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Biomedical subjects

G L Hines

Publications and source records attributed to G L Hines.

36 records · Page 2Linked to original sources
PubMed1979

Intra-aortic balloon pumping: two-year experience.

Experience with 29 patients who underwent intra-aortic counterpulsation between January, 1975, and December, 1977, was reviewed to determine (1) if the results of this method of treatment were similar at the community hospital and university hospital levels and (2) if earlier institution of counterpulsation made possible by easy availability of equipment resulted in improved survival. The balloon was successfully inserted in 27 patients. Arterial blood pressure was below 80 mm. Hg in all patients prior to institution of either pharmacologic or balloon therapy. Pulmonary capillary wedge pressure was greater than 12 mm. Hg in the 22 patients in whom it was measured. In 15 patients counterpulsation was instituted less than 12 hours after infarction (Group A), and in the 14 elapsed time was greater than 12 hours (Group B). There was no difference in precounterpulsation hemodynamic measurements between Group A and Group B. Ten patients in Group A were weaned and survived hospitalization. Seven (54 percent) are long-term survivors (6 months to 2 years). Four are in New York Heart Association Class I, two are in Class II, and one is in Class III. Ten patients in Group B were weaned, seven survived hospitalization, and five are long-term survivors (35 percent). Two are in N.Y.H.A. Class I, two are in Class II, and one is in Class III. These results indicate that counterpulsation is possible at the local hospital level and that early institution of the intra-aortic balloon pumping may improve long-term results.

Assisted Circulation↗
PubMedDate not supplied

Current thoughts on the management of renovascular disease.

Renal artery stenosis has long been recognized as a cause of systemic hypertension, and has more recently been identified as a cause of progressive renal insufficiency. The diagnosis of renal artery stenosis often has been overlooked because of the difficulty in establishing the diagnosis. Until recently, surgical intervention has been the only therapeutic modality available. This article will review some recent advances in imaging modalities, particularly duplex ultrasound and magnetic resonance angiography, which have allowed easier visibility of the renal vessels. Second, the introduction of renal percutaneous transluminal angioplasty, with and without stent placement, has made operative intervention more attractive. The early and short-term results of this procedure are discussed and compared with surgical experience. Finally, the implications for using these newer interventional techniques for minimally symptomatic renal artery stenosis are reviewed.

Angioplasty↗
PubMedDate not supplied

Physiologic and pathologic evaluation of chronic extra-aortic counterpulsation with latissimus dorsi flap. Preliminary results.

This study attempted to evaluate the efficacy of chronic extra-aortic counterpulsation with a latissimus dorsi neuro vascular flap. Five dogs had a preliminary procedure consisting of the creation of a latissimus dorsi flap and a thoracotomy in which the flap was wrapped around the descending aorta just distal to the left subclavian artery. An epicardial lead was placed on the left ventricle and a nerve stimulating lead placed around the thoraco-dorsal nerve. Three weeks later, both leads were connected to a cardiomyostimulator programmed to function in a counterpulsation mode with a 1:2 assist frequency. Hemodynamic measurements were made at 6 and 8 and 10 and 12 weeks and the dogs were sacrificed. Three dogs had all sets of hemodynamic measurements made. Two of the three dogs demonstrated diastolic augmentation at 6 and 8 and 10 and 12 weeks average 20 to 25 mmHg. The third dog failed to demonstrate any change. All dogs were sacrificed at 12 weeks and specimens were submitted for histologic evaluation. The muscle flap was preserved in all animals. The aorta subjacent to the flap showed, (1) normal intima with no evidence of disruption or thrombus in all animals, (2) in the animals in whom counterpulsation was observed, there appeared to be thinning of the media in the aorta subjacent to the muscle flap, and (3) no evidence of distal emboli. This study demonstrated that chronic counterpulsation can be obtained with a latissimus dorsi flap. The actual hemodynamic benefits are not determined from this study. The medial thinning in the aortic wall may limit the long-term benefit of this procedure.

Animals↗
PubMedDate not supplied

The effect of asanguinous cardioplegic arrest on atrial preservation using atrial ATP as a marker.

Changes in atrial adenosine triphosphate (ATP) and the presence of postoperative arrhythmias were studied in 14 patients during routine coronary artery bypass grafting to 1) attempt to evaluate atrial preservation, and 2) determine if a relationship exists between changes in ATP and the development of postoperative arrhythmias. Atrial biopsies were obtained at the time of cannulation (preischemic sample) and after the removal of the aortic crossclamp (postischemic sample). Methods of myocardial protection included systemic hypothermia (28 degrees C), periodic reinfusion of crystalloid cardioplegia into the aortic root and completed vein grafts, and iced slush in the pericardial well. Atrial temperature was monitored. Preischemic ATP was 0.412 +/- 0.32 mu mol/gm, and the postischemic value was 0.220 +/- 0.13 mu mol/gm (p less than .02). Atrial temperature routinely decreased to 13-18 degrees C after cardioplegic infusion but rose to 24 degrees C between infusions. There was no correlation between postoperative supraventricular arrhythmias (4 patients) and changes in ATP. In conclusion, routine coronary artery bypass grafting with standard methods of cardiac preservation does not appear to satisfactorily preserve atrial tissue. The clinical correlation and significance of this remains to be elucidated.

