[Coronary disease in younger people].
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Adult↗
Biomedical subjects
K Vatne
Publications and source records attributed to K Vatne.
Should the lungs be ventilated during cardiopulmonary bypass? Clinical, hemodynamic, and metabolic changes in patients undergoing elective coronary artery surgery.
No beneficial effects were achieved by ventilating the lungs of a group of 10 patients during total extracorporeal circulation for coronary artery bypass operation. Ventilation of nonperfused lungs, which was suggested to prevent postoperative atelectasis, may even have negative effects. Intrapulmonary shunting increased significantly (p less than 0.05), while the shunt fraction in the nonventilated lungs of another group of 10 patients remained unchanged. There were only minor differences between the two groups with respect to systemic and pulmonary hemodynamic changes.
Cardiopulmonary Bypass↗
Superior caval vein stenosis due to giant aneurysm of the right coronary artery.
Aneurysms of the coronary arteries may cause angina, myocardial infarction or sudden death due to thrombosis, embolization or rupture. The patient described herein may represent the first reported case of a large coronary artery aneurysm compressing the upper caval vein, and thereby producing a significant inflow gradient. The anatomical details were demonstrated by digital subtraction angiography (DSA). The patient successfully underwent resection of the aneurysm and reconstruction of the coronary artery with a saphenous vein bypass graft.
Aneurysm↗
Doppler echocardiography in adults with isolated ventricular septal defect.
Doppler echocardiography and cardiac catheterization were undertaken in 70 consecutive patients, 31-68 years of age (mean 39), who had isolated congenital ventricular septal defects (VSD), 28 of whom had been operated upon. In 50 patients with invasively proven VSD, 37 had a correct Doppler diagnosis of VSD (group 1) and in 13 a false negative result was obtained (group 2); i.e. a sensitivity of 74%. No false positive Doppler diagnosis was made in the 20 patients without evidence of shunt. Left to right ventricular systolic pressure difference (delta P) ranged between 55 and 142 mm Hg, with a mean value of 103 mm Hg in group 1 and 99 mm Hg in group 2. There was good correlation between delta P obtained by continuous wave Doppler and catheterisation in 17 group 1 patients with moderate and large shunts (r = 0.81, P less than 0.001). There was no correlation in the remaining 20 patients in group 1 with small shunts (r = 0.20, P greater than 0.1). Doppler echocardiography in the adult with isolated VSD has good sensitivity and excellent specificity. Doppler prediction of delta P is reasonably correct in patients with moderate and large shunts, but of no value in patients with small shunts.
Adult↗
Pulsatile vs. non-pulsatile flow during cardiopulmonary bypass. A comparison of early postoperative changes.
The aim of the study was to evaluate possible haemodynamic and metabolic effects of pulsatile flow in cardiopulmonary bypass. The subjects were 20 patients undergoing coronary artery bypass grafting. They had no complicating diseases. Ten consecutive patients with pulsatile perfusion were compared with ten consecutive patients with non-pulsatile perfusion. The haemodynamic parameters, chest X-rays, fluid balance and changes in circulating thrombocytes were unaffected by adding pulsatile flow to cardiopulmonary bypass. The arterial-venous oxygen content difference and intrapulmonary shunting were also unaffected. Whole-body oxygen consumption was higher in the pulsatile group immediately after bypass, but subsequently there were no differences. The haemoglobin and haematocrit values were higher in the non-pulsatile group two hours postoperatively, but did not differ in the rest of the observation period. The clinical course was similar in the two groups.
Blood Circulation↗
[Digital subtraction angiography].
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Cerebral Angiography↗
Reproducibility of ischaemic lactate metabolism during atrial pacing in man.
