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Biomedical subjects

K Chatterjee

Publications and source records attributed to K Chatterjee.

At least 253 records · Page 14Linked to original sources
PubMed1977

Selective cannulation of the anterior interventricular vein and coronary sinus: potential applications.

A technique of cannulation of the anterior interventricular vein (AIV) selectively, along with selective cannulation of the coronary sinus, is described. The technique was successful in 61 of 82 patients (76%) in whom it was attempted. There were no serious complications. The technique allows one to obtain blood samples simultaneously from the anterior interventricular vein and the coronary sinus, so that the metabolism of the left ventricular anterior wall and that of the overall left ventricle can be studied. Possible clinical applications of simultaneous investigation of the left ventricular anterior wall and global myocardial metabolism are discussed.

Cardiac Catheterization↗
PubMed1977

Hemodynamic advantage of combined administration of hydralazine orally and nitrates nonparenterally in the vasodilator therapy of chronic heart failure.

Patients with severe left ventricular failure generally have both reduced cardiac output and increased pulmonary and systemic venous pressures. A study was therefore made of the use of combined vasodilator therapy with nonparenterally administered nitrates, which act primarily on venous capacitance vessels and thus reduce preload, and orally administered hydralazine, which acts on arteriolar resistance vessels and thus reduces afterload. Twelve patients with chronic refractory heart failure were given these drugs individually and in combination during continuous hemodynamic monitoring. Heart rate and arterial pressure did not change significantly. Nitrates significantly reduced filling pressures of both ventricles without affecting cardiac index. Hydralazine did not alter filling pressures but dramatically increased cardiac index. The hemodynamic effects of each drug were additive during combined therapy, resulting in a 36 percent (28 to 18 mm Hg) mean decrease in left ventricular filling pressure and a 58 percent (2.1 to 3.3 liters/min per m(2)) mean increase in cardiac index. The seven patients who have continued to receive combined therapy for 3 to 10 months have shown sustained clinical improvement.

Administration, Oral↗
PubMed1977

Vasodilator treatment for acute and chronic heart failure.

The current status of the use of vasodilator drugs in the treatment of acute and chronic heart failure has been reviewed. It is apparent that vasodilator treatment can be used effectively in some patients with heart failure with a beneficial haemodynamics response, and that vasodilator agents are likely to find an important place in the management of such patients. Vasodilator treatment may be associated with complications and must be used with care. Though several nonparenteral vasodilator agents have been investigated, no ideal drug is yet available for the treatment of chronic heart failure. Nevertheless, it is probable that suitable drugs will emerge and find an important place in the management of such patients.

Aortic Valve Insufficiency↗
PubMed1977

The application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization.

To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scintigrams and enzymes with negative electrocardiograms. Thirty-four patients with negative electorcardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release.

Adult↗
PubMed1976

Automated precordial mapping for S-T segment analysis: variability in serial mappings of normal subjects and patients with stable S-T elevation.

An automated method of precordial mapping using a modified Caceres U.S. Public Health Service Electrocardiogram Diagnosing Program has been developed. The S-T segment elevation was measured in three successive complexes and averaged for each of the 35 precordial leads. The onset of the S-T segment (J point) was accurately located in over 99 percent of instances. The time required to sample the 35 leads averaged 8 1/2 minutes with subsequent data analysis requiring an additional 7 minutes. The S-T segment variability between serial mappings done over a 1 to 2 hour period was determined in normal subjects and patients with stable S-T elevation. The average S-T segment elevation/35 leads in normal subjects was 1.28 mv (range 0.41 to 2.14) and the between-mapping variability was +/- 0.25 mv at the 95 percent confidence level. The average S-T segment elevation/35 leads in the patients was 4.01 mv (range 1.35 to 7.28) mv. The between-mapping variability was +/- 0.29 mv (95 percent confidence level), and was not statistically different from the variability in normal subjects (P less than 0.05).

Adult↗
PubMed1976

Hemodynamic effects of nitroglycerin ointment in congestive heart failure.

The hemodynamic effects of nitroglycerin absorbed transcutaneously from an ointment base were determined in 10 patients with chronic congestive heart failure (9 with ischemic heart disease and 1 with cardiomyopathy). The response was characterized by a decrease in pulmonary capillary wedge pressure from an average of 30 to 19 mm Hg, and an increase in cardiac index from 1.7 to 2.2 liter/min per m2, with concomitant decreases in systemic and pulmonary vascular resistance and an increase in venous capacitance. Mean arterial pressure decreased from 85 to 80 mm Hg, and heart rate remained unchanged. The hemodynamic effects persisted for 3 to 6 hours. These results indicate that nitroglycerin ointment is a hemodynamically potent vasodilating agent with potential value in the therapy of congestive heart failure.

Aged↗
PubMed1976

Transaortic cannulation for balloon pumping: report of a patient undergoing closed chest decannulation.

A technique is described for introduction of an intraaortic balloon (for circulatory augmentation) through the transverse aorta using a crimped Dacron arterial graft brought out through a lateral skin incision. When balloon pumping is discontinued, the balloon catheter is withdrawn through the percutaneous graft without reopening the chest. The graft is amputated and buried without ill effect.

Aorta↗
PubMed1976

Effects of vasodilator therapy for severe pump failure in acute myocardial infarction on short-term and late prognosis.

