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Biomedical subjects

J I Haft

Publications and source records attributed to J I Haft.

At least 19 recordsLinked to original sources
PubMed1992

Coronary angioplasty in patients eighty years of age or older.

Percutaneous transluminal coronary angioplasty (PTCA) was performed on 58 lesions in 53 patients 80 years of age or older with unstable angina. Most patients had previous myocardial infarction, abnormal left ventricular contraction patterns, and multivessel coronary disease. In most (48) patients only one vessel was dilated. PTCA was successful in 48 (82.8%) lesions, but complications were frequent. Eight patients died, six after anatomically successful PTCA (three with cardiac complications, two with noncardiac complications, and one with both cardiac and noncardiac complications). Two patients died after unsuccessful PTCA (one of cardiac complications and one of noncardiac complications), and 11 patients with PTCA were alive with significant complications (all noncardiac). Twenty-nine patients had successful PTCA with no complications; 40 (74.5%) patients were discharged with clinically successful PTCA. It is concluded that PTCA is feasible in patients 80 years of age or older but that both cardiac and noncardiac complications are common in this group of very fragile patients.

Aged↗
PubMed1992

Chest pain secondary to membranous subaortic stenosis in a young woman.

Left ventricular outflow obstruction can be divided into three distinct categories: valvular aortic stenosis, the most common form; supravalvular aortic stenosis, which is often seen in early childhood; and subvalvular stenosis, which can be further subdivided into muscular, tunnel, and fibromembranous subtypes. All may be found in a patient seen with symptoms of angina, syncope, or heart failure as a precursor to sudden death. Prompt clinical recognition is essential as is a high degree of suspicion when these signs are associated with a systolic ejection murmur on clinical examination. Echocardiography and a meticulous Doppler examination are very useful in the diagnosis of these disorders as well as in further distinguishing among the different subtypes. The authors describe the case of a 40-year-old woman with chest pain refractory to medical therapy and a long systolic ejection murmur.

Adult↗
PubMed1991

The origin and fate of complex coronary lesions.

Complex irregular coronary artery stenoses, representing plaque rupture/thrombosis, are associated with the acute coronary syndromes. However, the natural history (origin and fate) of these lesions is not known. To examine this issue we studied 255 patients who had had two to four arteriograms within a mean interval of 2.6 +/- 1.7 years. Of 53 irregular lesions that had progressed on a later arteriogram, 35 (66%) originated from areas that were smooth and less than 50% in stenosis diameter. Of 44 irregular lesions on an earlier study, 10 (23%) became totally occluded, five (11%) progressed in severity (all remained irregular), 25 (57%) showed no change in severity (all remained irregular), and four (9%) regressed (two became smooth). Nine of the 10 lesions progressing to occlusion were greater than or equal to 95% stenosed on the earlier study. Only 2 of 44 lesions (5%) showed smoothing. These findings are in agreement with the concept that irregular lesions represent ruptured atherosclerotic plaques and demonstrate that they usually originate from mildly occlusive smooth plaques. Markedly narrowed irregular lesions (greater than or equal to 95% stenosis) frequently progress to occlusion. Irregular lesions less than 90% narrowed commonly remain angiographically stable, and irregular over several years. They were found rarely to evolve into smooth-walled plaques.

Coronary Angiography↗
PubMed1991

Correlation of cross-linked fibrin degradation products (D-dimer) with coronary angiographic lesion morphology.

We tested the hypothesis that complex irregular coronary lesions are "active" lesions and thus associated with ongoing fibrinolysis by measuring the degradation products of cross-linked fibrin (D-dimer) in 136 patients undergoing coronary arteriography. Blood samples obtained before catheterization were assayed by an enzyme linked immunosorbent assay (ELISA) using specific monoclonal antibodies for D-dimer particles. In the four groups with complex coronary morphologies (filling defects, extrinsic lesions with irregular borders and total occlusions with or without staining) the majority of patients (64%) had normal D-dimer levels. The incidence of abnormal D-dimer levels was not significantly higher in any of these four groups than in the two groups with normal coronaries or with smooth lesions. In the same patients, however, the clinical diagnosis was predictive of the presence of elevated D-dimer levels. These findings suggest that complex coronary lesions are often not associated with ongoing fibrinolysis and that endogenous fibrinolysis frequently ceases in the presence of persistent clot.

