulse was observed. In 99 rhythmograms without exit block, escape rhythm recovery time was an average 1.45 times basal escape RR intervals. Overdrive suppression was most marked in patients with a slow escape rhythm.

Cardiac Pacing, Artificial↗
PubMed1979

Left ventricular function after aortocoronary bypass surgery.

Aortocoronary bypass operations without additional myocardial surgery or valve replacement were performed at Ullevål Hospital in 190 patients during the period May 1971 to Dec. 1975. Postoperatively re-examination was made by left-heart catheterization in 124 patients at a mean interval of 18.2 months and right-heart catheterization in 108 patients at a mean interval of 16.0 months after surgery. The mean postoperative values for PCVP at rest, PCVP during exercise, LVEDP before contrast and LVEDP after contrast were significantly lower than the mean pre-operative values. The difference between pre- and postoperative values were largest in patients with elevated PCVP or LVEDP values before surgery, whereas in patients with low pre-operative values the mean values after surgery were unchanged or increased. The results indicate that marked improvement of left ventricular function may occur after aortocoronary bypass operations, even in patients with signs of ventricular failure at rest. A stress test is, however, of importance in evaluating the haemodynamic consequences of coronary surgery. No difference was found in patients with single versus patients with double or triple shunts. Post-operative shunt occlusion was found in 44 of 258 grafts at re-examination. No difference was found between patients with all shunts patent and patients with one or more shunts occluded as regard to mean postoperative PCVP and LVEDP values.

Adult↗
PubMed1978

Cardiac arrhythmias in patients with serious pulmonary diseases.

During a 5-year period, 1969-1973, 451 patients with acute severe pulmonary diseases were admitted to the three medical intensive care units (MICU) at Ullevaal Hospital. In 39% of the patients a major cardiac arrhythmia was recorded in the units during a mean observation time of 24 h. The subsequent mortality in the hospital was 31% in patients with arrhythmias in the MICU, and 8% in patients without arrhythmias. The association between arrhythmias and mortality was significant (P less than 0.004) in patients with a diagnosis of pneumonia. There was also an association (P less than 0.04) between arrhythmias and the severity of lung disease. Continuous electrocardiographic monitoring of patients with severe pneumonia or acute exacerbations of obstructive lung disease is recommended.

Acute Disease↗
PubMed1977

Aorto-coronary vein bypass and valvular surgery.

During the period 1972--1975, 26 patients underwent valvular surgery combined with aorto-coronary saphenous vein bypass at Ullevål Hospital, Oslo. Aortic valve replacement was performed in 13 patients, mitral valve replacement in 8 and double valve replacement in 3 patients. The Björk-Shiley tilting disc valve was used in all cases. A Carpentier ring was inserted in one case and an open mitral commissurotomy was performed in another. Twenty-nine saphenous vein grafts were inserted. Three early deaths (all patients in functional class IV (NYHA)) were due to myocardial failure. There were 2 late deaths (both patients in functional class III before operation) of which one was due to myocardial infarction and the other to ventricular fibrillation. The overall mortality was 19%. At follow-up with a mean observation time of 11 months, 19 of the 21 survivors were improved at least one functional class. Only 2 patients had mild angina pectoris. No valvular dysfunction was found. Twenty-one of 22 re-examined grafts were patent (95% graft patency). Valvular surgery combined with aorto-coronary vein bypass in this material shows low mortality and good clinical and haemodynamic results in patients in functional class II and III. Patients should be operated upon before they reach functional class IV, as the mortality in that group is very high.

Adult↗
PubMed1976

Pacemaker wires and electrodes. A follow-up study.

In 362 patients on permanent pacing, a follow up with regard to pacemaker electrode function time and connection to pulse-generators has been carried out. In 12 patients Elema epicardial electrode were used with an average function time of 3.8 years. 232 Elema EMT 588 endocardial electrodes were used in 216 patients. Average observation time for the electrodes was 3.3 years. Sixty-eight electrodes have been followed for more than 5 years. Early electrode complications comprise 10 per cent of displacements before implantation of the pulse-generator and another 6 per cent of electrode displacements within the first 3 months after implantation. Eleven per cent of the electrodes had to be corrected due to high threshold value before implantation and another 6 per cent during the first 3 months after implanattion of pulse-generator. On hundred and fifty-five unipolar electrodes of the types Cordis, Medtronic, Elema EMT 282, and Stanium were implanted in 149 patients. Average observation time for the electrodes were 1.2 years. During the first 3 months after pacemaker implant 7 per cent of the electrodes were dislocated, 5 per cent failed due to high threshold value. Three perforations of the right ventricle occurred, without serious complications. Late complications i.e. after 3 months, for EMT 588 electrode included 4 per cent electrode dislocations, 4.5 per cent failure due to high threshold, 3 cases of wire break and 4 defects in the insulation. Many of the late electrode complications were probably caused by replacement operations for pulse-generators. The most frequent late complications for the conventional unipolar electrode was wire break which occurred in 5 cases.

Arrhythmias, Cardiac↗