The reproducibility of myocardial ischaemia provoked by atrial pacing was studied in two groups of patients. The heart rate was slowly increased (10 beats per fourth min) until angina in group A, and quickly increased (10 beats per 20 s) in group B. Cardiac venous flow was measured by thermodilution and blood was sampled for metabolic studies at rest and during the maximum obtained heart rate and repeated after 20 min of rest. Ischaemia was defined as a reduction in myocardial lactate extraction ratio by 50% and to a ratio lower than 0.15. Lactate metabolism changed from production (-0.06 +/- 0.05) during the first pacing to extraction (0.05 +/- 0.05) during the second in group A (p less than 0.02). Lactate metabolism was quite reproducible in group B. All the other metabolic and haemodynamic parameters were unchanged in both groups. We conclude that the duration of atrial pacing is important for the reproducibility of pacing-induced myocardial ischaemia.
Cardiac Pacing, Artificial↗
Posterior left ventricular aneurysm due to occlusion of the circumflex coronary artery with recurrent ventricular tachycardia. Case report.
A 62-year-old male developed a large posterior left ventricular aneurysm diagnosed 6 months after a sustained myocardial infarction. Coronary angiography revealed a proximal occlusion of the circumflex artery, two 75% stenoses of the right coronary artery and a normal left anterior descending artery. The main clinical indication for surgery was residual bouts of ventricular tachycardia. A successful "mechanical conversion" of this arrhythmia by means of light precordial knocks in the apex region is reported. In this way the patient could be prepared for surgery without using myocardial depressant drugs. The aneurysm was resected, encircling endocardial ventriculotomy was performed and the right coronary artery was grafted. Nine months after the operation the patient is well without the need for antiarrhythmic drugs. The rarity of this condition is stressed and the possible mechanisms of ventricular tachycardia and its treatment in this particular case are discussed.
Coronary Disease↗
Angiographic and risk factor characteristics of subjects with early onset ischaemic heart disease.
Sixty-six consecutive patients less than 40 years of age with angiographically documented coronary artery disease and coronary heart disease took part in a study aimed at (1) identifying the presence of factors which might explain the premature onset of ischaemic heart disease, and (2) assessing the distribution and severity of the coronary artery lesions. For comparisons we have used a study of risk factors in 1832 men defined as "normals" according to a recent comprehensive examination. The findings show that the typical early onset coronary heart disease case is an overweight, heavily smoking male "blue collar" worker, with high serum levels, a marginally raised blood pressure, and a high prevalence of coronary heart disease among first degree relatives. Coronary angiography showed a preponderance of one vessel disease. In particular, left anterior descending artery lesions were common, which might have contributed to the early manifestation of disease.
Adult↗
Fibro-osseous lesions of the cranio-facial bones.
A brief review of cranio-facial fibro-osseous lesions is given and 15 cases of fibrous dysplasia and ossifying fibroma are presented with clinical, radiological and histomorphological findings. After histological verification of the fibro-osseous nature of the process, 5 lesions were diagnosed on an radiological basis as fibrous dysplasia exhibiting diffuse (blending) margins, while the diagnosis of ossifying fibroma was given to 10 radiologically sharply-demarcated lesions. Both groups of lesions presented the same histomorphological features, although to a varying degree. Spheroidal calcifications, however, were identified in ossifying fibroma only, but not in all of these. Thus, the differential diagnosis of fibrous dysplasia versus ossifying fibroma rests on a radiological criterion after the histopathologist has verified the fibro-osseous nature of a lesion. The observation times varied from 1 1/2 to 34 years. Two cases of fibrous dysplasia and 3 cases of ossifying fibroma recurred. In one case of fibrous dysplasia an osteosarcoma developed 33 years after irradiation. Pain was a common symptom in the present material.
Adolescent↗
Deviation of the descending aorta associated with enlarged left atrium.
The deviation to the left of the descending aorta associated with enlarged left atrium was analysed in 96 patients with mitral disease confirmed by angiography and cardiac catheterization. The opinion that this finding may be of value in patients below the age of 50 years was supported. In older age groups it is easily confused with the physiologic unfolding of the aorta, when this occurs at the level of the left atrium.
Adolescent↗
Safety of the nonionic contrast medium omnipaque in coronary angiography.
