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Biomedical subjects

G N Olinger

Publications and source records attributed to G N Olinger.

At least 91 records · Page 5Linked to original sources
PubMed1982

Prevention of lipid accumulation in experimental vein bypass grafts by antiplatelet therapy.

The ameliorative effect of antiplatelet therapy on atherogenesis of vein grafts was assessed in autologous cephalic veins grafted into femoral arteries of 16 normolipemic and 11 hyperlipemic stump-tailed macaque monkeys. Before grafting, one half of each vein was distended at high pressure (700 mm Hg) and the other half at low pressure (350 mm Hg). Eight normolipemic monkeys were treated with aspirin, 80 mg/day, and dipyridamole, 50 mg/day, and eight were controls. When grafts were harvested at 12 weeks, tissue cholesterol and beta-apoprotein content in grafts from untreated monkeys were significantly higher than in ungrafted, uninjured veins. Antiplatelet therapy eliminated the increase in lipid content of vein segments distended at low pressure, and significantly lowered lipid content of segments distended at high pressure, though not to be control levels of ungrafted veins. Seven of the 11 hyperlipemic monkeys received antiplatelet drugs and four did not. The lipid content of all graft segments was significantly higher than in grafted or ungrafted veins from normolipemic monkeys. Antiplatelet therapy again significantly reduced the lipid content in vein segments distended at both levels of pressure, and also reduced the elevated cholesterol content in ungrafted veins. Although this animal preparation differs in many ways from human coronary bypass operations, these observations may be pertinent to the prevention of atherosclerosis in human vein bypass grafts.

Animals↗
PubMed1981

Ventricular septal rupture detected by cross-sectional echocardiography.

Cross-sectional echocardiography was used to directly visualize abnormal wall motion and detect the site of ventricular septal rupture in a patient with acute inferior myocardial infarction. The presence of the defect was confirmed by injecting indocyanine green into the left ventricle at the time of cardiac catheterization. Cross-sectional echocardiography provides a rapid, atraumatic means for evaluating patients with complicated acute myocardial infarction.

Aged↗
PubMed1981

Direct ascending aortic insertion of the "percutaneous" intraaortic balloon catheter in the open chest: advantages and precautions.

When intraoperative balloon pump support is needed for patients who cannot be weaned from cardiopulmonary bypass and when the balloon catheter will not pass retrograde into the aorta from the femoral artery, the catheter must be inserted into the ascending aorta directly. We have found that the new Datascope "percutaneous" balloon catheter offers many advantages for direct insertion into the ascending aorta, but certain precautions are necessary to prevent cerebral emboli when the percutaneous balloon catheter is used this way.

Aged↗
PubMed1981

Noncoronary collateral distribution in coronary artery disease.

Noncoronary collateral flow is a potential hazard when cold cardioplegia is used for myocardial protection. In this study, noncoronary collateral flow was observed during coronary revascularization in 58 patients. It was distributed significantly (p less than 0.005) toward arteries demonstrating intercoronary collateral flow angiographically - 1.0 of 35 with and 12 of 121 without. Preponderance of coronary collateral flow in hearts with more extensive disease may complicate cardioplegic myocardial protection for such patients.

Collateral Circulation↗
PubMed1981

Long-term follow-up of survivors of prehospital sudden coronary death.

Fifty-two survivors of prehospital sudden coronary death (SCD) were studied with angiography and cardiac catheterization. Coronary bypass surgery (CAB) was performed and combined with medical therapy in 24 patients and 28 patients were treated with medical therapy alone. Severity of coronary artery disease (CAD), left ventricular function, and clinical characteristics are described in the surgical and medical groups. Most patients had at least two-vessel CAD and left ventricular dysfunction was common. Nineteen of the 24 surgical (79%) and 17 of the 28 medical patients (60%) had a primary dysrhythmia without an associated acute myocardial infarction (MI) as the cause of their SCD. After a maximal follow-up of 80 months (mean 38.2 months in surgical group, 32.2 months in medical group), there have been 12 deaths. Eight of the 10 cardiac deaths occurred in patients showed initial SCD was related to ventricular fibrillation (VF) not associated with acute MI. Four of these 10 deaths were in the surgical group and six were in the medical group. Two surgical patients died in the early postoperative period; the other two died from recurrent VF 36 and 48 months after SCD. No perioperative or postsurgical MIs have occurred and only two patients have angina. In the medical group, five of the six deaths were caused by recurrent VF. Twelve patients have symptoms: angina in eight, heart failure in five and myocardial infarction in three. Nine of the 12 surgical patients (75%) who were employed before their SCD are still employed, while seven of 15 medical patients (47%) are employed. We conclude that the majority of survivors of prehospital SCD have severe CAD, although an associated acute MI at the time of SCD is uncommon. Coronary bypass surgery can be successfully performed in many of these patients and most are asymptomatic after surgery. The long-term results appear encouraging, although further studies are necessary to confirm these results.

Aged↗
PubMed1981

An improved method of topical cardiac hypothermia.

Current methods of myocardial protection usually employ together with topical hypothermia by pericardial lavage. Pericardial lavage is inconvenient, inconsistent, and noisy: it wastes blood: it cannot cool the right ventricle effectively. We use a new myocardial protection jacket to cool the heart during operation other than simple coronary bypass procedures. Myocardial temperatures are maintained at 7 degrees to 14 degrees C indefinitely without reinfusion of cardioplegia solution. The jacket is a more convenient and much more effective method of obtaining profound topical hypothermia.

Cardiac Surgical Procedures↗
PubMed1980

Noncardiogenic pulmonary edema and peripheral vascular collapse following cardiopulmonary bypass: rare protamine reaction?

