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Biomedical subjects

H Feigenbaum

Publications and source records attributed to H Feigenbaum.

At least 109 records · Page 6Linked to original sources
PubMed1980

Medical condition, adherence to treatment regimens, and family functioning. Their interactions in patients receiving long-term dialysis treatment.

Twenty-three medically stable patients receiving long-term dialysis treatment and their families were studied to investigate the relationship between medical condition, adherence to treatment, and patterns of family interaction. We found significant correlations between ratings of overall family functioning and overall medical condition, and a near-significant relationship between ratings of adherence to treatment and overall family functioning. In addition, specific family variables that related either to medical condition or to adherence were identified. Our findings suggest that family assessment can be used for early identification of patients at risk for poor adherence to treatment or poor medical progress. Furthermore, it may be possible to improve medical condition and adherence by working with the family in specific areas of family functioning found to be related to medical condition or adherence.

Adult↗
PubMed1980

Effect of atrial septal defect repair on left ventricular geometry and degree of mitral valve prolapse.

To ascertain the effects of surgical closure of atrial septal defect on left ventricular geometry and degree of mitral prolapse, 14 patients with atrial septal defect were studied by cross-sectional and M-mode echocardiography preoperatively and 7 days postoperatively. Seven of the 14 patients (50%) had mitral valve prolapse preoperatively by cross-sectional echocardiography. To quantitate the degree of prolapse, we measured the net algebraic area subtended by the apposed mitral valve leaflets in systole (MVAS) with respect to the mitral ring. The mitral valve prolapse group had an MVAS of 0.3 +/- 3.1 units (mean +/- SEM) preoperatively, while the group without mitral valve prolapse had an MVAS of 12.5 +/- 3.1 units (p less than 0.02). Postoperatively, prolapse either decreased in degree or was abolished in six of seven patients (86%), associated with an increase in MVAS to 14.7 +/- 4.4 units (p less than 0.02). In all patients, septal curvature in diastole on short-axis view normalized either partially or completely postoperatively, resulting in decreased left ventricular eccentricity (1.34 +/- 0.06 preop vs. 1.06 +/- 0.07 postop, p less than 0.001). Atrial septal defect closure, therefore, leads to normalization of left ventricular geometry and in patients with evidence of mitral valve prolapse, is associated with a decrease in the degree of prolapse.

Adult↗
PubMed1980

Evaluation of left coronary artery anatomy in vitro by cross-sectional echocardiography.

This study was undertaken to provide a better anatomic description of the location and course of the left coronary artery within a commonly used ultrasonic tomographic plane. Twenty-three hearts were excised at autopsy and scanned in vitro. The locations of the left main (LMCA), left anterior descending (LAD), and left circumflex (LCCA) coronary arteries were confirmed by direct cannulation, by Cardio-Green injection, and by subsequent dissection. While the proximal LMCA was recorded in all specimens, the entire LMCA was visible in only 70%. Proximal portions of the LAD and LCCA were also identifiable in 70% of examinations, and their spatial positions were defined. In most recordings, the first branch of the LAD OR LCCA arose distal to the segment seen echocardiographically. The spatial orientation of the ultrasonic beam relative to the LAD and LCCA and the presence of other overlying cardiac structures limit the imaging of these vessels by cross-sectional echocardiography to only their most proximal portions.

Adolescent↗
PubMed1980

Possible detection of atherosclerotic coronary calcification by two-dimensional echocardiography.

Using two-dimensional echocardiography, a technique was developed for digitizing reflected acoustic signals and performing variable signal processing. This resulted in accentuation of differences in focal reflectivity of target tissues and improved ultrasonic tissue characterization. Study of a learning population of 200 patients demonstrated abnormal specular reflections from the proximal left coronary artery in patients with coronary artery disease. A prospective study of 100 patients was then performed to test the reliability of this method in predicting the presence of significant stenosis. Abnormal echocardiograms were a highly sensitive (94%) but less specific (65%) indicator of significant atherosclerosis of the left coronary symstem. One-third of patients had fluoroscopically identifiable coronary calcification, and 95% had abnormal echocardiograms. We postulate that our echocardiographic findings may be secondary to the presence of small amounts of coronary calcification. Echocardiographic tissue differentiation, therefore, may prove to be a noninvasive means of evaluating patients for coronary atherosclerosis.