Adenosine Triphosphate↗
PubMedDate not supplied

Crossover femoral-popliteal and femoral-tibial bypass.

Crossover femoral-popliteal or femoral-tibial bypass has been employed as an alternative extra-anatomic bypass in 3 patients who had occlusion of an iliac artery with subsequent occlusion of the ipsilateral femoral artery with patency of either a popliteal or tibial artery and a patency of the contralateral common femoral artery. Each patient had a contraindication to a more conventional type of procedure. All procedures were performed with reinforced PTFE grafts. All grafts have remained patent for 6 months to 3 years. This operation should be considered as an alternative extra-anatomic reconstructive procedure in patients with the appropriate anatomy and who are not candidates for more standard types of vascular reconstruction.

Aged↗
PubMedDate not supplied

Papaverine hydrochloride as an adjunct to asanguinous cardioplegia, is it beneficial?

Papaverine hydrochloride was added to a standard asanguinous cardioplegic solution to study its effect on cardioplegic distribution by evaluating coronary resistance, myocardial temperature, and postoperative enzyme changes. Seventeen patients were randomized into a control group (8 patients) and a papaverine group (9 patients). All patients received 300 cc of a standard asanguinous cardioplegic solution into the aortic root after systemic cooling to 28 degrees C and measurement of septal temperature (To). The duration of infusion (t1), root pressure (p1), and septal temperature (T1) were recorded. All patients received a subsequent infusion of 200 cc of cardioplegia to which had been added either 10 cc normal saline (control group) or 1 mg papaverine hydrochloride in 10 cc normal saline (papaverine group). Time of infusion, root pressure, and septal temperature (t2, p2, T2) were recorded. Coronary resistance was calculated. Postoperative CPK and CPK-MB were recorded and compared. Mean high CPK in the papaverine group was 163 units and 182 units in the control group. There was no statistically significant difference in any parameter between groups. This study, in contradistinction to experience with animal research models, failed to demonstrate any significant value in adding papaverine hydrochloride to standard cardioplegic solutions.

Body Temperature↗
PubMedDate not supplied

Near fatal hemolysis following repair of ostium primum atrial septal defect.

A 15 month old black male who developed near fatal intravascular hemolysis two days after repair of an ostium primum septal defect with a teflon patch is presented. One month after initial operation, reoperation was required for control of hemolysis. At that time a piece of pericardium was placed over the underendothelialized left atrial side of the patch and the mitral cleft was repaired. He initially did well but within several days developed mitral regurgitation. Hemolysis recurred two months postoperatively, but then spontaneously subsided. We propose that the recurrent mitral insufficiency created a defect in the pericardial patch and that caused recurrent hemolysis. Normal endothelial ingrowth probably covered this small defect and hemolysis subsided. Following the second hemolytic episode six months ago, the patient continues to do well.

Anemia, Hemolytic↗
PubMedDate not supplied

Congenital diaphragmatic hernia in the adult.

The onset of symptoms from a congenital posterolateral (Bochdalek Hernia) defect is rare in the adult. We are reporting a 25-year-old female with a previously asymptomatic Bochdalek hernia who presented with acute intestinal obstruction. The abnormal embryology, pathophysiology, and clinical manifestations of this condition in the adult are discussed.

Adult↗
PubMedDate not supplied

Femoral-femoral bypass. Non-invasive hemodynamic evaluation.

Seven patients who underwent femoral-femoral by pass between June 1980 and September 1982 underwent pre-operative angiography and pre and post-operative non-invasive evaluation to determine: (1) the hemodynamic effects created by the crossover graft, and (2) if angiographic findings would be predicative of post-operative results. The mean ankle/arm (a/a) index in the donor extremity changed from 0.82 +/- 0.20 to 0.70 +/- 0.27 (NS). The a/a index in the recipient extremity increased from 0.39 +/- 0.30 to 0.74 +/- (p less than 0.02). One patient developed a "steal" syndrome. There was no correlation between angiographic findings and post-operative changes. This study demonstrated a significant increase in recipient extremity ankle pressure and a clinically insignificant decrease in donor limb pressure.

Aged↗
PubMedDate not supplied

Avulsion of the innominate vein during median sternotomy.

Two cases of disinsertion of the left innominate vein from the superior vena cava (S.V.C.) during primary median sternotomy have been encountered during the past 6 years. Methods of management consisting of either (1) ligation and division of the left innominate vein and patch angioplasty of the SVC injury, or (2) patch angioplasty of the disinsertion injury itself with preservation of the left innominate vein are presented. The rationale and possible complications of each method of treatment are discussed based on the anatomy and collateral circulation of the left innominate vein and other experiences with division of the left innominate vein.

Aged↗
PubMedDate not supplied

Rupture of non-traumatic thoracic aneurysms into the right hemithorax.

The natural progression of arteriosclerotic descending thoracic aneurysms results in rupture in a high percentage of patients. Reports of surgical experience with these problems are not common although much as been written about elective resection of thoracic aneurysms. Two patients with ruptured non-traumatic descending thoracic aneurysms are presented. hemorrhage into the right hemithorax was a presenting manifestation in both patients. The mechanism for this type of rupture is discussed. Both patients were operated upon with one survivor. Preoperative evaluation, operative approach, and methods of bypass are discussed.

Aged↗