Diagnosis of traumatic aortic rupture by transesophageal echocardiography.
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Aorta, Thoracic↗
Biomedical subjects
G S Reeder
Publications and source records attributed to G S Reeder.
Doppler echocardiography in aortic stenosis: feasibility and clinical impact.
The clinical utility of Doppler echocardiography for the assessment of aortic stenosis was prospectively studied in 425 consecutive patients referred to the echocardiography laboratory over 1 year with the clinical diagnosis of aortic stenosis. Optimal peak Doppler velocities were obtained in 405 (95%) patients of all ages. In 108 patients, the severity of aortic stenosis as determined by subsequent cardiac catheterization was compared with that found by Doppler assessment. Categorization of severity was concordant in 8 (89%) of 9 cases of mild aortic stenosis and in 28 (78%) of 36 cases of severe aortic stenosis, but there was considerable diagnostic overlap in cases of moderate stenosis. Forty-nine patients with mild aortic stenosis as determined clinically had moderate or severe stenosis as assessed by Doppler; 7 (14%) of these patients underwent subsequent replacement of the aortic valve. Increased aortic velocity, as determined by Doppler, was associated with a significant incidence of subsequent (mean follow-up period, 22 months) cardiac events (cardiac death, aortic valvar replacement, New York Heart Association functional class III or IV). Patients with mild aortic stenosis as assessed by Doppler (peak aortic velocity less than 2.5 m/sec) had greater than 95% event-free survival at 1 year and rarely required cardiac catheterization. Conversely, only 45% of patients with severe aortic stenosis as determined by Doppler were free of a cardiovascular event at 1 year. Although the noninvasive assessment of aortic stenosis should ideally include determination of the area of the aortic valve and the mean aortic gradient by Doppler echocardiography, this is not always possible. Prognostic information derived from peak aortic velocity alone is clinically useful. It has the additional advantage that it is much less laborious and time-consuming to obtain and is obtainable in almost all (99%) patients.
Aged↗
Expression of atrial natriuretic factor in the human ventricle is independent of chamber dilation.
This study investigated the presence of atrial natriuretic factor in ventricular tissue obtained from humans with dilated or restrictive heart disease. In 17 patients with ventricular dilation and impaired systolic function and in 8 patients with restrictive heart disease and preserved systolic function, the presence of ventricular atrial natriuretic factor was investigated in tissue obtained by ventricular endomyocardial biopsy. The objective of the study was to determine if the ventricular presence of atrial natriuretic factor is dependent on ventricular dilation. Left ventricular end-diastolic volume index was greater in the group with dilated cardiomyopathy than in the group with restrictive cardiomyopathy (134 +/- 13 versus 78 +/- 5 ml/m2, p less than 0.05); end-diastolic pressure was elevated in the two groups (20 +/- 2 versus 25 +/- 4 mm Hg, p = NS). With the use of immunohistochemical techniques, ventricular atrial natriuretic factor was clearly detected in 15 of the 17 patients with dilated cardiomyopathy and in 6 of the 8 patients with restrictive cardiomyopathy. This study demonstrates the high prevalence of ventricular atrial natriuretic factor in living patients with either systolic or diastolic dysfunction. Whereas in the atria, stretch or dilation may be an important stimulus, atrial natriuretic factor in the ventricular chamber occurs independent of dilation.
Atrial Natriuretic Factor↗
Contrast echocardiography and coronary collateral flow.
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Collateral Circulation↗
Percutaneous transluminal angioplasty in patients with multivessel coronary disease: how important is complete revascularization for cardiac event-free survival?
The relative influences of revascularization status and baseline characteristics on long-term outcome were examined in 867 patients with multivessel coronary disease who had undergone successful coronary angioplasty. These patients represented 83% of a total of 1,039 patients in whom angioplasty had been attempted with an in-hospital mortality and infarction rate of 2.5% and 4.8%, respectively. Emergency coronary bypass surgery was needed in 4.9%. Of the 867 patients, 41% (group 1) were considered to have complete revascularization and 59% (group 2) to have incomplete revascularization. Univariate analysis revealed major differences between these two groups with patients in group 2 characterized by advanced age, more severe angina, a greater likelihood of previous coronary surgery and infarction, more extensive disease and poorer left ventricular function. Over a mean follow-up period of 26 months, the probability of event-free survival was significantly lower for group 2 only with respect to the need for coronary artery surgery (p = 0.004) and occurrence of severe angina (p = 0.04). The difference in mortality was of borderline significance (p = 0.051) and there were no significant differences between groups 1 and 2 in either the incidence of myocardial infarction or the need for repeat angioplasty. Multivariate analysis identified independent baseline predictors of late cardiac events that were then used to adjust the probabilities of event-free survival. This adjustment effectively removed any significant influence of completeness of revascularization on event-free survival for any of the above end points including the combination of death, myocardial infarction and need for coronary artery surgery. Therefore, late outcome in these patients is not significantly influenced by revascularization status but depends more on baseline patient characteristics.