Antibodies, Monoclonal↗
PubMed1991

Effect of severe pulmonary hypertension on the calculation of mitral valve area in patients with mitral stenosis.

We studied 50 consecutive patients with mitral valve stenosis (MS) by cardiac catheterization and Doppler echocardiography to assess whether the presence of severe pulmonary hypertension affected the calculation of valve area by Doppler pressure half-time method and by the Gorlin formula using pulmonary capillary wedge pressure as an index of left atrial pressure. Patients with severe mitral regurgitation were excluded. In patients with pulmonary artery systolic pressure (PAS) less than 70 mm Hg (n = 33), there was good correlation between the mitral valve area derived from Doppler echocardiography and from cardiac catheterization (r = 0.85). However, in patients with PAS greater than or equal to 70 mm Hg (n = 17), this correlation was not as good (r = 0.57). In these 17 patients, the Gorlin formula tended to underestimate the valve orifice area (mean valve area 0.85 +/- 0.49 and 1.06 +/- 0.46 cm2 by catheterization and by Doppler respectively, p = NS). Direct measurement of the valve area by two-dimensional echocardiography was possible in 12 of the 17 patients and correlated well with Doppler values (r = 0.91). Hence in the presence of severe pulmonary hypertension, Doppler pressure half-time estimation of mitral valve area is more accurate than is catheterization-derived valve area, using the wedge pressure and the Gorlin formula.

Acute Disease↗
PubMed1990

PTCA following myocardial infarction: use of bailout fibrinolysis to improve results.

The results of percutaneous transluminal coronary angioplasty (PTCA) in 307 lesions in 235 patients within 60 days of myocardial infarction (MI) were compared with the PTCA results in 591 lesions in 489 patients without recent MI, and the effect of fibrinolysis to treat recurring occlusive clot during angioplasty was studied. In 210 lesions in patients with MI who did not receive fibrinolysis during the MI (group A), 58 lesions were categorized as primary failures; bailout fibrinolysis brought the final failure incidence to 42 lesions (20%). In 97 lesions in patients with MI who received fibrinolysis during the acute MI (group B), 22 lesions were categorized as primary failures; bailout fibrinolysis resulted in final failures of 16 lesions (16.5%). In 591 lesions in patients without a recent MI (group C), there were 85 primary failures and 81 final failures after bailout fibrinolysis. Analysis of the PTCA results in each group with respect to whether the lesions were totally or partially occluded showed that more of the lesions attempted in the groups with MI (groups A and B) were totally occluded (TO) and that with use of bailout fibrinolysis the success rate of PTCA in TO lesions was the same in all groups. Similarly, with use of fibinolytic bailout during PTCA the success rate in partially occlusive lesions was not different between the groups. We conclude that bailout thrombolysis during PTCA is usually effective, especially in those who have recently had an MI, and that with availability of bailout fibrinolysis, PTCA in those with recent MI is not any less sucessful than in those without recent MI.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1990

Coronary angioplasty in symptomatic patients after bypass surgery.

With the availability of percutaneous transluminal coronary angioplasty (PTCA), the management of patients who present with recurrent angina following coronary artery bypass surgery (CABG) has changed. From January 1987 to December 1988, 149 symptomatic post CABG patients underwent coronary angiography at our institution. Ninety were treated with medical antianginal therapy, 14 had repeat surgery, and 45 underwent PTCA. Complications of repeat CABG included one death, two perioperative myocardial infarctions, and four patients with postoperative supraventricular arrhythmia. PTCA was performed on 42 lesions in 37 native vessels (88% success rate), and on 24 lesions in 23 vein grafts (91.7% success rate). Complications included acute reocclusion (one patient), peripheral artery occlusion (one patient), hematoma formation (one patient), and periprocedure myocardial infarction (one patient). No deaths occurred. At a mean follow-up of 5.9 +/- 3.8 months, 10 patients had recurrent symptoms, six of whom were found to have restenosis. Repeat PTCA was successfully accomplished in four patients; the other two were treated medically. It is concluded that PTCA is a feasible alternative to repeat CABG in selected patients and can be achieved with a high success rate and minimal complications.