Four instances of severe anaphylactoid reaction occurring subsequent to cardiopulmonary bypass are described. These catastrophic reactions, from which 2 patients died, took place approximately an hour following administration of protamine and were characterized by marked peripheral vasodilatation, loss of capillary membrane integrity, and fulminant noncardiogenic pulmonary edema. Primary cardiac depression was not evident. We hypothesize that protamine was the causative agent in these unusually severe reactions. Differential diagnosis from other causes of acute cardiorespiratory dysfunction depended on early assessment of pulmonary artery and left ventricular filling pressures, cardiac output, respiratory mechanics, and arterial blood gases. Therapy was difficult; success in 1 of the patients seemed to have been effected in part by prompt administration of high-dose corticosteroids and maintenance of peripheral vascular tone with an alpha-adrenergic agonist.

Aged↗
PubMed1980

Management of long-standing cardiocutaneous fistulas after resection of left ventricular aneurysms.

Cardiocutaneous fistulas arising from pledgets used in the closure of resected left ventricular aneurysms are rare but have serious implications. The case histories of four patients, each managed in a somewhat different manner, are presented. From this experience we recommend an aggressive approach to remove the infected pledgets once scar formation is complete and before erosion of the pledgets into the left ventricular cavity can occur.

Adult↗
PubMed1980

Aspergillus terreus infective endocarditis on a porcine heterograft valve.

We present the first reported case of Aspergillus endocarditis occurring on a porcine heterograft prosthesis and discuss the literature regarding both Aspergillus endocarditis and endocarditis on a porcine valve. A 65-year-old man underwent aortic valve replacement with a porcine heterograft. Several weeks later he exhibited signs of infection and then of valve failure. Upon removal, the porcine valve substance was found to be grossly infiltrated and destroyed by the Aspergillus organism. The porcine valve has an excellent reputation of being resistant to infection and relatively easy to sterilize by medical management alone. Several surveys attest to the low incidence of endocarditis. Because of our experience with the destruction caused by Aspergillus, however, and because antimicrobials generally fail to eradicate this organism, we urge prompt operation to remove the heterograft valve involved with infection by this organism. The valve diseased with Aspergillus should be replaced with a mechanical prosthesis. In the aortic position, extra-anatomic replacement should be considered to facilitate eradication of periannular infection postoperatively.

Aged↗
PubMed1979

Vasodilator effects of the sodium acetate in pooled protein fraction.

Paradoxical hypotension during rapid infusion of plasma protein fraction (PPF) has been attributed to vasodilation by bradykinin in PPF. This study employed a canine, controlled right heart bypass preparation to assess changes in systemic vascular resistance and venous capacitance during infusion of PPF and other possibly vasoactive mediators. Plasma protein fraction caused consistent vasodilation, whereas purified human albumin did not. This vasodilation could be ascribed entirely to acetate, present in PPF as a buffer. Bradykinin in PPF had no effect during venous infusion. Acetate is used widely as a buffer in intravenous and dialysate solutions. Its vasoactive properties must be recognized when such solutions are administered to patients with limited capacity to compensate for sudden vasodilation.

Acetates↗
PubMed1979

Intra-aortic balloon counterpulsation for cardiac support during noncardiac operations.

Major noncardiac surgery is a serious hazard to patients with advanced coronary disease. Perioperative infarction is common, and preliminary coronary bypass is often unwarranted. We suggest that the use of the intra-aortic balloon pump (IABP) for perioperative support of such patients makes perioperative infarction unlikely and permits otherwise hazardous operations. Three patients with advanced coronary disease (unstable angina in two) had major thoracotomies for lung masses without cardiac complications. This management plan has wider implications for other noncardiac surgical problems in such patients, particularly for mandatory operations wuch as relieving intestinal obstructions.

Aged↗
PubMed1979

Infected left atrial myxoma with bacteremia simulating infective endocarditis.

A 58-year-old man had intermittent fever of eight months' duration following a dental extraction. There were no abnormal cardiac auscultatory findings. Multiple blood cultures yielded Streptococcus mutans. Treatment for infective endocarditis was initiated; however, an echocardiogram suggested the presence of a left atrial myxoma. The diagnosis was confirmed by angiography and the infected tumor was removed successfully. Differentiating features between left atrial myxoma and mitral valve endocarditis may not be obvious clinically, and bacteremia does not preclude atrial myxoma as a diagnostic possibility. We therefore suggest that all cases of infective endocarditis be evaluated by echocardiography to elucidate lesions such as large vegetations or left atrial myxoma, both of which may require urgent operative intervention.

Diagnosis, Differential↗
PubMed1978

Ventricular venting during coronary revascularization: assessment of benefit by intraoperative ventricular function curves.

Although the physiological benefits of left ventricular venting during cardiopulmonary bypass have been documented experimentally, air embolus is still a concern clinically, and surgeons, therefore, continue to debate whether or not to vent routinely during coronary revascularization. In this study, 10 patients vented during revascularization and 10 not vented were studied immediately before and after cardiopulmonary bypass using Sarnoff ventricular function curves to assess changes in ventricular performance. Stroke work index by each patient before and after bypass was compared at common left atrial pressures and concomitant similar systemic resistances. In patients who were vented, there was overall no change in function (98 +/- 7% of control; range, 146--73%). In patients who were not vented, there was overall significant depression of function (67 +/- 5% of control; range, 91--45%, p less than 0.01). The overall absence of depression in patients who were vented, several of whom had very poor ventricles before bypass, strongly supports venting for coronary revascularization.

Cardiopulmonary Bypass↗