Age Factors↗
Intravascular ultrasound imaging: in vitro validation and pathologic correlation.
Intravascular ultrasound imaging is a new method in which high resolution images of the arterial wall are obtained with use of a catheter placed within an artery. An in vitro Plexiglas well model was used to validate measurements of the luminal area, and an excellent correlation was obtained. One hundred thirty segments of fresh peripheral arteries underwent ultrasound imaging and the findings were compared with the corresponding histopathologic sections. Luminal areas determined with ultrasound imaging correlated well with those calculated from microscopic slides (r = 0.98). Three patterns were identified on the ultrasound images: 1) distinct interface between media and adventitia, 2) indistinct interface between media and adventitia but different echo density layers, and 3) diffuse homogeneous appearance. The types of patterns depended on the relative composition of the media and adventitia. Calcification of intimal plaque obscured underlying structures. Atherosclerotic plaque was readily visualized but could not always be differentiated from the underlying media.
Adult↗
Percutaneous balloon valvuloplasty.
In the technique of percutaneous balloon valvuloplasty, one or more large balloons are inserted percutaneously and then inflated across a stenotic valve to decrease the degree of obstruction. Currently, the procedure is being performed for patients with pulmonic, mitral, or aortic stenosis. The results vary according to the type of valve and the age of the patient. In patients with pulmonic stenosis, balloon valvuloplasty can be performed safely and the results are excellent. Therefore, at many institutions it is the procedure of choice for the treatment of isolated pulmonic stenosis. In patients with mitral stenosis, the results depend on the morphologic features of the stenotic valve. In patients with highly calcified and fibrotic mitral valve leaflets, the risks of the procedure are increased and the results are suboptimal. In experienced hands, however, balloon valvuloplasty is excellent for patients with a pliable, noncalcified mitral valve or those for whom operation imposes an extremely high risk. The use of balloon valvuloplasty for aortic stenosis has been limited to the frail, elderly patient who either is not a surgical candidate or is at high risk for operation. Although mortality and restenosis rates are high on short-term follow-up, aortic balloon valvuloplasty provides palliation of symptoms in many patients who otherwise would have been unable to undergo any intervention. Long-term follow-up is necessary for determining the ultimate role of balloon valvuloplasty in cardiology.
Aortic Valve Stenosis↗
Percutaneous aortic balloon valvuloplasty: relief of obstruction to outflow or inflow?
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Aortic Valve Stenosis↗
Intravascular ultrasonography: image interpretation and limitations.
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Arteriosclerosis↗
Emergency "rescue" percutaneous transluminal coronary angioplasty after failed thrombolysis with streptokinase. Early and late results.
Although thrombolytic therapy has been a major advance in the treatment of acute myocardial infarction, in at least 25% of patients the artery remains occluded after administration. In these patients, the strategy of "rescue" or "salvage" angioplasty is frequently used although follow-up data are limited. Sixty-three patients underwent percutaneous transluminal coronary angioplasty (PTCA) after thrombolytic therapy for acute myocardial infarction. The decision to proceed with PTCA was based on physician preference and not a specific research protocol. In 34 of these selected patients, PTCA was performed as a rescue procedure because the infarct-related artery remained occluded (group 1); in 29 of these patients, it was performed to treat a severe but subtotal residual stenosis (group 2). PTCA successfully restored patency in 71% of group 1 and in 90% of group 2. Group 1 patients had a significantly worse baseline ejection fraction than did those in group 2 (47 +/- 13% vs. 58 +/- 13%, p = 0.0015). Group 1 patients also had a significantly worse predismissal ejection fraction (36 +/- 13% vs. 50 +/- 14%, p = 0.0004). During initial hospitalization, 14 (22%) patients underwent coronary bypass surgery. In-hospital mortality was low in each group (3% in group 1 and 0% in group 2). During a mean follow-up of 4 years, 89% of group 1 patients remained alive as compared with 97% of group 2 patients. This excellent 4-year survival rate, despite the depressed predismissal ejection fraction in patients undergoing rescue PTCA, raises the issue of whether acute reperfusion has a beneficial effect aside from any impact on myocardial salvage and preservation of left ventricular function.