Aortic Valve Stenosis↗
PubMed1980

Aneurysms of the posterior interventricular septum with postinfarction ventricular septal defect. Echocardiographic identification.

Using real-time, two-dimensional echocardiographic techniques, we recently studied six consecutive patients with acute myocardial infarction complicated by rupture of the posterior interventricular septum. Each patient experienced an inferior wall myocardial infarction, with a prior anteroseptal infarction in one. In each case, the clinical course was punctuated by the onset of heart failure and a low output state prior to, or coincident with, the appearance of a pansystolic murmur. During two-dimensional echocardiographic study, all six were found to have a discrete aneurysm of the posterior interventricular septum. Septal dyskinesis produced bulging of the interventricular septum far into the right ventricular cavity during systole. Our findings suggest that (1) septal dyskinesis and aneurysm formation may be a valuable sign in diagnosing ventricular septal performation; (2) the reported incidence of postinfarction septal aneurysm at surgery or autopsy may significantly underestimate its true frequency; and (3) septal dyskinesis must by considered as a contributing factor to the compromised hemodynamic status of patients with postinfarction ventricular septal rupture.

Aged↗
PubMed1979

Serial echocardiographic appearance of healing bacterial vegetations.

Serial M mode and cross-sectional echocardiograms were obtained from six patients who had been treated with antibiotic drugs for infectious endocarditis. Three to six M mode echocardiograms and one to six cross-sectional echocardiograms were obtained from each patient over a follow-up period averaging 50 weeks (range 10 to 108 weeks). On echocardiography, vegetations were observed to have become smaller and more echo-reflective with healing. A dramatic change was seen in two patients after peripheral embolization. M mode echocardiography was particularly helpful in determining the quality of echo reflection by vegetations; cross-sectional echocardiography was more helpful in judging the size and shape of a vegetation. Echocardiography is ideally suited for the serial visualization of healing vegetations in patients who do not require early valve replacement. It may prove helpful to examine serially valve vegetations with both M mode and cross-sectional echocardiography when following up patients with infectious endocarditis treated with antibiotic agents.

Adult↗
PubMed1979

Mid systolic notching of the pulmonary valve in the absence of pulmonary hypertension.

In a patient with idiopathic dilatation of the pulmonary artery the pulmonary valve echogram showed a prominent mid systolic closing motion or notching indistinguishable from that seen in pulmonary hypertension. Normal right ventricular and pulmonary arterial pressures were recorded simultaneously with echocardiograms of the pulmonary valve.

Adult↗
PubMed1979

Right ventricular outflow tract assessment by cross-sectional echocardiography in tetralogy of Fallot.

Cross-sectional echocardiographic (CSE) studies were obtained in 29 children with tetralogy of Fallot. In this study we evaluated the capability of CSE to record the right ventricular outflow tract (RVOT) and compared the severity of infundibular obstruction determined by CSE with cineangiographic (cine) determinations. In addition, we examined capabilities of CSE and M-mode echocardiography (M-mode) to record the diagnostic features of tetralogy of Fallot, including RVOT obstruction, aortic overriding, ventricular septal defect, and presence of the pulmonary valve. An excellent correlation (r = 0.925) was found for the combined pre- and post-repair patients studied by CSE vs cine, while the correlation (r = 0.805) for M-mode was not as good. The difference was even more striking for the unrepaired patients, in which the correlation (r = 0.746) for CSE was much better than for M-mode (r = 0.374). In the unrepaired patients, CSE allowed easier detection of the ventricular septal defect than M-mode (95% for CSE vs 76% for M-mode). The pulmonary valve was recorded in 90% by CSE, but in only 26% by M-mode. Aortic overriding was recorded in all unrepaired patients both by CSE and M-mode. These data indicate that CSE is better than M-mode for recording the RVOT dimensions, ventricular septal defect, and the pulmonary valve in unrepaired patients with tetralogy of Fallot.

Aorta↗
PubMed1979

Long-term changes in mitral valve area after successful mitral commissurotomy.