The low osmolar nonionic contrast medium Omnipaque was used in 5,339 consecutive coronary angiographies and serious complications were registered. Myocardial infarction occurred in 4 patients, of whom 2 died, and ventricular fibrillation in 1. Cerebral embolism occurred in 11 patients, all of whom survived. The results are compared with those of previous series of coronary angiography with high osmolar ionic media. It is concluded that use of the nonionic medium Omnipaque resulted in a significant reduction of the frequency of serious complications.
Adult↗
A reinvestigation of the usefulness of breath analysis in the determination of blood acetaldehyde concentrations.
Human volunteers were given ethanol (0.4 g/kg) either intravenous or per os. They were also given ethanol (0.2 g/kg) intravenous 4 hr after receiving a dose of 50 mg citrated calcium carbimide, an aldehyde dehydrogenase inhibitor. During the first hour after starting the administration of ethanol, ethanol and acetaldehyde concentrations were determined in expired air, blood from the right atrium, arterial blood, and venous blood. In the absence of calcium carbimide treatment, the respective maximal blood acetaldehyde concentrations were (range): 6-30 microM (calculated from breath analysis using a blood:breath partition ratio of 190 for acetaldehyde); 0-3.5 microM (right atrium blood); and 0 microM (arterial and venous blood). After calcium carbimide treatment, the maximal blood acetaldehyde concentrations were 10-220 microM (calculated from concentrations in expired air), 38-280 microM (right atrium), 31-250 microM (arterial blood), and 7-186 microM (venous blood). With aldehyde dehydrogenase inhibition, a clear correlation existed between breath concentrations and blood concentrations. Without this inhibition, no such correlation was found. A clear arterio-venous difference was seen for acetaldehyde concentrations while they were artificially elevated by calcium carbimide. Our study suggests that factors other than the equilibration of acetaldehyde between alveolar air and pulmonary blood are of great importance in determining the concentration of acetaldehyde in expired air.
Acetaldehyde↗
Metrizamide compared with metrizoate in cardioangiography in high-risk patients with coronary artery disease.
In a double-blind, randomized, two-group study of 99 'high-risk' patients mainly with coronary artery disease, the non-ionic contrast medium, Amipaque (metrizamide), was compared with the ionic medium, Isopaque Coronar (meglumine-Na-Ca-metrizoate) in cinecardioangiography. In evaluating the influence of the contrast media on the left ventricular end diastolic pressure (LVEDP), the material was divided into 2 groups, 55 patients with a basal LVEDP of 15 mmHg or less and 44 with an LVEDP above this level. In the former group LVEDP increased significantly after injection of the contrast medium into the left ventricle, but significantly less (p = 0.006) after Amipaque than after Isopaque Coronar. In the patients with a basal LVEDP above 15 mmHg, no significant change occurred in LVEDP after left ventriculography with any of the 2 contrast media. No serious complications occurred.
Adult↗
Percutaneous transluminal coronary angioplasty. Six years experience.
In a six-year period (1982-1987), 248 patients were treated with 297 procedures (percutaneous transluminal coronary angioplasty, PTCA) on 282 vessels. Two hundred and fifty-nine (87.2%) of the procedures in 210 (76.7%) of the patients appeared successful angiographically. Thirty-eight procedures were unsuccessful due to failure to pass the stenosis in 18 patients, dissection or occlusion of the treated vessel in 11, and significant residual stenosis in 9 patients. Emergency operations were performed after 11 (3.7%) of the procedures. Two patients died postoperatively. Myocardial infarction was seen in 13 patients, of whom 4 developed pathologic Q-waves in their ECG. Restenosis occurred in 60 (28.6%) of the patients. In the last year of the study, the patients selected for PTCA were in a poorer state angiographically, but the results of PTCA were better, without any increase of the complication rate. Our results, which are in accordance with others, support the concept that PTCA is a relatively safe procedure with a primary success rate of almost 90 percent. However, approximately one third of the patients developed restenosis, which in most cases occurred within 3 months.
Adult↗