Search PubMed⌕ Search

Biomedical subjects

J M Matloff

Publications and source records attributed to J M Matloff.

At least 73 records · Page 4Linked to original sources
PubMed1987

Prospective evaluation of ultrafast cardiac computed tomography for determination of coronary bypass graft patency.

Twenty-five consecutive patients with 68 independent (single distal anastomosis) saphenous vein aortocoronary and 12 internal mammary bypass grafts (27 to left anterior descending, 10 to diagonal, 23 to left circumflex, 20 to right coronary artery) entered a reader-blinded, prospective, standardized study to establish the accuracy of ultrafast (cine) cardiac computed tomography (CT) for determining graft patency compared with invasive angiography. All patients underwent imaging after injection of 35 to 45 ml of meglumine diatrizoate (Renografin-76; 7 to 9 ml/sec for 5 sec) into an arm vein. Electrocardiographically triggered images were acquired over eight to 16 tomographic levels at 1 cm intervals from aortic arch to mid left ventricle. Criteria for graft patency were contrast opacification on at least two noncontinguous levels and contrast density-time curves morphologically similar to that of the aorta. Ultrafast CT correctly determined that 46 of 48 bypass grafts were patent and 31 of 32 were occluded (sensitivity, specificity, and accuracy 96%, 97%, and 96%); there were no interpretation errors in 23 (92%) of the 25 patients. Accuracy was independent of vessel bypassed and not different for saphenous veins (96%) compared with internal mammary bypasses (100%). This study establishes a 20 min outpatient intravenous injection technique that is highly accurate for determining patency of coronary artery bypass grafts.

Coronary Angiography↗
PubMed1987

Comparative clinical experience with porcine bioprosthetic and St. Jude valve replacement.

From 1976 to 1984, 656 patients underwent aortic, mitral, or double valve replacement with a Hancock or Carpentier-Edwards porcine bioprosthesis (POR; n = 293) or with a St. Jude bileaflet valve (SJ; n = 363). Recipients of the St. Jude valve were of more advanced NYHA class preoperatively, required smaller prosthetic sizes, and more often had associated coronary artery disease necessitating bypass grafting (p less than .05). Despite these differences, POR and SJ recipients demonstrated similar 30-day mortality (7.5 vs 10.2 percent), five-year freedom from embolism (92 +/- 2 percent vs 92 +/- 2 percent), freedom from all valve-related complications (79 +/- 3 percent vs 79 +/- 4 percent), and survival (72 +/- 3 percent vs 71 +/- 3 percent) (p = NS). Structural failures occurred exclusively in POR recipients (3.0-4.5 percent/pt-yr after four years), and endocarditis was more common (1.0 vs 0.5 percent/pt-yr); as a result, the reoperation rate was three times higher in POR than SJ recipients (1.4 vs 0.46 percent/pt-yr, p less than .05). Warfarin-related bleeding (2.5 percent/pt-yr) was the most common complication in SJ recipients, but occurred equally frequently in POR recipients requiring anticoagulation; seven (44 percent) of 16 valve-related late deaths were warfarin-related. In properly anticoagulated patients, the thromboembolic rate was low (2.0 percent and 1.1 percent/pt-yr, POR and SJ); this rate increased significantly in SJ recipients receiving antiplatelet drugs alone (4.2 percent/pt-yr; n = 16) or no anticoagulant or antiplatelet therapy (26.4 percent/pt-yr; n = 18) (p less than .05), but increased only slightly in POR recipients (to 1.5 percent/pt-yr, n = 108, and 2.0 percent/pt-yr, n = 63, respectively). Postoperatively, NYHA class 1 was more often achieved in SJ than POR recipients (60 vs 39 percent, p less than .05), perhaps because of the better hemodynamic performance of the SJ valve. Thus, despite differences in patient selection and the nature of complications observed with each prosthetic type, porcine and St. Jude valves provide similar early and late survival, frequency of embolism, total complication rate, and freedom from valve-related morbidity and mortality after five years of follow-up. Limited durability, susceptibility to infection, and inferior hemodynamics remain drawbacks to use of the porcine bioprosthesis. The necessity for warfarin anticoagulation and the frequency of resultant bleeding complications are the major shortcomings of the St. Jude valve.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

Harken caged-disc mitral valve replacement, 1969-1975: analysis of late mortality, thromboembolism, and valve failure.

