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Biomedical subjects

J R Utley

Publications and source records attributed to J R Utley.

At least 37 records · Page 2Linked to original sources
PubMed1989

Correlates of preoperative hematocrit value in patients undergoing coronary artery bypass.

The patient's preoperative red cell volume and hematocrit value are among the strongest predictors of need for postoperative transfusion. We have determined the factors that correlate with preoperative hematocrit value. We performed multiple regression analysis with preoperative hematocrit value as the dependent variable. The factors that were significantly correlated with preoperative hematocrit value, in order of their decreasing contribution to variability, were sex, date of operation, preoperative hospital stay, weight, left ventricular end-diastolic pressure, age, smoking history, and recent myocardial infarction (less than 6 weeks). Factors that did not contribute significantly to predicting preoperative hematocrit value included ejection fraction, emergency operation, previous streptokinase use, number of coronary arteries diseased, body mass index (obesity), diabetes, height, body surface area, and history of percutaneous transluminal coronary angioplasty. The patient most likely to have a low preoperative hematocrit value can be characterized as a small, elderly, female nonsmoker with a recent myocardial infarction and elevated left ventricular end-diastolic pressure. The prevalence of low preoperative hematocrit value is increasing with time independent of other factors.

Aged↗
PubMed1984

Reoperation for correction of anomalous origin of the left coronary artery from the pulmonary artery with return of left ventricular function.

An adult patient is presented in whom anomalous origin of the left coronary artery from the pulmonary artery was diagnosed in infancy. Initial treatment included a palliative poudrage procedure. Resulting widespread, dense adhesions were encountered during reoperation in adulthood and precluded direct reimplantation of the left coronary artery into the aorta. Instead, a tunnel within the pulmonary artery was constructed from the aorta to the left coronary ostium using a baffle of woven Dacron. Preoperative and postoperative studies showed improvement in ejection fraction and resolution of diaphragmatic hypokinesis.

Adult↗
PubMed1984

Right pulmonary artery--left atrial communication. A case report and literature review.

A 22-month-old girl with Down's syndrome with a direct communication between the right pulmonary artery and left atrium leading to systemic desaturation is presented. She also had an atrial septal defect of the secondum type, which spontaneously closed. She underwent successful ligation of the abnormal communication. The literature is reviewed and, considering the high incidence of cerebral and systemic emboli, early surgical intervention is recommended.

Blood Pressure↗
PubMed1983

Inflammatory constriction following complete pericardiectomy in tuberculous constrictive pericarditis.

A 13-year-old boy with active tuberculous constrictive pericarditis underwent complete pericardiectomy together with antituberculous therapy and a short course of steroids. Six weeks following the surgery, he was seen with clinical and hemodynamic findings of recurrent pericardial constriction, presumably due to an inflammatory collection around the heart. Symptoms gradually resolved within six months with resumption of steroid therapy. Repeat hemodynamic study showed normal hemodynamics. The case demonstrates the production of cardiac constriction by nonpericardial inflammatory tissue and the possible benefits of steroid therapy in the treatment of tuberculous constrictive pericarditis.

Adolescent↗
PubMed1983

Pulmonary artery partition: new method for correction of interrupted aortic arch.

We have successfully corrected interrupted aortic arch with ventricular septal defect by employing deep hypothermia and circulatory arrest, a median sternotomy incision, and a pulmonary arteriotomy. This simplified technique has the advantage of an abbreviated period of cerebral ischemia, with a relatively simple partitioning of the pulmonary artery.

Aorta, Thoracic↗
PubMed1982

Effect of albumin and mannitol on organ blood flow, oxygen delivery, water content, and renal function during hypothermic hemodilution cardiopulmonary bypass.

