Congenital absence of the pericardium: report of a case.
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Adult↗
Biomedical subjects
H Goldberg
Publications and source records attributed to H Goldberg.
The combined use of computed tomography and endoscopic retrograde cholangiopancreatography in the assessment of suspected pancreatic neoplasm: a blind clinical evaluation.
Sixty-one consecutive patients suspected of having pancreatic neoplasms had endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT). The ERCP results were 62% accurate, 8% false negative, and 3% failure. The overall accuracy in cases of successful pancreatic duct cannulation was 88%. The results of CT were 76% correct, 5% false positive, 13% false negative, and 6% indeterminate. Excluding ERCP failure, the CT-ERCP diagnosis was identical in 67%. When findings were identical, the accuracy rate was 93%, high than that of either study alone. The ERCP-CT examinations were often complementary and generally led to a more accurate and specific diagnosis.
Adult↗
Tricuspid regurgitation: clinical and angiographic assessment.
Because previous attempts to diagnose and quantitate tricuspid regurgitation (TR) by angiography have been unreliable, 60 patients with mitral or combined mitral and aortic valve disease had right ventriculography using a special preshaped catheter. A clinical diagnosis of TR was confirmed in 45% of the patients with moderate and severe TR. A pansystolic murmur increasing in intensity with inspiration, a pulsatile liver, and a prominent CV wave in the jugular veins when present together were specific for severe TR but were seen in only 30% of the patients with severe TR but were seen in only 30% of the patients with severe TR (3+ or 4+). Ventricularization of the right atrial pressure contour was specific for severe TR but was seen in only 40% of the patients with severe TR. A normal right atrial mean pressure (RAP) did not exclude TR, but a rise in RAP or an unchanged RAP with deep inspiration was seen in all patients with TR. Similar findings were observed in two patients with severe pulmonary hypertension who had no TR. There was no relation between the magnitude of this rise in RAP, the degree of pulmonary hypertension, and the severity of TR. The use of a special preshaped catheter tends to avoid the induction of premature beats, and right ventriculograms with a preshaped catheter may be useful in diagnosing TR.
Blood Pressure↗
The posterior thoracic approach in echocardiography.
Echocardiograms were recorded using a left posterior thoracic approach in 17 patients with left pleural effusion. Comparison of these records with those obtained using the conventional technique in the same patients revealed that the left posterior thoracic approach yielded records of adequate quality in all patients. The mitral valve, the left ventricle, and the posterior pericardium were well defined. In 10 patients in whom pericardial effusion was also p;esent, the posterior approach facilitated clear separation of the pleural and pericardial effusions. A major limitation of the posterior technique appears to be inability to record the aortic root, the aortic valve, and the left atrium.
Echocardiography↗
Cardiac specific antigen and antibody in immunopathogenesis of cardiac disease.
Antibody to human cardiac extracts was detected in the sera of many patients undergoing open heart surgery. A passive hemagglutination assay using cardiac extracts as antigen coated onto erythrocytes showed the development of cardiac antibody in the patients, with peak titers usually one to three weeks after the surgery. Radioimmunoassay revealed the presence of cardiac specific myoglobin antigen antigen in the sera of many patients, with peak levels 1-3 days after the procedure. A correlation was observed between development of circulating serum antibody and appearance of cardiac myoglobin antigen. These results support the view that immunologic disease related to release of cardiac antigen in patients undergoing heart surgery may be a factor in post-cardiotomy disease.
Antibodies↗
A new technique: right ventriculography using a preshaped catheter.
Right ventriculography with a preshaped catheter (J- or L-shaped) was evaluated in make the diagnosis of tricuspid regurgitation. Thirty normal subjects who did not have valvular disease showed no evidence of tricuspid regurgitation or premature ventricular contractions during injection except in one case. On the other hand, 24 patients with combined aortic and mitral valve disease showed mild to moderate tricuspid regurgitation in 11 patients and severe tricuspid regurgitation in eight patients. Only two patients developed frequent run of premature ventricular contraction during injection. Seven patients with severe tricuspid regurgitation were found to have severe tricuspid regurgitation during surgery. No evidence of tricuspid regurgitation was found in all six patients with isolated aortic valve disease. We can conclude that right ventriculography by the preshaped catheter improves the diagnostic accuracy of tricuspid regurgitation and a grading system of tricuspid regurgitation by angiography is proposed.
Aortic Valve↗
Echocardiographic assessment of a Blalock-Taussig shunt.