We evaluated the long-term outcome of mitral valve replacement with a Harken caged-disc prosthesis for up to 11 years (range, 50 to 130 months; mean, 81 months) in 170 patients whose mean age was 55 years. The early (30-day) mortality was 11.2% (19 out of 170 patients). Late follow-up information was obtained for 144 (95%) of the 151 survivors. The actuarial survival was 57% at 5 years and 40% at 10 years. Overall mortality was associated with advanced age, male sex, an ischemic origin for the mitral valve disease, and nonuse of warfarin anticoagulation. Late deaths (n=59) were valve-related in 46%, cardiac but non-valve-related in 44%, and noncardiac in 10% of the cases. One thromboembolic event or more occurred in 41 patients (incidence, 5.7% per patient year), 14 of whom died (24% of the late deaths). All four patients who were not on warfarin, aspirin, or other antithrombotic therapy experienced thromboemboli. This complication was correlated with the nonuse of warfarin-type anticoagulation, with mitral regurgitation, and with late cardiac death. Mechanical prosthetic failure resulted in reoperation or death in 7.6% of the late survivors (1.5% per patient year). In 75 patients with normally functioning prostheses, the disc-to-sewing ring ratio was established by means of cinefluoroscopy (0.93 +/- 0.04, mean +/- 25D). Because of the high proportion of cardiac valve-related deaths (46%), the high incidence of late mortality due to thromboembolic events (24%), and the 7.6% incidence of reoperation or death resulting from mechanical valve failure, close follow-up with cinefluoroscopy and continued warfarin anticoagulation (alone or in combination with dipyridamole) are essential after mitral valve replacement with the Harken caged-disc prosthesis.

Journal Article↗
PubMed1986

Combined valve and coronary artery bypass procedures in septuagenarians and octogenarians: results in 120 patients.

A consecutive series of 96 septuagenarians (mean age, 74) and 24 octogenarians (mean age, 83) underwent coronary artery bypass (CAB) and valve operations using hypothermia and hyperkalemic cardioplegia in a 45-month period; there was a mean of 2.6 grafts per patient. Most patients were in New York Heart Association (NYHA) class IV (57% of the septuagenarians and 88% of the octogenarians) preoperatively. The early deaths were 19% for septuagenarians and 37% for octogenarians; late deaths were 9% and 6%, respectively, after a mean of 25 months. Of 92 survivors, 78% of the septuagenarians and 87% of the octogenarians improved by one or more NYHA class postoperatively. Of 58 patients with combined CAB and aortic valve replacement, 12 (21%) died; of 38 with combined CAB and mitral valve replacement 19 (50%) died; 2 of 9 (22%) with combined CAB and double valve replacement died; and 2 of 11 (18%) with CAB and MV repair died. In comparison, of patients with isolated valve replacement in the same period, 2 of 30 (7%) in the AVR group died, 5 of 17 (29%) died in the MVR group, 2 of 7 (33%) in the DVR group died. The risk of combined valve procedures and bypass surgery was significantly increased in the elderly and may warrant a less aggressive procedure, especially in the mitral position.

Aged↗
PubMed1986

Cine computed tomographic evaluation of aortocoronary bypass graft patency.

Evaluation of the patency of coronary bypass grafts has previously required hospitalization for invasive angiography. This report of three cases documents the unique capability of cardiac cine computed tomography to easily and accurately define coronary bypass graft patency. In each case, the findings altered therapeutic decisions. This early experience justifies wider application of this technique and suggests that it may eliminate the need for diagnostically motivated graft angiography. Large scale studies to establish the sensitivity and specificity of cardiac cine computed tomography for determining graft patency are indicated.

Coronary Angiography↗
PubMed1986

Hemodynamic differentiation of pathologic and physiologic stenosis in mitral porcine bioprostheses.

