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Biomedical subjects

J J Cheng

Publications and source records attributed to J J Cheng.

13 recordsLinked to original sources
PubMed1992

Reappraisal by transesophageal echocardiography of the significance of left atrial thrombi in the prediction of systemic arterial embolization in rheumatic mitral valve disease.

Systemic arterial embolization imparts a significant risk of serious complications throughout the lives of patients with rheumatic heart disease. Left atrial (LA) thrombi have been thought to be the major source of emboli. A transesophageal echocardiography (TEE) study of 260 consecutive patients with rheumatic mitral valve disease was performed during a period of 24 months, with particular reference to understanding the association between LA thrombi and embolic complications. Of these patients, 155 had predominant mitral stenosis, 24 had significant mitral regurgitation, and the remaining 81 with xenograft mitral valve replacement developed valvular dysfunction (25 resulted in predominant mitral stenosis and 56 in significant mitral regurgitation). LA thrombi were detected in 38 patients (group A) and absent in 222 (group B). Group A patients had a higher frequency of recent (less than or equal to 1 week before TEE study) and remote (greater than 1 week before) embolization than did group B patients (recent: 26.3 vs 5.4% [p less than 0.001]; remote: 18.4 vs 5.0% [p less than 0.01]). The frequency of atrial fibrillation was also greater in group A patients (100 vs 74.3%; p less than 0.001). The exclusion of patients with significant mitral regurgitation and sinus rhythm had no effect on the association between LA thrombi and evidence of previous embolization. It is concluded that TEE is a convenient diagnostic modality that can be used to identify a subset of patients with rheumatic mitral valve disease at high risk for systemic embolization. Consequently, preventive anticoagulation for possible embolic complications should be more vigorously adhered to in patients with rheumatic mitral valve disease and LA thrombi.

Echocardiography↗
PubMed1992

Prospective study of blood culture during transesophageal echocardiography.

To ascertain the incidence and significance of bacteremia associated with transesophageal echocardiography (TEE), 132 consecutive patients (aged 17 to 73 years) free of apparent infection who were undergoing 135 transesophageal echocardiographic procedures from October 1990 to August 1991, were prospectively studied. For each procedure, two sets of blood cultures were obtained for culture 30 to 60 minutes before TEE, immediately after, and 180 to 240 minutes after the procedure. For each blood culture, 10 ml of venous blood was evenly inoculated into aerobic and anaerobic culture bottles and inoculated for 7 days using a radiometric system. A throat swab was obtained immediately before each procedure. Three of 270 preprocedure blood cultures were positive for Bacillus cereus, Staphylococcus simulans, and Peptostreptococcus species, respectively. No blood culture was positive in the immediate postprocedure period. Two of 270 late blood samples grew Staphylococcus epidermidis in the same patient. Nevertheless, the microorganisms isolated from blood cultures were different from those isolated from the throat swab. No patients had fever or evidence of infective endocarditis after TEE during the follow-up period. It is concluded that the incidence of TEE-related bacteremia is extremely low, and a general recommendation for antibiotic prophylaxis during TEE is not warranted.

Adolescent↗
PubMed1992

Inheritance of hypertrophic cardiomyopathy in Chinese--M-mode and two-dimensional echocardiographic analysis of 28 families.

To determine the mode of inheritance and degree of penetrance of hypertrophic cardiomyopathy (HC) in Chinese, 132 family members of 28 probands with HC were assessed by M-mode and two-dimensional echocardiography. Of these 132, 103 cases were first-degree relatives of the probands. Twenty-seven (20.4%) family members, including 19 cases of first-degree relatives of the probands, had HC. Familial occurrence of HC was noted in 13 (46.4%) families. In 10 families, the affected relatives were identified in successive generations, and the mode of inheritance was most consistent with an autosomal dominant trait. The frequency with which HC was identified in relatives increased significantly with the number of subjects studied and a positive family history of sudden death. Subgroup analysis, using multivariate logistic regression analysis, revealed that increasing age was independently associated with a higher frequency of definite cases in first-degree relatives of the probands. In contrast, by multivariate analysis, there were no significant differences between frequency of definite cases in female and male relatives or in different familial relationships (parent, sibling, offspring) to the probands.

Adolescent↗
PubMed1991

Local dermal hypersensitivity from dobutamine hydrochloride (Dobutrex solution) injection.

Two patients had local dermal hypersensitivity at the site of dobutamine hydrochloride (Dobutrex solution) injection. Such local dermal lesions characterized by erythema, pruritus, and phlebitis with or without bullae formation have not been reported previously (to our knowledge). Hypersensitivity reaction to sulfites as a possible mechanism of the dermal lesions was substantiated further by skin tests and peripheral eosinophila. Oral antihistamine therapy can minimize such a minor but bothersome problem.

Aged↗
PubMed1991

[Treatment with new surgical method for chronic atrial fibrillation in 5 cases with mitral valve disease].