The present study was designed to determine if the addition of albumin or mannitol to the priming solution of the pump oxygenator would diminish edema in organs, without diminishing some of the beneficial effects of hemodilution on blood flow and renal function. Tissue blood flow (15 mu spheres), water content, and renal clearances were determined in 8 animals during cardiopulmonary bypass. A 2(2) factorial, completely fixed experimental design was used. All animals were placed on cardiopulmonary bypass with hemodilution (hematocrit 25 +/- 2%) and hypothermia (25 degrees +/- 1 degree C). Albumin decreased flow to the midmyocardium of the left ventricle and to the spleen, and increased flow to the inner cortex of the kidney. Albumin caused decreased urine flow and decreased urine sodium, and also diminished renal osmolar, sodium, and free-water clearances. both mannitol and albumin decreased lung water. Mannitol decreased water content of the outer renal cortex, and decreased flow to the inner cortex and medulla of the kidney and to the spleen. Mannitol had no significant effect on urine flow, renal plasma flow, or renal clearances. Neither albumin nor mannitol had any effect on water content of the intestine, stomach, liver, or myocardium where the greatest accumulation of water occurs with hemodilution. The effect of albumin on renal function is potentially deleterious during cardiopulmonary bypass because it decreases urine flow, and osmolar and free-water clearance.

Animals↗
PubMed1982

Effectiveness of stroma-free hemoglobin solution as seen in a right heart bypass swine model.

To determine if tolerance to severe anemia (Hct less than or equal to 10%) might be improved with stroma-free hemoglobin solution (SFH), 15 swine were placed on normothermic right heart bypass (RHBP) for evaluation of stroke volume (SV), coronary blood flow (CBF), arterial-coronary sinus oxygen content difference S(a-cs)O2, and myocardial oxygen consumption (MVO2) during a control period at a hematocrit (Hct) level of 30%. These 15 animals, divided into three equal groups, subsequently underwent exchange transfusion either to a Hct of 5% using 7% SFH (group 1), or to a Hct of 5% (group 2) or 10% (group 3) using 7% bovine albumin solution. All tests were repeated during these experimental conditions. Myocardial performance after albumin solution exchange was sustained on RHBP in only 1 of 10 animals. SFH animals (group 1) had a significant drop in SV at 14 torr after exchange (20 +/- 3 ml vs 10 +/- 4 ml, p less than 0.025), but this 50% performance level could be sustained. CBF rose and MVO2 fell in all groups, although the statistically nonsignificant mean differences were less with SFH. S(a-c)O2 fell significantly (p less than 0.05) with albumin solution (group 2 7.3 +/- 1.4 vs 2.2 +/- 0.2, group 3 8.9 +/- 2.0 vs 3.8 +/- 1.0), and nonsignificantly with SFH (5.6 +/- 0.7 vs 4.1 +/- 1.4). Although myocardial performance decreased with SFH, the authors believe these comparative results support the use of SFH at an Hct of 5%.

Animals↗
PubMed1982

Pulmonary endarterectomy for chronic thromboembolic obstruction: recent surgical experience.

Pulmonary thromboendarterectomy for chronic pulmonary emboli was performed on ten patients, ages 20 to 67 years, between July 1977 and June 1981. Five patients each were assigned to New York Heart Association functional classes III and IV. All patients had pulmonary hypertension and increased pulmonary vascular resistance. Obstruction beginning in the lobar arteries and involving more than 50% of the sequential arteries was present in all patients. Five patients had complete obstruction of a pulmonary artery. All patients had obstructive disease in both lungs. Pulmonary thromboendarterectomy was performed through central pulmonary arteriotomies and by use of deep hypothermia and circulatory arrest. Circulatory arrest was employed in one to four periods totaling up to 60 minutes. No neurologic deficit was observed. All patients developed reperfusion edema in the lungs. All patients had improvement in pulmonary hypertension and pulmonary vascular resistance. One patient died of lung failure in the late postoperative period. All survivors had improved lung function, with two functional classes in seven patients. Improvement in one equaled three functional classes and in one, by one functional class.

Adult↗
PubMed1981

Contractile fibroblasts (myofibroblasts) in a painful pacemaker pocket.

Electron microscopy of a painful fibrotic capsule around a cardiac pacemaker revealed classic myofibroblasts. These contractile fibroblasts share characteristics of both smooth muscle cells and fibroblasts and are thought to be the cellular cause of wound and scar contraction. The occurrence of pain and tenderness around a sterile pacemaker probably indicates contraction of scar tissue as the basis of the symptoms. This scar tissue is similar to that seen around other large inert implants placed in the thoracic tissue.

Cicatrix↗
PubMed1981

Aortopulmonary anastomosis in patients with levotransposition.