Porcine bioprostheses are physiologically stenotic valves. Degenerative calcification leading to pathologic stenosis is an increasingly recognized serious late complication of mitral valve replacement with a porcine bioprosthesis. Hemodynamic differentiation of pathologic from physiologic stenosis is important for identification of porcine bioprosthetic valve dysfunction. In 42 patients with a normal Hancock porcine bioprosthesis (standard model, sizes 27 to 33 mm), mean diastolic flow (65 to 461 ml/s), mean gradient (2.0 to 13.4 mm Hg) and effective orifice area (1.1 to 4.4 cm2) were determined at rest, during epicardial pacing (90, 110 and 130/min) and with isoproterenol infusion. A statistically significant increase in mean gradient occurred with increases in flow and decreases in valve size (p less than 0.05). Effective orifice area increased significantly as flow rate increased and as valve size increased (p less than 0.05). These measurements were compared with those in 16 patients with pathologically confirmed porcine bioprosthetic valve stenosis: 8 patients with reoperation (1.1% per patient-year) 3 to 8.5 years after mitral valve replacement and 8 previously reported abnormal cases. Stenotic failure rate was inversely related to valve size (2.1, 1.4, 0.5 and 0% per patient-year for sizes 27 to 33 mm). Stenotic and normal bioprostheses were not accurately differentiated on the basis of a single value for gradient or effective orifice area. A mathematical model that related flow to the square root of the mean gradient allowed complete separation of stenotic from normal prosthetic valve function, after valve size was accounted for and normal confidence limits were established (r = 0.74 to 0.94, sizes 27 to 33, p less than 0.0001). The effective orifice area-flow relation did not provide accurate differentiation of abnormal from normal function. Thus, normal mitral bioprostheses have significant transvalvular gradients whose magnitude depends on flow. Risk of stenotic failure is increased in the smaller valves, which have a larger gradient at implantation. Differentiation of pathologic from physiologic stenosis cannot be made on the basis of a single value for gradient or effective orifice area. Accurate hemodynamic differentiation is achieved by relating mean gradient to mean diastolic flow rate and valve size.

Bioprosthesis↗
PubMed1986

Cardiac surgery in the octogenarian.

Seventy-six consecutive patients, aged 80 to 89 (mean 82), underwent cardiac operations with cardiopulmonary bypass. Hypothermia (22 degrees C) and hyperkalemic cardioplegia were used in each. There were 35 men and 41 women. Thirteen patients (17%) were in New York Heart Association Functional Class III and 62 patients (81%) were in Class IV preoperatively. Coronary bypass procedures (Group I) were performed in 38 patients, of whom five had combined carotid endarterectomy. The average number of grafts was 3.7 per patient. There were two early deaths (5.2%). Single or double valve replacement, without coronary bypass (Group II), was done in 15 patients, with one early death (6.6%). Coronary bypass and valve procedures (Group III) were performed in 23 patients with seven early deaths (30%). Total early mortality was 10 deaths in 76 patients (13%). Of the 66 (87%) 30 day survivors, 19 (29.1%) had major postoperative complications, including bleeding, pericardial tamponade, sternal dehiscence, myocardial infarction, arrhythmia, and pump failure. Mean hospital stay was 23 days (9 to 117 days). Late cardiac-related deaths occurred in eight patients (9%) during the 58 (mean 28) months of follow-up. Thus combined early and late mortality was 18 deaths (24%). Mortality at any time was related to Functional Class IV status (17/18 deaths, 94% in Class IV); combined procedures (12/28 patients died, 43%); use of intra-aortic balloon pumping (8/13 patients died, 62%); and postoperative bleeding necessitating reoperation (4/6 patients died, 67%). At follow-up 84% of survivors had improved by one or more functional classes, and there was a low incidence of cardiac-related late deaths. This experience supports the concept that in octogenarians the indications for operation should be as for other patients of less advanced age, especially in those with isolated coronary artery disease and pure valve disease. Operation should not be delayed, so that these patients will not advance to higher-risk Class IV status preoperatively.

Age Factors↗
PubMed1985

Use of esmolol in hypertension after cardiac surgery.

