Search PubMed⌕ Search

Biomedical subjects

J D Slack

Publications and source records attributed to J D Slack.

At least 37 records · Page 2Linked to original sources
PubMed1991

Restenosis 1 to 24 months after clinically successful coronary balloon angioplasty: a necropsy study of 20 patients.

This report describes clinical, morphologic and histologic findings at necropsy late (range 1.6 to 24.1 months [average 8.2 months]) after clinically successful coronary balloon angioplasty in 20 patients with coronary angioplasty restenosis. Clinical evidence of restenosis occurred in 14 patients (70%), including 6 patients with sudden coronary death. Of the 20 patients, 14 (70%) had a cardiac cause of death and 6 (30%) had a noncardiac cause of death. Two major subgroups of histologic findings were observed: 1) intimal proliferation (60%), and 2) atherosclerotic plaque only (40%). Of the eight sites with atherosclerotic plaque only, six were eccentric lesions and two were concentric lesions. No morphologic evidence of previous angioplasty injury (cracks, breaks, tears) was observed in the eight patients with atherosclerotic plaque only. Proposed mechanisms for the development of intimal proliferation involve the reaction of smooth muscle cells and platelets, whereas elastic recoil of overstretched eccentric or concentric atherosclerotic lesions represents the most likely explanation for the findings in the latter subgroup. On the basis of these morphologic findings at angioplasty restenosis sites, specific treatment strategies for restenosis after coronary artery balloon angioplasty are proposed.

Angioplasty, Balloon, Coronary↗
PubMed1991

Morphological observations late (greater than 30 days) after clinically successful coronary balloon angioplasty.

This report describes clinical, morphological, and histological findings late (1.6-24.1 months [average, 8.2 months]) after clinically successful coronary balloon angioplasty in 20 necropsied patients with coronary angioplasty restenosis. Clinical evidence of restenosis occurred in 14 (70%) of patients, including six patients with sudden coronary death. Of the 20 patients, 14 (70%) had cardiac causes of death and six (30%) had noncardiac causes of death. Two major subgroups of histological findings were observed: 1) intimal proliferation (60%) and 2) atherosclerotic plaques only. Of the eight sites with atherosclerotic plaques only, six were eccentric lesions and two were concentric lesions. No morphological evidence of previous angioplasty injury (cracks, breaks, or tears) was observed in the eight patients with atherosclerotic plaques only. Proposed mechanisms for the development of intimal proliferation involve the reaction of smooth muscle cells and platelets, whereas elastic recoil of overstretched eccentric or concentric atherosclerotic lesions represents the most likely explanation for the findings in the latter subgroup. On the basis of these morphological findings at angioplasty restenosis sites, specific treatment strategies for coronary artery balloon angioplasty restenosis are proposed.

Angioplasty, Balloon, Coronary↗
PubMed1990

Tomographic views of normal and abnormal hearts: the anatomic basis for various cardiac imaging techniques. Part I.

Recent developments have taken place in the diagnosis of cardiovascular disorders in the area of cardiac imaging techniques. From a previous era of imaging by silhouettes (chest roentgenography, fluoroscopy, angiocardiography), we have emerged into an era of imaging by tomographic scanning (echocardiography, radionuclide tomography, computed tomography, magnetic resonance). A basic understanding of tomographic cardiac anatomy is the foundation for proper use and interpretation of these new imaging modalities. The present report provides a description of the techniques of tomographic cutting of necropsy cardiac specimens and illustrates some of the pathologic cardiac abnormalities cut in these tomographic planes. Part I of this report describes position of the heart and tomographic axis planes, preparation of the heart and methods of cutting at necropsy, and the short-axis, two-chamber, and four-chamber views of the heart.

Heart↗
PubMed1990

Tomographic views of normal and abnormal hearts: the anatomic basis for various cardiac imaging techniques. Part II.

Recent developments have enhanced the diagnosis of cardiovascular disorders in the area of cardiac imaging techniques. From an era of imaging by silhouettes (chest roentgenography, fluoroscopy, angiocardiography), we have emerged into an era of imaging by tomographic scanning (echocardiography, radionuclide tomography, computed tomography, magnetic resonance). A basic understanding of tomographic cardiac anatomy is the foundation for proper use and interpretation of these new imaging modalities. The present report provides a description of the techniques of tomographic cutting of necropsy cardiac specimens and illustrates some of the pathologic cardiac abnormalities cut in these tomographic planes. Part II of this report describes the long-axis method, methods using the body rather than the heart as the reference axis, and includes transverse, frontal, and parasagittal methods of imaging the heart.

Autopsy↗
PubMed1990

Cardiac myxoma: the Indiana Heart Institute experience.

Surgical resection of a cardiac myxoma was performed in 14 patients at the Indiana Heart Institute at St. Vincent Hospital and Health Care Center in Indianapolis from 1974 to 1989. Thirteen were located in the left atrium and one in the right atrium. The 10 women and four men ranged in ages from 28 to 75 years. Surgical complications included one perioperative death, one late death and one late recurrence requiring reoperation. Physicians must be highly suspicious to correctly diagnose this unusual but surgically correctable entity. Two-dimensional echocardiography is the diagnostic technique of choice for both early diagnosis of a cardiac myxoma and late follow-up after resection.

Adult↗
PubMed1990

Cardiac rupture following acute myocardial infarction: a case with successful surgical treatment.