Forty-three patients with severe pump failure complicating acute myocardial infarction were treated with vasodilators (nitroprusside (40) and phentolamine (3)) for four hours to 27 days. Cardiac index, stroke volume index, and stroke work index (SWI) increased while the left ventricular filling pressure (LVFP) decreased during vasodilator therapy. Twenty-four of the 43 patients (56%) survived. Of patients with initial SWI between 11-20 gm-m/m2 and LVFP less than 15 mm Hg, 68% survived. In contrast only 18% of patients with SWI of 10 gm-m/m2 or less and LVFP greater than 15 mm Hg survived. Of the 17 patients with clinical shock, 8 (47%) survived. All 24 patients discharged from the hospital were followed for at least 12 months. Fourteen patients died one to 25 months (average 9.2 months) after discharge and the cause of death was pump failure in ten of them (71%). The ten survivors at last follow-up had been followed for 15 to 32 months (average 24 months). The cumulative survival at 24 months was 28%. Thus, despite improvement in short-term prognosis with vasodilator therapy in patients with severe pump failure complicating acute myocardial infarction, the prognosis for long term survival remains unfavorable, possibly due to severe intrinsic cardiac damage.

Acute Disease↗
PubMed1976

The similarity of changes in segmental contraction patterns induced by postextrasystolic potentiation and nitroglycerin.

Despite a fundamental difference in their underlying mechanisms, both postextrasystolic potentiation (PESP) and administration of nitroglycerin (TNG) have been utilized to predict reversibility of abnormal segmental wall motion in patients with ischemic heart disease. To determine whether these interventions induce the same changes in segmental contraction pattern, we analyzed biplane ventriculograms of 14 patients who had an adequately visualized PESP beat on a basal ventriculogram as well as a post-TNG ventriculogram. Four segments in each plane were defined and the area ejection fraction of each segment was calculated for a basal sinus, PESP, and post-TNG beat. To correct for global differences in the response to PESP and TNG, we normalized each segmental ejection fraction (NSEF) by the ventricular ejection fraction for that beat and then compared the differences in NSEF from the basal value after PESP and TNG. Eleven patients demonstrated similar responses to both interventions. The three patients whose responses were discordant had elevated or unchanged left ventricular systolic or end-diastolic pressures at the time of the TNG ventriculogram. Our data suggest that, provided these pressures are lower than basal values at the time of the TNG ventriculogram, PESP and TNG will induce similar changes in segmental contraction patterns. Seven patients with similar responses had a PESP beat on their post-TNG ventriculogram. Changes in NSEF after PESP+TNG were identical to those after either intervention. This implies that the combination of interventions does not induce further changes in segmental contraction pattern beyond that produced by either intervention alone.

Angiocardiography↗
PubMed1976

Oral hydralazine therapy for chronic refractory heart failure.

The hemodynamic effects of oral hydralazine were investigated in ten patients (nine in NYHA Class IV and one in Class III) with chronic refractory heart failure. With hemodynamic monitoring, adequate oral doses of hydralazine (50 or 75 mg) were determined and then administered every six hours. Hemodynamics were determined at 2-3, 6-8 and 24 hours on hydralazine therapy. Arterial pressure decreased slightly (5%) and systemic vascular resistance decreased significantly (42%). Cardiac and stroke volume index increased by 70 and 66%, respectively, without any significant change in heart rate, pulmonary capillary wedge or right atrial pressure. Hemodynamic improvement was associated with clinical improvement without a major complication. During the follow-up period of 3-7 months, seven of nine patients were in NYHA Class II and one in Class III. One other patient died suddenly six weeks after discharge. These findings suggest that hydralazine in an effective oral vasodilator for the treatment of refractory heart failure.

Adult↗
PubMed1976

Combination vasodilator therapy for severe chronic congestive heart failure.

A patient with severe, chronic congestive heart failure was unresponsive not only to conventional therapy, but also to nonparenteral nitroglycerin and isosorbide dinitrate; he became nitroprusside dependent. Oral minoxidil therapy produced a significant decrease in systemic vascular resistance and an increase in cardiac output, with no tachycardia, hypotension, or decrease in systemic and pulmonary venous pressures. The addition of sublingual isosorbide dinitrate decreased venous pressures and produced a further increase in cardiac output. The combination of oral minoxidil and sublingual isosorbide dinitrate maintained clinical and hemodynamic improvements, and the patient could be weaned off nitroprusside. Deterioration in hemodynamics occurred with the withdrawal of minoxidil. Therapy with oral hydralazine produced hemodynamic effects comparable to those of oral minoxidil. These observations suggest that chronic reduction of impedance to left ventricular ejection with minoxidil or hydralazine is possible in patients with severe intractable heart failure and deserves further clinical trial.

Chronic Disease↗
PubMed1976

Bedside hemodynamic monitoring. Its value in the diagnosis of tamponade complicating cardiac surgery.

Cardiac tamponade may be a difficult clinical diagnosis in the early postoperative period in patients undergoing open-hear surgery, particularly when the anterior or lateral pericardium is left open. Bedside monitoring of intracardiac pressures and determination of a "pressure plateau" between right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressures are useful in the early diagnosis of cardiac tamponade. The value of such hemodynamic monitoring in the diagnosis and treatment of cardiac tamponade in three patients with aorta-coronary artery bypass surgery in the early postoperative period is reported. Appropriate therapy, carried out on the basis of these studies, minimized the occurrence of further morbidity or possible death.

Adult↗