Chronic atrial fibrillation is the most common arrhythmia in patients with mitral valve disease, it not only deteriorates cardiac output, but also promotes a 5.6 times higher incidence of thromboembolic events. Nevertheless, the exact mechanism of atrial fibrillation is still poorly understood. Moreover, the long-term results of treatment, either by drugs or cardioversion, are almost always disappointing. Recent investigations suggest that atrial fibrillation is probably due to intraatrial multiple reentrant waves. It is also well-known from animal experiments that for sustenance of the fibrillation a critical mass of atrium is necessary. Based on these data, a new surgical method has been carefully designed to reduce atrial mass and to prevent sustenance of fibrillation. Between July and December 1988, five patients, one male and four females, with mitral valve disease and chronic atrial fibrillation were selected for this new surgical method. The age distribution ranged from 25 to 57 years, with a mean of 36 +/- 13 years. All of them had chronic atrial fibrillation which had been documented for more than one year. The operation was performed using the cardiopulmonary bypass and cardioplegia myocardial protection techniques. The left atrium was opened via the interatrial sulcus. After the mitral valve was repaired, cryosurgery (-60 degrees C for 120 sec) was applied along the borders of the left atrial free-wall. The left atrium was separated by these cryolesions into two sections, each about half the mass of the original and both sections were connected with a few atrial fibers located behind the coronary sinus. No surgical mortality or complications were encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

The frequency of patent foramen ovale in patients with ischemic stroke: a transesophageal echocardiographic study.

Transesophageal echocardiography has been described as superior to transthoracic echocardiography in the detection of patent foramen ovale (PFO). Utilizing both methods, we were able to determine the frequency of PFO in younger adult patients with ischemic stroke (patient group) and in age-matched control subjects (control group). Thirty-four patients under 55 years of age with cerebral or retinal ischemic attacks (mean age 39 years) and 40 controls (mean age 39 years) were studied. Transesophageal echocardiography detected a significantly higher frequency of PFO in the patient group (44%) than in the control group (18%, p less than 0.05). In comparison with transthoracic echocardiography, transesophageal echocardiography found a higher frequency of PFO in both the patient group (12% vs 44%, p less than 0.01) and the control group (3% vs 18%, p less than 0.05). All of the foramina proved to be patent by transthoracic echocardiography were also found by transesophageal echocardiography. The results suggest that transesophageal echocardiography is a sensitive method for demonstrating PFO. Paradoxical embolism through an interatrial communication (PFO) may be a possible cause of strokes in the young adult.

Adult↗
PubMed1990

Clinical features of rheumatic carditis in adolescents and adults.

A retrospective study on the clinical features of acute rheumatic fever (RF) with carditis in 45 patients, 15 years of age and older (range 15-61), is described. Nineteen patients were seen at initial attack; the remaining 26 patients (28 recurrences) were admitted because of RF recurrence. Of the total 47 episodes, carditis was manifested by a significant murmur without previous RF or any known rheumatic heart disease in 40%; change in the character of a murmur under observation or the appearance of a new murmur in 15%; and acute pericarditis in 19%. Congestive heart failure of recent onset was noted in 85% of the episodes, while classical polyarthritis or polyarthralgia occurred in 57%. The aortic valve was newly damaged or preexisting aortic regurgitation worsened in 12 episodes. Twenty-nine patients were followed for 1/2-16 years. Of 11 patients with an initial attack who were maintained on regular prophylaxis (intramuscular benzathine penicillin 1,200,000 units every 4 weeks), the mitral valve murmur disappeared in 3 and none of the patients had recurrence. Of the remaining 18 patients with no or incomplete prophylaxis, 1 died from congestive heart failure 6 months later, and 3 had recurrences with involvement of the aortic valve. In conclusion, RF with carditis in adolescents and adults in our practice at the National Taiwan University Hospital is likely to show more cardiac problems and complications than that seen in the West. Although active rheumatic carditis among this patient population is relatively uncommon, recurrences with subsequent involvement of the aortic valve (aortic regurgitation) do occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Retrospective analysis of 97 patients with infective endocarditis seen over the past 8 years.

The medical records of 97 consecutive patients (101 episodes) of infective endocarditis seen from January 1979 through January 1987 were reviewed. Only 30% of the patients were over 50 years of age and the majority (69%) of infecting organisms were streptococci (mainly of the viridans group), which were similar to those reported from the West in the early antibiotic era. Pseudomonas organisms and enterococci accounted for 6% and 5%, respectively. Fungal infections were noted in 2 patients. There was a high incidence (38%) of predisposing rheumatic valvular disease; approximately half of these patients had prosthetic valve infections. Mitral valve prolapse was also an important predisposing disease (11%). One-third (34%) of the patients had febrile illness for longer than 8 weeks before the diagnosis was established. The hospital morality rate was 22%; cerebral embolism and ruptured mycotic aneurysm, congestive heart failure, and sudden death were the major causes of death. Echocardiography disclosed vegetations on the cardiac valves and preexisting lesions in 75% of the episodes. Early recognition and proper treatment should be the focus of efforts to reduce mortality from infective endocarditis.

Adolescent↗