A technique for approximating the right pulmonary artery to the aorta in levo (L) transposition is described. The anastomosis is placed high on the ascending aorta to avoid occluding the coronary circulation by the clamp during the anastomosis. It is in patients with occluded left side anastomoses or single right pulmonary arteries that the right-sided anastomoses are most useful in L-transposition.

Aorta↗
PubMed1981

Blood conservation techniques.

Increasing numbers of operations requiring cardiopulmonary bypass have been accompanied by greater demands for blood resources. Improved techniques of blood conservation have diminished the average blood requirements per operation and have increased the percent of operations that can be done without homologous blood. The conservation of blood can be planned according to each patient's requirements. The techniques include preoperative blood donation, intraoperative withdrawal of blood, reinfusion of oxygenator blood, autotransfusion of blood after heparin neutralization, autotransfusion after wound closure, and hemodilution. The availability of techniques for filtration, centrifugation, and washing of blood have improved the safety of autotransfusion. The techniques that gives the best cost/benefit ratio appear to be preoperative withdrawal of blood, reinfusion of centrifuged oxygenator contents, and reinfusion of filtered blood from chest drainage.

Blood Transfusion↗
PubMed1981

Effects of hypothermia, hemodilution, and pump oxygenation on organ water content, blood flow and oxygen delivery, and renal function.

Hypothermia, hemodilution, and the pump-oxygenator each contribute important effects during cardiopulmonary bypass. We studied their separate effects with a 2(3) factorial, completely fixed experimental design in 16 adult male mongrel dogs. Animals undergoing hypothermia were cooled to 25 degrees +/- 1 degree C. In dogs having hemodilution, hematocrit was adjusted to 25 +/- 2%. An analysis of variance was used to determine the effects of hypothermia, hemodilution, and pump oxygenation. The experiments show that hemodilution produces increased water content in tissue and that edema is greatest in heart and gastrointestinal organs. The pump-oxygenator decreased flow to the subendocardium, whereas hemodilution increased subendocardial flow. Both hypothermia and pump oxygenation diminished flow to the outer kidney cortex, and hemodilution augmented flow to this region. Hypothermia and pump oxygenation decreased and hemodilution raised renal free-water clearance. Although none affected glomerular filtration rate, hypothermia increased filtration fraction while hemodilution diminished it. Hypothermia lessened cerebral cortical flow, an effect opposite that of hemodilution. Thus, hemodilution opposes the adverse effect of hypothermia or pump oxygenation on blood flow, oxygen delivery, or renal function. Increased water content in gastrointestinal organs and myocardium accompanies the beneficial vascular and renal effects of hemodilution.

Animals↗
PubMed1981

Effects of halothane and morphine sulfate on myocardial compliance following total cardiopulmonary bypass.

We evaluated the effect on diastolic myocardial compliance of halothane and morphine sulfate using 15 swine placed on total cardiopulmonary and right heart bypass with controlled aortic pressure, heart rate, and left ventricular preload. The animals were divided into three equal groups: (I) regional block anesthesia, (II) morphine sulfate (10 mg/kg), and (III) halothane anesthesia at 0.5%. Myocardial performance was evaluated on right heart bypass following a 30 minute period of total cardiopulmonary bypass before and after administration of the anesthetic agent by measuring stroke volume, left ventricular end-diastolic pressure, and left ventricular end-diastolic volume. All perfusions were at normothermia, at a hematocrit level of 30%, and at a normal arterial Po2. PCO2, and pH. Neither regional block nor morphine sulfate anesthesia significantly depressed the myocardium or changed diastolic compliance. Halothane, however, significantly decreased diastolic compliance so that stroke volume was less at a given left ventricular end-diastolic pressure, but not at a given left ventricular end-diastolic volume. The depression of stroke volume with halothane following cardiopulmonary bypass at equal filling pressures appears to be due primarily to a change in compliance rather than to a change in contractility.

Anesthesia↗
PubMed1981

Cardiopulmonary bypass in the presence of uncorrected coarctation.