This report involves a patient who sustained an acute lateral wall myocardial infarction complicated by cardiogenic shock. Cardiac catheterization revealed diastolic equilibration of all intracardiac pressures. Cardiac angiography revealed only acute occlusion of a small branch of the left circumflex coronary artery with good left ventricular systolic function. Since these findings could not explain the degree of cardiogenic shock, an immediate echocardiogram revealed a moderate pericardial effusion with an echo-dense mass suggestive of subacute cardiac rupture. Emergency cardiac surgery confirmed the diagnosis and successful surgical correction resulted in survival of the patient.

Cardiac Catheterization↗
PubMed1990

The signal averaged electrocardiogram: a practical primer.

Sudden cardiac death unfortunately continues to be a relatively common clinical problem despite recent advances in anti-arrhythmic medications, cardiac surgery and angioplasty. A non-invasive screening test capable of identifying specific patients at high risk for sudden cardiac death is needed. A technique using sophisticated electronic signal filtration and computerized signal enhancement permits analysis of the electrocardiogram for evidence of ventricular conduction delay, which may serve as a matrix for sustained ventricular tachycardia. This procedure, termed the signal averaged electrocardiogram, is reviewed. Its use in context with the left ventricular ejection fraction, Holter monitoring and exercise testing also is examined.

Arrhythmias, Cardiac↗
PubMed1989

Percutaneous transluminal coronary angioplasty: update 1988.

This report updates the current indications, techniques and investigational devices used in a busy interventional cardiology practice. Specific attention is devoted toward the problem areas of thrombolytic treatment of acute myocardial infarction, restenosis after angioplasty and the use of angioplasty in the treatment of multivessel coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed1988

Percutaneous transluminal angioplasty in patients with prior myocardial revascularization surgery.

Direct myocardial revascularization surgery using either the saphenous vein or internal mammary artery has become the definitive surgical treatment for coronary artery occlusive disease. Certain patients who have undergone these procedures, however, have recurrent myocardial ischemia due to progression of disease in unbypassed vessels, to obstruction in the arteries distal to the insertion of the bypass conduit, or to disease of the conduit itself. Balloon angioplasty may be used to relieve myocardial ischemia in these situations; however, initial studies suggested a low primary success rate coupled with excessive mortality and morbidity. Improvements in patient selection, equipment and technical expertise now allow angioplasty to be performed in this patient population with results comparable to that in the general coronary angioplasty population. Of the 3,016 angioplasty procedures performed between September 1980 and June 1987, 236 patients had previously undergone revascularization surgery. The primary success rate was 93% (390 of 419 stenoses successfully dilated). Overall, clinical restenosis was observed in 39%, including a 43% restenosis rate in patients undergoing only saphenous vein graft angioplasty. This did not differ appreciably from the restenosis rate in postbypass patients undergoing angioplasty of only native vessels (37%) or internal mammary arteries (42%). Emergency revascularization surgery was required in 7 of 236 patients (3%), each of whom had myocardial infarction. One of 236 patients (0.4%) died. Thus, angioplasty may be used to relieve recurrent myocardial ischemia in patients with prior direct myocardial revascularization procedures with a high initial success rate and acceptable risk. Early (less than 6 months) restenosis is not infrequent and remains the largest obstacle to a satisfactory clinical outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1986

Left main coronary artery dissection during percutaneous transluminal coronary angioplasty.

Acute dissection of the left main coronary artery during diagnostic cardiac catheterization with selective coronary arteriography is an uncommon but recognized complication of the procedure. That similar dissection may occur during percutaneous transluminal coronary angioplasty is less well recognized. This report describes two cases of left main coronary dissection resulting in acute occlusion that occurred during percutaneous transluminal coronary angioplasty and demonstrates that survival with essentially complete functional recovery may result if immediate surgical intervention is undertaken. Recognition and treatment of this potentially catastrophic complication of angioplasty is described.

Angioplasty, Balloon↗
PubMed1986

The electrocardiogram often fails to identify pericarditis after percutaneous transluminal coronary angioplasty.

Acute pericarditis was recognized in six of 1,316 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) between September, 1980 and December, 1984. "Atypical" chest pain different from the patients' usual exertional angina pectoris accompanied by a low grade fever and a pericardial friction rub on cardiac auscultation was considered diagnostic. Cardiac enzymes (CK-MB) were mildly elevated in three of six patients. None had perfusion defects on thallium-201 perfusion images. Serial ECG's showed minor ST-T abnormalities in five of six, while only one had the "classical" generalized ST elevation commonly expected with acute pericarditis. No patient had occlusion of the vessel undergoing PTCA nor compromise of any branch vessels in the region of the stenosis. All patients had significant dissection at the site of PTCA which may cause a regional, localized acute pericarditis not recognized by standard 12-lead ECG records.

Acute Disease↗
PubMed1986

Acute congestive heart failure due to the arteritis of rheumatoid arthritis: early diagnosis by endomyocardial biopsy: a case report.

A 49-year-old man with rheumatoid arthritis presented with acute congestive heart failure. Acute viral myocarditis was suspected clinically as a Gallium-67 myocardial scan was positive. Percutaneous catheter-directed biopsy of the right ventricular endomyocardium, however, revealed heavy endothelial deposits of IgM in the small blood vessels of the myocardium. Prednisone therapy resulted in normalization of both the myocardial Gallium-67 scan and left ventricular ejection fraction with resolution of the symptoms of congestive heart failure. This is the first report documenting rheumatoid arteritis antemortem by myocardial biopsy.

Arteritis↗