A case of echocardiographic confirmation of the patency of a Blalock-Taussig anastomosis is presented. Using the left atrium-to-aortic ratio (LA/Ao), we could document an increase in left atrial size representing an increase in pulmonary blood flow. This is the first report using echocardiography to prove the patency of a systemic-to-pulmonary artery anastomosis.
Echocardiography↗
Alterations in regional cerebral hemodynamics and metabolism produced by focal cerebral ischemia.
Since diffuse changes in blood flow and metabolism occur in the brain following a focal ischemic insult, changes of cerebral blood flow on the side opposite a cerebral infarction were observed. We have examined the course of the cerebral hemodynamic changes occurring in 15 patients with unilateral acute strokes. In 12 of these patients, significant blood flow changes (over 15%) occurred in the nonischemic hemisphere during the period of observation. A similar time course of change was found in the ischemic hemisphere and the flow changes in the two hemispheres appeared parallel to one another (diaschisis). Thus we have demonstrated a significant reduction in flow in the contralateral cortex following a unilateral ischemic insult. This reduction in flow was of the order of 38% from the control value which agrees quite well with the reduction in cortical glucose consumption of the order of 31%. We postulate that these changes are the hemodynamic and metabolic concomitants of diaschisis and may in part be due to a transneuronal depression of function.
Animals↗
Silent coronary artery-left ventricular fistula: a disorder of the thebesian system?
Two cases with abnormal electrocardiogram were found to have the unusual direct communication between the coronary artery and left ventricular chamber without any manifestations of the other reported coronary arterial fistula.
Coronary Angiography↗
The ultrasound guided 32P test.
The accurate and early diagnosis of intraocular malignant melanoma in eyes with opaque media remains a diagnostic problem. Ultrasonography and the radioactive phosphorus (32P) uptake test have been used separately as modalities for diagnosis of choroidal melanoma. However, their combined use has received limited attention. This report presents our experience in 5 cases with the combined use of a contact B-scan ultrasound unit and a posterior eye probe. In all cases we were able to accurately perform the 32P uptake test with simultaneously ultrasound visualization of the tumor and the probe.
Aged↗
Effect of additional valve lesions on left ventricular ejection time in aortic stenosis.
Rate-corrected left ventricular ejection time was measured from the aortic pressure tracings of 171 catheterised patients with aortic valve area less than or equal to 1.2 cm2. In 50 patients with pure aortic stenosis, left ventricular ejection time in increased with decreasing valve area and was significantly higher (468 +/- 5 ms, mean +/- SEM) than in 13 normal subjects (435 +/- 5 ms). Additional aortic regurgitation in 72 patients further increased the left ventricular ejection time to 484 +/- 4 ms. Significant mitral stenosis (mitral valve are less than or equal to 1.2 cm2) in 6 patients with aortic stenosis and 33 patients with aortic stenosis and regurgitation reduced the left ventricular ejection time to normal. Similarly, severe mitral regurgitation in 3 patients with aortic stenosis and regurgitation reduced left ventricular ejection time to normal, though slight or moderate mitral regurgitation in 4 of these patients did not. These data show that the prolonged left ventricular ejection time in aortic valve disease may be restored to normal in the presence of coexisting significant mitral disease.
Aortic Valve Insufficiency↗
Electrocardiographic changes during chest pain in unstable angina.
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Adult↗
Mean velocity of circumferential fiber shortening in prolapsed mitral leaflet syndrome.
In 26 patients with mitral valve prolapse, ventricular function was evaluated by mean velocity of circumferential fiber shortening (MVCF) as measured along the basilar, middle and apical axes. Significantly increased rates of MVCF were found in patients with mitral prolapse along the basilar axis (1.75 +/- 0.23 circ/sec) and middle axis (2.09 +/- 0.34 cir/sec) (P less than 0.025 and P less than 0.05, respectively). Patients with mitral valve prolapse and regurgitation demonstrated a significant increase in MVCF along the basilar axes (1.72 +/- 0.15 cir/sec) (P less than 0.05). Asynergy apperars to have a negative effect on the MVCF along the middle axis. The MVCF was found not to be related to clinical findings, symptoms or electrocardiographic changes. The mechanism for the increase in MVCF in patients with mitral valve prolapse remains unsettled.
Adolescent↗
Sinus node dysfunction in acute myocardial infarction.