Systolic hypertension, which is common soon after cardiac surgery, increases cardiac work and may threaten fresh vascular anastomoses. Because postoperative hypertension is often associated with elevated catecholamines and preoperative use of beta-blocking agents, esmolol, an ultrashort-acting beta-blocking agent, was compared with nitroprusside in a crossover study in this setting. Twelve patients, 18 to 28 hours after cardiac surgery (coronary artery bypass graft in 9, aortic valve replacement in 2 and valved aortic conduit with reimplantation of coronary arteries in 1 patient) received controlled infusions of esmolol (mean dosage 142 +/- 100 micrograms/kg/min, range 50 to 300 micrograms/kg/min) and nitroprusside (mean dose 1.6 +/- 1.3 micrograms/kg/min, range 0.5 to 2.75 micrograms/kg/min). In this open-label study, choice of the first drug was randomized, after which patients were then crossed over to the other study drug. Therapeutic response (greater than or equal to 15% systolic blood pressure reduction) was achieved in 11 of 12 esmolol patients and 12 of 12 nitroprusside patients. Both drugs significantly lowered systolic and diastolic blood pressure, as well as left ventricular stroke work index. While the cardiac index was decreased by esmolol and increased by nitroprusside, neither drug significantly changed stroke volume index. Systemic vascular resistance, unchanged by esmolol, was decreased significantly by nitroprusside. Oxygen saturation and Pao2, unchanged with esmolol, were both significantly reduced with nitroprusside. Thus, for hypertension early after cardiac surgery, esmolol is safe, effective and rapid and, compared with nitroprusside, results in less unwanted decrease in diastolic blood pressure and oxygen saturation, but there is more decrease in heart rate and cardiac index.

Adrenergic beta-Antagonists↗
PubMed1985

Myxoid degeneration of the aortic valve and isolated severe aortic regurgitation.

Clinical and pathologic data were reviewed in 55 patients who had valve replacement for pure aortic regurgitation (AR) during a 6-year period. The clinical histories established the cause for AR in 34 cases: 11 rheumatic, 13 infective endocarditis, 4 congenital, 4 associated with aortic aneurysms and 2 the Marfan syndrome. In the valves from the other 21 patients, 13 had myxoid degeneration, defined as significant disruption of the valve fibrosa and its replacement by acid mucopolysaccharides and cystic change. Myxoid degeneration was also the primary pathologic abnormality in the 2 patients with the Marfan's syndrome, in 3 patients with a history of rheumatic disease and in 1 patient with a history of infective endocarditis. The patients with myxoid degeneration of uncertain origin were predominantly elderly (average age 63 years), had a long-standing history of systemic hypertension (77%) and had coronary artery disease (46%); 85% were male. In these patients the replacement valves were not larger than those of the other groups studied, indicating that dilatation of the aortic anulus was not a significant factor in the pathogenesis of the valve disease. These findings indicate that myxoid degeneration of the aortic valve is common (36% of all valves examined) and, in many cases, may be secondary to long-standing systemic hypertension.

Adolescent↗
PubMed1985

Angioscopic visualization of blood vessel interior in animals and humans.

The purpose of this study is to describe the use of angioscopes in flowing bloodstreams of animals and humans, to demonstrate the ability to precisely deliver laser energy to an intravascular target using visual guidance and to determine the information content and spatial content of angioscopy. Angioscopy was performed in 5 living dogs, 16 cadaver vascular segments, and 14 patients at the time of peripheral or coronary bypass surgery. Five canine femoral artery segments received angioscopically directed intravascular Nd:YAG laser irradiation. We were able to precisely direct the laser irradiation to predetermined intimal targets. Gross tissue injury varied from none to carbonization and vascular perforation, depending on incident energy. Using a variety of flexible fiberoptic endoscopes ranging in diameter from 1.5 to 3.7 mm, we were able to visualize intravascular structures including plaque, suture lines, venous valves, and thrombi in living patients. No patient incurred complications of any sort. We conclude that angioscopy using flexible endoscopes can be performed safely, can provide clinically useful information, and may provide a means for delivering visually directed intravascular laser irradiation.

Animals↗
PubMed1985

Effects of intubation on coronary blood flow and myocardial oxygenation.

Effects on haemodynamics and myocardial oxygenation of endotracheal intubation were examined in 17 patients after halothane induction and 12 after 1 mg X kg-1 of IV morphine. Six patients having each anaesthetic were pretreated with IV propranolol (0.1 mg X kg-1) 45 minutes earlier. Arterial and intracardiac pressures, cardiac output and total coronary sinus blood flow (CSBF), both by thermodilution, were determined plus arterial-coronary differences of oxygen, haemoglobin and lactate. Blood pressure (BP), heart rate and CSBF were recorded continuously during intubation. The subjects were candidates for coronary bypass grafts, but had good ventricular function (mean ejection fraction 0.68 +/- 0.13 SD). From their reduced levels after induction, BP, cardiac index and systemic vascular resistance increased to awake levels following intubation. Mean CSBF in nonbetablocked patients increased to awake level along with BP. More myocardial oxygen was extracted and consumed after intubation, but lactate extraction continued: these data are evidence of adequate oxygen supply. Induction with either halothane or morphine effectively prevented the hypertensive response to intubation. Acute beta blockade led to less increase in heart rate from intubation.

