The purpose of this study was to determine the accuracy of Doppler-derived modal and maximum velocity and peak and mean acceleration of ascending aortic blood for the assessment of left ventricular systolic function. Studies were performed in six anesthetized open-chest dogs. Doppler-derived modal velocity, maximum velocity, and peak and mean acceleration were compared with left ventricular dP/dt, maximum aortic blood flow, and rate of blood flow measured with an electromagnetic flow probe under varying inotropic states. Maximum Doppler velocity showed better correlation (r = 0.94, y = 0.34 + 3.95) with maximum aortic blood flow than the modal velocity (r = 0.85, y = 1.49 + 3.85x). Peak acceleration also correlated better with the rate of blood flow (r = 0.92, y = 12.3 + 4.92x) than the mean acceleration (r = 0.83, y = 12.2 + 4.27x). Modal and maximum velocity and mean and peak acceleration correlated well with left ventricular dP/dt. We conclude that peak modal and peak maximum velocity and peak and mean acceleration are accurate measurements of left ventricular function. Maximum velocity and peak acceleration are more accurate than modal velocity and mean acceleration.

Animals↗

PubMedDate not supplied

Ascending aorta complications of cardiac surgery: CT evaluation.

Dissecting aortic aneurysms and pseudoaneurysms of the ascending aorta can occur secondary to clamping of the ascending aorta, incision of the great vessels, or secondary to aortic cannulation for cardiopulmonary bypass. Contrast-enhanced CT offers an excellent means of distinguishing between aortic pathology and other causes of mediastinal widening following cardiac surgery. Five cases are reported in which iatrogenic vascular lesions were identified on CT as the cause of postoperative mediastinal widening.

Adolescent↗

PubMedDate not supplied

CT diagnosis of an unusual aortic dissection with intimointimal intussusception: the wind sock sign.

A unique combination of CT findings is reported in a rare case of aortic dissection with intimointimal intussusception. The CT showed a wind sock-like appearance in the contrast column of the aortic arch, which was felt to be characteristic of the intussuceptum. Complementary CT findings, including proximal flap in the dilated root of the aorta, no mid-ascending aortic flap, a descending aortic flap, and pericardial effusion, enabled establishment of the preoperative diagnosis.

Aortic Dissection↗

PubMedDate not supplied

Intraoperative epiaortic ultrasound during cardiac surgery.

BACKGROUND AND AIMS: Recent evidence suggests that the incidence of stroke during cardiac surgery may be reduced by using intraoperative epiaortic ultrasound (IEU) to detect ascending aortic atherosclerosis (AAA). To better define the role of this modality, IEU was performed in 89 patients during elective cardiac procedures. METHODS: The ascending aorta and proximal arch were divided into four segments that were graded (0 to 2) on the extent of disease both by palpation and IEU. A patient score (range 0 to 8) was determined for each modality by summing the segmental scores. Operative plan was determined in part by IEU findings. Preoperative variables were evaluated for associated risk of AAA. Palpation and IEU scores were compared for their ability to identify AAA. RESULTS: Operative technique was modified to avoid AAA in ten (11.2%) patients (mean age 68.3 +/- 2.2 years; mean IEU score = 4.40 +/- 0.40). Stroke occurred in two patients (2.2%), one whose operation was modified to avoid severe AAA and another who had minimal AAA. Mean IEU scores were significantly higher for patients > or = 65 years compared with younger patients (1.35 +/- 0.26 vs 0.66 +/- 0.21; p < 0.05) and for smokers compared with nonsmokers (1.15 +/- 0.19 vs 0 +/- 0; p < 0.05). Mean patient IEU score was greater than mean palpation score (1.06 +/- 0.18 vs 0.74 +/- 0.16; p < 0.05). Sensitivity of palpation (based on 356 segments) was 0.46; however, specificity was 0.96, predictive power of a negative palpation exam was 0.88, and overall accuracy of palpation was 0.86. Thirty of the 38 false negatives resulted from failure to detect 1+ disease. None of the 63 (71%) patients with a palpation score of zero required a technical modification or had a stroke. CONCLUSIONS: These data suggest that AAA may be more severe in older patients and smokers. Aortic palpation may not identify mild AAA. IEU can confirm and clearly define both the extent and distribution of suspected AAA and is useful for determining optimal operative strategy in patients with aortic disease.

Adult↗

PubMedDate not supplied

Patients who die awaiting heart transplantation.

In the United States, heart donor availability has increasingly failed to keep pace with rising demand. Transplant data were obtained from the United Network for Organ Sharing for 1988, 1989, and 1990 and by survey of 50 heart transplantation centers, which performed 1932 transplantations between 1983 and 1989. According to the United Network for Organ Sharing, 512 patients on the waiting list died in 1988; 527, in 1989; 650, in 1990, and if present trends continue more than 800 will have died in 1991. Similar numbers of patients were inactivated or removed from the list each year. Only 49% of patients (1647 of 3390) on the heart transplant waiting list at some time in 1988 underwent the procedure in that year. For 1989 the figure fell to 42% (1630 of 3915 patients). Survey data revealed a threefold increase in the ratio of the number of patients who died/number of patients who underwent transplantation from 0.07 in 1983 to 0.21 in 1989 and in the ratio (number of patients who died+number of patients who were removed from the list)/number of patients who underwent transplantation from 0.12 in 1983 to 0.38 in 1989. The major causes of death among waiting patients were congestive heart failure (46%) and arrhythmia (29%). From 1983 to 1989, 55% (134 of 243) of those patients with documented urgency status died in the intensive care unit; 45% (109 of 243) died elsewhere. Waiting time for patients dying in the intensive care unit rose from 10.7 days in 1985 to 50.3 days in 1989; patients dying out of the intensive care unit waited 103.7 days in 1985 and 85.6 days in 1989. In conclusion, the number and proportion of potential recipients who die awaiting heart transplantation is increasing every year. Congestive heart failure and arrhythmia are the major causes of death, and similar numbers of patients die in and out of the intensive care unit.

Adolescent↗