Adult↗
Safety and efficacy of percutaneous transluminal coronary angioplasty performed at time of diagnostic catheterization compared with that performed at other times.
Performing diagnostic cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA) as a single, combined procedure might provide savings in patient hospitalization days and more efficient use of catheterization laboratory time. To assess the safety and efficacy of combined diagnostic coronary angiography and PTCA, we reviewed all elective PTCA procedures performed at our institution during 1985 and 1986 so that we could compare patients who had diagnostic angiography and angioplasty on separate days (n = 404) with those who had the combined procedure (n = 120). The success rate and incidences of urgent bypass surgery, acute myocardial infarction, transient azotemia and procedure-related death were not different in the 2 groups. The mean hospitalization time was 6.2 days in the group with combined angiography and angioplasty, and 7.3 days in the group having separate procedures.
Angiography↗
Optimal display of the coronary arterial tree with an upscan 1,023-line video display system.
Differences of opinion exist as to whether visualization of the coronary arterial tree is better with 525-line or 1,023-line video imaging systems. The 1,023-line acquisition has been associated with image degradation; 525-line display, however, has prominent raster lines that may also degrade the image. For evaluation of this issue, identical coronary arterial images were obtained with 525-line acquisition and then displayed with either 525-line or 1,023-line display. The 525-line acquisition with digital upscan 1,023-line display had superior image quality compared with 525-line display. With the use of 525-line acquisition and 1,023-line display, video images were similar to or slightly better than the identical cineangiographic images.
Cineangiography↗
Palliative percutaneous aortic balloon valvuloplasty before noncardiac operations and invasive diagnostic procedures.
Percutaneous aortic balloon valvuloplasty (PABV) is useful in palliating symptoms of severe aortic stenosis in patients who are not candidates for aortic valve replacement. In 15 patients who had severe aortic stenosis and a contraindication to aortic valve replacement, PABV was performed before a noncardiac procedure, in an attempt to improve their hemodynamics and reduce the risks associated with the operation or preoperative diagnostic test. The mean aortic gradient was reduced from 58.1 +/- 6.0 mm Hg to 32.2 +/- 4.0 mm Hg (P less than 0.0002), and the aortic valve area was increased from 0.49 +/- 0.04 cm2 to 0.85 +/- 0.10 cm2 (P less than 0.0002). Complications associated with PABV included left ventricular perforation in three patients (which resulted in death in one of them), transient congestive heart failure in one, and development of femoral pseudoaneurysms in one. After PABV, nine patients underwent the planned surgical procedure under general anesthesia without complications. Five patients underwent surgical diagnostic procedures after PABV that resulted in a change in treatment strategy. Three of these patients required no further treatment, and two required resection of the colon for bleeding, which was preceded by aortic valve replacement. This study demonstrates that PABV may be useful in reducing the risks of noncardiac procedures in selected patients with severe aortic stenosis who are otherwise not candidates for aortic valve replacement.
Aged↗
A new approach for dilation of bifurcation stenoses: the dual probe technique.
When coronary balloon angioplasty is performed on lesions that involve a major bifurcation in the coronary arterial tree, side-branch occlusion often results. Previously described strategies for avoiding this problem have been cumbersome and relatively impractical for routine application. In this report, we describe a simple method of dilating bifurcation lesions, made possible by recent innovations in angioplasty equipment. Two individual Probe dilation catheters are passed through a triple-armed Duostat adapter into a single guiding catheter. The bifurcation lesions are then sequentially traversed with the Probe catheters, after which the balloons can be inflated simultaneously or serially. Our early experience with this technique suggests that it is a safe, simple, and effective method to dilate bifurcation stenoses.
Aged↗
Continuous wave Doppler echocardiographic measurement of prosthetic valve gradients. A simultaneous Doppler-catheter correlative study.