Aged↗
PubMed1985

Adrenal function following coronary bypass surgery.

Little is known about adrenocortical function after coronary bypass surgery in which moderate to deep hypothermia and cardiopulmonary bypass are used particularly with intraoperative steroid administration. Therefore, we performed a pilot study in which immediately preoperative and 18-hour postoperative serum cortisol levels were determined in eight patients who received 1.0 to 1.5 gm of methylprednisolone intravenously during surgery; postoperative serum cortisol (3 +/- 1 microgram%) levels were lower than preoperative levels (15 +/- 3 microgram%, p less than 0.05). To determine the possible cause of these striking findings, the effects of moderate to profound hypothermia and cardiopulmonary bypass upon adrenocortical functioning were investigated without the influence of intraoperative steroid administration. Serum cortisol and aldosterone levels and their response to adrenocorticotropic hormone (ACTH) (Cortrosyn) were determined before coronary bypass surgery and at various postoperative intervals in seven patients. Postoperative cortisol and aldosterone levels increased markedly over their preoperative values, reaching a maximum at 6 to 12 hours (cortisol 16 +/- 8 vs 63 +/- 23 micrograms%, p less than 0.05, aldosterone 15 +/- 5 vs 51 +/- 22 ng%, p less than 0.05). Adrenal response to ACTH was normal preoperatively, during rewarming from hypothermia, and 18 hours, and 7 days postoperatively. In summary, normal adrenal responsiveness occurs after coronary bypass surgery, in spite of hypothermic cardiopulmonary bypass and the effects of anesthesia, and a single dose of methylprednisolone during surgery is associated with markedly lower serum cortisol levels and prevents the usual adrenal stress response to bypass surgery for at least 18 hours postoperatively.

Adrenal Cortex Function Tests↗
PubMed1985

Fibrinolytic therapy of St. Jude valve thrombosis under guidance of digital cinefluoroscopy.

Fibrinolytic therapy is an alternative to urgent reoperation for patients with St. Jude prosthetic valve thrombosis, but requires an accurate method for repeated assessment of prosthetic function. Since the St. Jude valve is not well visualized by conventional cinefluoroscopy, digital subtraction techniques were developed that improved visualization of the value and allowed assessment of leaflet separation and velocity. A 74 year old woman with prosthetic valve thrombosis 5 years after St. Jude aortic valve placement had an opening angle of 58 degrees (normal range 10 to 13; n = 8) with a maximal opening velocity of 1.37 degrees/ms (normal range 2.46 to 2.93). The closing angle was 125 degrees (normal range 120 to 127) with a maximal closing velocity of 1.38 degrees/ms (normal range 2.24 to 3.60). The patient received 250,000 U of streptokinase intravenously, then 100,000 U/h for 72 hours. Improvement in auscultatory findings occurred at 12 hours; repeat digital cinefluoroscopy showed an opening angle of 20 degrees with a maximal velocity of 2.77 degrees/ms, and a closing angle of 126 degrees with a maximal velocity of 1.91 degrees/ms. Digital cinefluoroscopy 4 weeks after discharge on warfarin and dipyridamole therapy was unchanged. There have been no thromboembolic complications after 6 months of follow-up. Thus, digital cinefluoroscopy is a new noninvasive technique that permits accurate measurement of normal and abnormal St. Jude leaflet function. Intravenous streptokinase dissolution of prosthetic valve thrombosis under digital cinefluoroscopic guidance may be an acceptable alternative to emergency reoperation. The frequency and significance of residual subclinical leaflet dysfunction after fibrinolytic therapy and the indications for elective reoperation require further evaluation.

Aged↗
PubMed1985

Esmolol: a new ultrashort-acting beta-adrenergic blocking agent for rapid control of heart rate in postoperative supraventricular tachyarrhythmias.