We performed correction of intracardiac lesions in 10 patients with coarctation. All cardiovascular lesions were corrected except coarctation. Six patients had a large left-to-right shunt though a ventricular septal defect (VSD), two patients had left ventricular outflow obstruction, two patients had mitral insufficiency, and one patient had mitral stenosis. Arterial perfusion was through the ascending aorta. Urine output was 6.0 +/- 1.5 cc/kg/hr during cardiopulmonary bypass. There was no morbidity related to cardiopulmonary bypass or inadequate perfusion of the lower body, and left ventricular failure did not occur. One patient with Taussig-Bing abnormality and pulmonary vascular disease died postoperatively of right ventricular failure. Intracardiac repair with aortic perfusion in the presence of coarctation is a safe alternative to coarctation repair or combined procedures.

Aortic Coarctation↗
PubMed1981

Extending the limits of hemodilution on cardiopulmonary bypass using stroma-free hemoglobin solution.

Ten swine were subjected to exchange transfusion to a hematocrit level of 5% with either stroma-free hemoglobin solution (SFHS) or 7% albumin solution. Myocardial performance, oxygen kinetics, and myocardial metabolism were subsequently examined using a perfused, in situ, right heart bypass, swine heart model with control of preload, afterload, and heart rate. Animals were tested during a control period (hematocrit = 30%) and following exchange transfusion with either solution to a hematocrit level of 5%. We found that myocardial performance following albumin solution exchange could not be sustained on right heart bypass, and these animals had a stroke volume of zero at a left ventricular end-diastolic pressure of 14 torr. SFHS animals had a significant drop in stroke volume at 14 torr following exchange (20 +/- 3 versus 10 +/- 4, p < 0.025), but this 50% performance level could be sustained. Coronary blood flow rose and myocardial oxygen consumption fell in both groups, although the statistically nonsignificant mean differences were less with SFHS. Arterial-coronary sinus oxygen difference fell significantly (p < 0.05) with albumin solution (7.3 +/- 0.8 versus 2.2 +/- 0.2) and nonsignificantly with SFHS (5.6 +/- 0.4 versus 4.1 +/- 0.7). Lactate production occurred in both groups, but was greater with albumin (34% +/- 6%) than with SFHS (3% +/- 16%). No changes in myocardial tissue gasses were noted in either group. Although myocardial performance decreased and some lactate production occurred with SFHS, we believe these comparative results provide promise in the eventual utilization of an oxygen-carrying agent such as SFHS to extend the limits of hemodilution to a hematocrit value of 5% or less.

Animals↗
PubMed1980

Repair of mycotic aneurysms of the aorta involving the aortic valve.

This report summarizes our successful management of 6 patients who underwent repair of mycotic aneurysms of the ascending aorta within a four-year period. Repairs have been successful despite involvement of as much as two-thirds of the circumference of the aortic valve annulus, involvement of the origin of the right coronary artery, and development of heart block. Three patients required surgical intervention because of hemodynamic decompensation before they had completed antibiotic therapy for endocarditis. In 3 patients, the aneurysm was buttressed with the valve skirt so that aneurysm repair and valve replacement were accomplished in continuity. In 2 patients, the aneurysm was repaired separately and the valve seated on the repair. In 1 patient, a large defect between the left and right coronary arteries was repaired with a woven Dacron patch secured to the valve skirt. The valve was seated to the left ventricle and the graft to the aorta. There were no operative or postoperative deaths. Our data suggest that mycotic aneurysms of the aortic annulus can be successfully repaired despite extensive damage.

Adolescent↗
PubMed1980

Interstitial fluid pressure changes during cardiopulmonary bypass.

The effects of cardiopulmonary bypass using hemodilution on interstitial fluid pressure were measured using the Scholander wick technique. In 10 mongrel dogs, interstitial fluid pressure was measured in subcutaneous tissue, skeletal muscle, stomach, and left ventricle before and during 2 hours of cardiopulmonary bypass. Changes in interstitial fluid pressure were correlated with plasma colloidal osmotic pressure and duration of bypass. In subcutaneous tissue and skeletal muscle, interstitial fluid pressure increased during bypass; it did not change in the stomach. End-diastolic interstitial fluid pressure in the left ventricle increased significantly. These increases in pressure were presumably due to an increase in interstitial water. The rise in interstitial fluid pressure acts to partially neutralize the fall in plasma colloidal osmotic pressure.

Animals↗