Studies correlating prosthetic valve gradients determined by continuous wave Doppler echocardiography with gradients obtained by cardiac catheterization have, to date, been limited to patients with mitral and tricuspid prostheses or have compared nonsimultaneous measurements. Simultaneous Doppler and catheter pressure gradients in 36 patients (mean age, 63 +/- 13 years) with 42 prosthetic valves (20 aortic, 20 mitral, one tricuspid, and one pulmonary) were studied. Catheter gradients were obtained using a dual-catheter technique. The simultaneous pressure tracings and Doppler flow velocity profiles were digitized at 10-msec intervals to derive the corresponding maximal and mean gradients. The correlation between the maximal Doppler gradient and the simultaneously measured maximal catheter gradient was 0.94 (SEE = 6), and that between the Doppler gradient and the simultaneously measured mean catheter gradient was 0.96 (SEE = 3). There were no significant differences in correlation between gradients for the 32 mechanical valves (maximal gradients: r = 0.95, SEE = 6; mean gradients: r = 0.96, SEE = 3) and the 10 bioprosthetic valves (maximal gradients: r = 0.89, SEE = 6; mean gradients: r = 0.93, SEE = 3). In patients with mitral prostheses, Doppler gradients correlated well with the corresponding catheter gradients obtained with direct measurement of left atrial pressure (maximal gradients: r = 0.96, SEE = 2; mean gradients: r = 0.97, SEE = 1.2). A close correlation between corresponding Doppler and catheter gradients also was found in patients with aortic prostheses (maximal gradients: r = 0.94, SEE = 6; mean gradients: r = 0.94, SEE = 3). Thus, continuous wave Doppler echocardiography can accurately predict the pressure gradient across prosthetic valves.
Aged↗
Prolongation of ventricular depolarization. ECG manifestation of mexiletine toxicity.
Mexiletine is a type 1B antiarrhythmic drug similar to lidocaine. Prolongation of ventricular depolarization has not been previously reported with the usual oral dosage of mexiletine. We describe a patient with renal failure and heart failure on low-dose oral therapy who developed mexiletine toxicity, which was manifested by ECG prolongation of ventricular depolarization. This was confirmed by elevated plasma concentration of mexiletine. This case illustrates that contrary to the usual belief, mexiletine pharmacokinetics are altered by renal failure. It is important to monitor mexiletine therapy by plasma levels in patients with impaired renal function to avoid mexiletine toxicity.
Aged↗
Clinical follow-up after percutaneous aortic balloon valvuloplasty.
Percutaneous aortic balloon valvuloplasty has been applied in a growing number of patients with severe symptomatic calcific aortic stenosis. Follow-up data from these patients have not been well characterized. In 88 patients (mean age, 80 +/- 8 years) who underwent percutaneous aortic balloon valvuloplasty, the average initial aortic valve area was 0.48 +/- 0.20 cm2, and it increased to 0.74 +/- 0.26 cm2 after dilation. The average duration of follow-up in survivors was 7.8 months. Actuarial survival at 6 and 12 months was 75% and 63%, respectively. Factors associated with subsequent death included more severe impairment from heart failure at baseline, smaller initial aortic valve area, smaller final aortic valve area, low baseline cardiac output, and low ejection fraction. Among the surviving patients, 50% had no cardiac symptoms, and 85% had improved symptoms from congestive heart failure. Percutaneous aortic balloon valvuloplasty is associated with continued increased mortality during follow-up, although symptomatic improvement in survivors is good. Percutaneous aortic balloon valvuloplasty can be considered a palliative approach for severely symptomatic patients at high risk for aortic valve operation or patients with a limited life span due to other medical problems, but it is not indicated in patients at acceptably low risk for aortic valve replacement.
Aged↗
Results of percutaneous transluminal coronary angioplasty for angina pectoris early after acute myocardial infarction.
Between May 1980 and July 1985, 70 patients underwent percutaneous transluminal coronary angioplasty (PTCA) for angina occurring 24 hours after and within 30 days of acute myocardial infarction (32 with Q-wave infarction and 38 with non-Q-wave infarction). One-vessel disease was present in 42 (60%) and multivessel in 28 (40%); the mean ejection fraction was 0.56 (greater than or equal to 0.50 in 77% of patients). PTCA was successful in 56 patients (80%) and after introduction of steerable dilating systems in February 1983 this rate became 86%. The success rate for complete occlusions was 76%. The interval from myocardial infarction to PTCA was similar in patients with successful dilation (12.7 +/- 8.1 days) and those without (13.4 +/- 8.0 days). PTCA failed in 14 patients (20%); 8 underwent emergency coronary artery bypass for acute occlusion and 4 of 6 patients whose lesions could not be crossed had elective bypass surgery. There was 1 operative death. No patient sustained a Q-wave infarction. Three patients had non-Q-wave infarctions after technically successful PTCAs. Mean follow-up was 27 months (6 to 67 months). Of the 56 patients successfully dilated, 14 (25%) had 15 cardiac events during follow-up: death (1), non-Q-wave infarction (2), repeat PTCA (7), coronary bypass (4) and recurrence of severe angina (1). The cumulative mortality was 3% and the reinfarction rate was 7% (no Q-wave reinfarctions). Forty-two (60%) of the 70 patients were free of complicating events acutely and during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