Prompt control of heart rate is important for successful treatment of supraventricular tachyarrhythmias early after open heart surgery when sympathetic tone is high and ventricular response rates may be rapid. Esmolol, a new ultrashort-acting (9 minute half-life) beta-receptor blocking agent, was given by continuous intravenous infusion for up to 24 hours in 24 patients (21 with isolated coronary bypass surgery and 3 with valve replacement) 1 to 7 days after surgery. Atrial fibrillation was present in 9 patients, atrial flutter in 2 and sinus tachycardia in 13. Eleven patients had received intravenous digoxin (average dose 0.6 mg, average serum level 1.19 mg/100 ml) before esmolol infusion without adequate control of the supraventricular tachyarrhythmia. After a 1 minute loading infusion of esmolol (500 micrograms/kg per min), maintenance dose, titrated to heart rate and blood pressure response, varied from 25 to 300 micrograms/kg per min. After esmolol administration, at an average dose of 139 +/- 83 micrograms/kg per min, mean heart rate decreased from 130 +/- 15 to 99 +/- 15 beats/min. Within 5 to 18 minutes after initiation of therapy, all patients had achieved a 15% reduction in heart rate at a maintenance dose of 150 micrograms/kg per min or less. A 20% reduction in heart rate was attained in 19 of the 24 patients, and conversion to sinus rhythm occurred during esmolol infusion in 5 of the 11 patients with atrial flutter or fibrillation. Transient asymptomatic hypotension (less than 90/50 mm Hg) was seen in 13 patients, requiring cessation of esmolol therapy in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1985

Fascicular conduction disturbances and ischemic heart disease: adverse prognosis despite coronary revascularization.

In patients with ischemic heart disease, fascicular conduction disturbances are associated with increased mortality. This study reveals that increased mortality also exists for certain types of fascicular conduction disturbances after myocardial revascularization. In 227 consecutive patients undergoing bypass surgery, 24 had preoperative and an additional 52 developed at surgery a fascicular conduction disturbance. At 66 +/- 14 months of follow-up, 6 (4%) of 148 control patients without pre- or postoperative fascicular conduction disturbances had died from cardiac causes. Although right bundle branch block and left hemifascicular block were the most common form of fascicular conduction disturbance, only 1 of 55 of these patients died (p = NS). Mortality rates were much higher for patients with left bundle branch block or an intraventricular conduction defect; 8 (38%) of 21 died from cardiac causes (p less than 0.05). A high risk subgroup was identified by comparing 14 consecutive patients with left bundle branch block or an intraventricular conduction defect who survived more than 1 year postoperatively with 21 consecutive patients with these same conduction defects who died within 1 year of surgery. The following variables were significantly (p less than 0.05) different (survivors versus nonsurvivors): age (58 +/- 7 versus 65 +/- 9 years); class IV angina (2 of 14 versus 16 of 21), prior myocardial infarction (9 of 14 versus 21 of 21), left ventricular ejection fraction (53 +/- 18 versus 41 +/- 15%), three vessel disease (9 of 14 versus 20 of 21) and left ventricular aneurysm (2 of 14 versus 13 of 21).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Cardiac causes of shock early after open heart surgery: etiologic classification by radionuclide ventriculography.

Early after open heart surgery, cardiac shock due to tamponade is easily misdiagnosed as ventricular dysfunction. The distinction is critical to successful therapy. We assessed the utility of 99mTc-red blood cell, gated equilibrium radionuclide ventriculography in 50 patients with early postoperative cardiac shock after historical, clinical, and invasive hemodynamic evaluation failed to identify either tamponade or ventricular dysfunction as the specific cause of their shock. The cause was established by radionuclide ventriculography in 45 of 50 patients and led to a change in therapy in 21 patients. A single cause was found in 35 patients: 13 had severe global dysfunction of the left ventricle (three patients), right ventricle (seven patients), or both ventricles (three patients); three had severe segmental left ventricular dysfunction; and 19 had an exaggerated region of photon deficiency (nine patients) or an abnormal and accumulating blood pool (10 patients) surrounding small hyperdynamic ventricles. Sixteen of these 19 patients with scintigraphic evidence of tamponade underwent aspiration with a pericardial needle or reoperation early after radionuclide ventriculography, resulting in confirmation of scintigraphic findings and improved hemodynamics. Ten additional patients had combined ventricular dysfunction and a pericardial abnormality, and five of these underwent reoperation resulting in improved hemodynamics. Radionuclide ventriculography provided no explanation for the cause of cardiac shock in five patients. Thus, the various causes of cardiac shock early after open heart surgery can be distinguished by 99mTc-red blood cell, gated equilibrium radionuclide ventriculography, eliminating diagnostic uncertainty that can occur with traditional evaluation.

Adult↗