Adult↗
PubMed1990

Use of tissue plasminogen activator in the coronary care unit for acute closure after coronary angioplasty.

Coronary angioplasty in a patient ten days following myocardial infarction was complicated by repeated thrombotic occlusion requiring intracoronary streptokinase. Recurrence of chest pain and ST elevations after transfer to the coronary care unit was successfully managed with intravenous tissue plasminogen activator without returning the patient to the catheterization laboratory.

Angioplasty, Balloon, Coronary↗
PubMed1989

Morphology of coronary lesions in the prediction of early PTCA outcome.

The coronary lesions in 164 patients who underwent 194 PTCA procedures were analyzed in an effort to define if there were morphological characteristics that would predict thrombotic problems following percutaneous transluminal angioplasty (PTCA). Patients with smooth and concentric or eccentric lesions rarely had difficulty at PTCA, whereas those with filling defects or with eccentric and irregular lesions frequently had postprocedure thrombi. Total occlusions were amenable to angioplasty when there was lesion staining present, but the success rate was significantly less in patients in whom there was no staining. These findings suggest that the acute outcome of PTCA can be predicted on the basis of the morphology of coronary lesions on preprocedure angiography.

Adult↗
PubMed1989

PTCA in anomalous coronary artery.

A significant coronary artery lesion in a congenitally anomalous right coronary artery (RCA) was dilated successfully using percutaneous transluminal coronary angioplasty (PTCA). The anomalous coronary artery did not react any differently than an anatomically normal coronary artery.

Angioplasty, Balloon↗
PubMed1989

Left atrial myxoma.

Although atrial tumors usually present with cardiac symptoms, myxomas may cause only nonspecific systemic symptoms early in their course, before they are large enough to have a hemodynamic effect. Two-dimensional echocardiography can be useful when diagnosing is problematic.

Adult↗
PubMed1988

Coronary dissection following chest trauma with systemic emboli.

Coronary artery dissection is a rare entity which occurs following blunt chest trauma, during coronary angiography and coronary bypass surgery, and spontaneously in the peripartum period. We report a young man who presented with recurrent systemic emboli following an asymptomatic anterior wall myocardial infarction associated with dissection of the LAD and mural thrombus three years earlier after sustaining blunt chest trauma.

Adult↗
PubMed1988

Development of significant coronary artery lesions in areas of minimal disease. A common mechanism for coronary disease progression.

In 62 patients with coronary disease who had serial arteriograms without intervening coronary artery bypass graft (CABG) or percutaneous transluminal coronary arteriography (PTCA), progression was seen in 48 (77 percent). Progression from a normal or minimally narrowed lumen diameter to narrowing greater than or equal to 75 percent (to greater than or equal to 90 percent) in 21 patients) occurred in at least one vessel in 33 patients (69 percent) (group A, type I progression). Less striking progression and progression of initially more severe lesions was seen in 15 of 29 patients without type 1 progression (Group B) and in other vessels in 12 group A patients. Improvement in at least one vessel was seen in eight patients. There was no difference between groups A and B in the incidence of risk factors, intervening myocardial infarction, or recent unstable angina. It is concluded that progression of occlusive coronary disease occurs as commonly in areas of the coronary tree that are minimally diseased as in segments that are initially severely narrowed. Methods to stabilize the endothelium may prevent progression of coronary artery disease.

Coronary Angiography↗
PubMed1988

Computed tomography of the abdomen in the diagnosis of splenic emboli.

Abdominal computed tomographic scans were performed in 25 consecutive patients with bacterial endocarditis. Six patients had splenic infarcts, only two of whom had symptoms. Three of the six patients had no evidence of emboli to other organs. In patients with endocarditis who have had clinically apparent emboli or who are, for other reasons, being considered for valvular surgery, a computed tomographic scan of the abdomen may help in decision making.

Adult↗