We examined the long-term effects of closed instrumental mitral commissurotomy on mitral valve area (MVA) in 18 patients, followed for as long as 14 years after successful operation. Each patient had preoperative and early postoperative cardiac catheterization; late postoperative determination of MVA was obtained 10-14 years (mean 12.2 years) after commissurotomy. In 17 patients, the MVA was determined by cross-sectional echocardiography and in one patient by repeat cardiac catheterization. Thirteen of 18 patients had no change in MVA between early postoperative study (mean MVA = 2.7 cm2) and late postoperative study (mean MVA = 2.9 CM2). MVA in five patients decreased 0.7-2.2 cm2 (mean 1.4 cm2) during the follow-up period. In these five patients, the mean MVA at early postoperative study was 2.7 cm2 and at late postoperative study was 1.3 cm2 (p less than 0.001). At late postoperative evaluation, cardiac symptoms were associated with severity of mitral stenosis but did not predict restenosis. A successful, closed, instrumental mitral commisurotomy can provide substantial long-term improvement in MVA.

Cardiac Catheterization↗
PubMed1979

Comparison of M-mode and cross-sectional echocardiography in infective endocarditis.

Cross-sectional and M-mode echocardiograms were performed on 23 consecutive patients with infective endocarditis. Both M-mode and cross-sectional echocardiography identified vegetations in 18 patients, 10 of whom required valve replacement within 1 month of presentation. Cross-sectional echocardiography alone identified a vegetation in one patient with a prosthetic valve. Neither technique identified vegetations in five instances. The size and shape of a vegetation on cross-sectional echocardiography did not accurately predict the need for early valve replacement of the incidence of major peripheral emboli.

Adult↗
PubMed1979

Exercise cross-sectional echocardiography in ischemic heart disease.

We performed cross-sectional echocardiograms at rest, during supine bicycle exercise, and after sublingual nitroglycerin administration in 28 patients suspected of having ischemic heart disease. Technically adequate exercise cross-sectional echocardiograms were obtained in 20 patients (71%). Ten patients had new areas of reversible segmental dysynergy, and all 10 had significant stenoses of coronary arteries supplying areas of the heart corresponding to the location of reversible dysynergy. Six of these 10 patients also underwent exercise thallium-201 perfusion scanning, and all six had reversible perfusion defects in the area that demonstrated reversible dysynergy on exercise cross-sectional echocardiography. At least two of the remaining 10 patients who did not have reversible segmental dysynergy on exercise cross-sectional echocardiography probably experienced myocardial ischemia that we did not detect. We conclude that exercise cross-sectional echocardiography is technically difficult but feasible. The mechanical consequences of exercise-induced regional myocardial ischemia can be detected noninvasively by real-time, two-dimensional, cross-sectional echocardiography.

Adult↗
PubMed1978

Detection of myocardial scar tissue by M-mode echocardiography.

Wall thicknesses were measured and echo densities were evaluated from the left ventricular echograms of 182 patients. The echogram was considered to reflect scar tissue when 1) either the interventricular septum, the posterior left ventricular wall or the anterior left ventricular wall was less than 7 mm thick in mid-diastole and was more echo-producing than its opposing wall or another area of the same wall in a sector scan, or 2) an area of myocardium was 30% less thick than an adjacent area within a sector scan. Myocardial scarring was diagnosed by echocardiography in 52 of the 182 patients. The echocardiographic presence or absence of scarring was confirmed in 95% (173 of 182) of cases, 34 cases by microscopic examination and 139 by surgical appearance. This study shows that M-mode echocardiography is both a sensitive and specfic method for detecting myocardial scar tissue.

Coronary Angiography↗
PubMed1978

Cross-sectional echocardiographic characterization of aortic obstruction. 1. Supravalvular aortic stenosis and aortic hypoplasia.

Cross-sectional echocardiographic and cineangiographic studies of the left ventricular outflow tract and ascending aorta were performed in five patients with supravalvular aortic stenosis (four hourglass and one hypoplastic). Visualization of the area of obstruction was possible in each patient using the cross-sectional system. In each case the echocardiographically determined diameter at the level of obstruction was within 3 mm of the similar angiographic value. Assessment of the extent of the lesion was possible in four of five cases. In three of these four cases the echocardiographic measurement was within 5 mm of the angiographic measurement while in the fourth the obstruction was felt to involve the total ascending aorta by both techniques. Determination of percent decrease in LVOT diameter from the aortic anulus to the level of obstruction was useful in defining obstruction and estimating severity. Cross-sectional echocardiography is a valuable noninvasive method for evaluating the ascending aorta in patients with supravalvular aortic stenosis.

Adolescent↗