The frequency, clinical course, and prognosis of sinus node dysfunction in 431 patients with acute myocardial infarction admitted to the coronary care unit were studied. Sinus node dysfunction occurred in 20 patients. In 13, the principal manifestation consisted of severe sinus bradycardia. In the remaining 7, periods of bradycardia alternating with episodes of supraventricular tachycardia were noted. Though several of the patients with sinus bradycardia required intravenous atropine or temporary pacing, normal sinus rhythm returned in virtually all during follow-up. The clinical course of patients with both bradycardia and tachycardia was less benign, during the acute phase and during follow-up; 5 of the 6 survivors required continued antiarrhythmic therapy or permanent pacing. The differences in the clinical course between these two groups of patients may reflect distinct underlying pathological changes. The findings in this study suggest that in contrast to sinus bradycardia, the occurrence of bradycardia-tachycardia syndrome during the acute phase of myocardial infarction may have important prognostic implications.
Acute Disease↗
Spontaneous variations in atrioventricular conduction in pre-excitation.
Atrial pacing in a patient with a Wolff-Parkinson-White syndrome pattern showed unusual variability in AV nodal conduction time. Changes in the AV nodal conduction time occurred predominantly at paced rates in excess of 100/min and consisted of abrupt or gradual decreases in the AH interval. Such decreases resulted in unexpected normalization of the QRS pattern. In addition, pacing also revealed evidence of block in the accessory pathway. Such changes in atrioventricular conduction may account for the known variability of the QRS pattern in patients with the WPW syndrome. Further, they may also explain the benign clinical course in this patient.
Adult↗
Effect of thoracic blood volume changes on steady state cardiac output.
We have investigated the extent to which shifts of blood volume out of or into the thoracic region influence the steady state cardiac output. The systemic circulation of anesthetized dogs was replaced with an artificial circuit which stimulated the pertinent mechanical characteristics of an intact circulation. As in the normal animal, the steady state venous return was proportional to the pressure gradient for venous return (i.e, mean systemic minus right atrial pressure). Cardiac function was altered either by administration of epinephrine or by changes in left ventricular afterload. At a constant mean aortic pressure of 100 mm Hg, epinephrine administration increased the steady state cardiac output by 55%. Half of this increase resulted from the lowered mean right atrial pressure (caused by improved cardiac function); the remainder resulted from an increased mean systemic pressure (caused by the volume shift to the systemic circulation). Increases in afterload transferred sufficient volume to the heart-lung compartment to reduce significantly the mean systemic pressure and, hence, the steady state venous return. Our results indicate that the heart-lung compartment contains a significant volume which is under cardiac control. In addition to being able to alter the right atrial pressure, the heart can modulate the steady state cardiac output by adjusting the mean systemic pressure. To this degree the heart can adjust its own venous return.
Animals↗
Late thrombosis of the aortic Bjork-Shiley prosthesis. Its clinical recognition and management.
Seven cases of massive thrombosis of an aortic Bjork-Shiley prosthesis were encountered among 433 valvular implants. Four patients died before treatment could be instituted, and three underwent repeat surgery successfully. Anticoagulation therapy was probably well maintained in four, and poorly maintained in three patients. These cases illustrated the need for a high index of suspicion and prompt recognition of this complication in patients with Bjork-Shiley prostheses. The diagnosis of massive thrombosis should be suspected with the rapid onset of (1) signs of congestive heart failure, (2) absence or attenuation of valvular clicks, (3) aortic regurgitation, or (4) hemolytic anemia. Salvage of these patients requires emergency replacement of the thrombosed prosthesis or removal of the thrombus.
Aged↗
The relationship between prolapsing mitral leaflet syndrome and angina and normal coronary arteriograms.
Patients with a prolapsing mitral leaflet frequently have chest pain while their coronary arteriograms are normal. In this regard, these patients are similar to the group of patients with angina and normal coronary arteriograms. In the present study, clinical, electrocardiographic, cardiac hemodynamic, angiographic, and metabolic findings in 20 patients with a prolapsing mitral leaflet were compared to those of 16 patients with angina and normal coronary arteriograms. Except for the presence of mitral leaflet prolapse and systolic clicks, the findings were similar in both groups. We postulate that prolapsing mitral leaflet is probably related to two different mechanisms. In one the primary pathologic change is in the mitral valve (mainly myxomatous transformation), and the abnormalities of ventricular contraction are secondary to unloading of the heart because of a volume shift into the distended and enlarged mitral leaflets. In the other group, the primary pathologic change is in the myocardium, with secondary prolapse of the mitral valve. The myocardial abnormality itself is probably related to primary underlying myocardial disease or to arteriolar pathologic changes. The latter group has probably the same pathophysiologic abnormality as patients with angina and normal coronary arteriograms.
Adult↗