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Biomedical subjects

M Choy

Publications and source records attributed to M Choy.

36 records · Page 2Linked to original sources
PubMed1991

Effects of ischemia on epicardial segment shortening.

To evaluate the effects of nontransmural ischemia on epicardial contractile function, we implanted sonomicrometers in 15 open-chest, anesthetized (halothane) dogs. One cylindrical crystal (radiating ultrasound 360 degrees) was used as a transmitter for three conventional flat plate crystals arrayed to measure epicardial segment shortening along three different axes that were deviated 0 degree (parallel), 45 degrees (oblique), and 90 degrees (perpendicular) from surface fiber orientation in the anteroapical or posterior-basal left ventricle. During baseline conditions, epicardial shortening was maximal parallel with fiber orientation. Shortening decreased in a non-linear manner as deviation from fiber orientation increased, but there were significant differences between the two left ventricular regions suggesting that more substantial lateral strain occurs in the anterior-apical than the posterior-basal area. During coronary inflow restriction, changes in epicardial segment shortening also varied greatly depending on location and alignment. At levels of wall thickening impairment associated with normal subepicardial perfusion, changes in epicardial function were restricted to the segments aligned perpendicular to fiber orientation whereas the parallel and oblique segments displayed moderate dysfunction or none at all. Thus, transmural tethering modifies epicardial segmental motion during coronary inflow restriction, but the severity of the influence depends on the alignment and location of the epicardial measurements.

Animals↗
PubMed1991

Sonographic spectrum of fetal cardiac hypoplasia.

Four cases of hypoplastic left ventricle and three cases of hypoplastic right ventricle detected sonographically prenatally are presented. A four-chamber view of the heart was abnormal in all seven cases. The sonographic appearance of the hypoplastic ventricle was variable, being smaller than normal in six of seven cases and not being identified at all in one case. Other ultrasound findings included an atrial septal defect (n = 7); increased size of the contralateral ventricle (n = 6); nonvisualization or poor visualization of the outflow tract of the affected ventricle (n = 6), and intact ventricular septum (n = 5). In one of four cases of hypoplastic left ventricle the pregnancy was terminated; the other three infants died within 5 days after birth. One of the three fetuses with hypoplastic right ventricle was aborted. Of the remaining two infants included one had tricuspid atresia with a ventricular septal defect and one had pulmonary atresia with an intact ventricular septum. Both infants are alive, have had palliative surgery, and will be considered for a more definitive surgical repair. An abnormal four-chamber view of the heart should alert those performing routine obstetrical ultrasound to a possible hypoplastic ventricle, so that the pregnant woman can be referred to a center capable of performing more sophisticated fetal echocardiography.

Abortion, Induced↗
PubMed1991

Implementing a computerized operating room management system.

The Queen's Medical Center implemented a computerized operating room management system in 1987 that includes surgery scheduling, intraoperative recording, and resource tracking. In addition to the important functional components, the system provides management with a better tool for decision-making. The purpose of this article is to describe this implementation. Background is provided to identify the manual system's deficiencies followed by the anticipated benefits of the computer system. The paper concentrates on Queen's implementation experiences in coding the surgical procedure information, confronting staff anxiety, managing the changing roles of the staff and providing adequate resources. Minimum requirements for a successful implementation include designating an effective project leader, assigning system responsibilities to the user, relieving all operational responsibilities from key members of the project team and providing adequate resources to support the system.

Appointments and Schedules↗
PubMed1991

Ebstein's anomaly appearing in the neonate. A new surgical approach.

Ebstein's anomaly appearing during the neonatal period carries a high mortality rate. These infants exhibit cyanosis, acidosis, and congestive heart failure. The pathophysiologic characteristics consist of severe tricuspid regurgitation and functional pulmonary atresia. As a result of the inability of the right ventricle to generate forward flow through the pulmonary arteries, these infants remain dependent on ductal patency. Since May 1988, five newborn infants with severe Ebstein's anomaly have been admitted for treatment at our institution. At initial examination, they weighed 3.6 +/- 1.8 kg and had a mean oxygen tension of 29.6 +/- 2.3 mm Hg and a mean pH of 7.20 +/- 0.05. Chest roentgenography demonstrated a mean cardiothoracic ratio of 0.81 +/- 0.02. As determined by echocardiography, the right atria were massively enlarged, severe tricuspid regurgitation was present in all patients, and the pulmonary valves were not opening. All infants were dependent on prostaglandin E1 and attempts to wean them from this drug were unsuccessful. Palliative treatment consisted of tricuspid closure with autologous pericardium and an aortopulmonary shunt of 4 mm polytetrafluoroethylene tubing. There were no operative or late deaths. At discharge, mean oxygen tension was 42.2 +/- 0.85 mm Hg and mean systemic oxygen saturation was 83.2% +/- 1.94%. Infants have grown satisfactorily during the follow-up period. Three infants have since returned for further surgical intervention. One infant, at 11 months of age, underwent a Glenn anastomosis for progressive oxygen desaturation. Two infants have returned, at ages 23 and 22 months, for Fontan procedures, which represent their definitive operative management. We believe this new procedure offers excellent palliative treatment for Ebstein's anomaly in critically ill neonates. Feasibility of later definitive correction is demonstrated by the good results obtained with the Fontan procedure in two infants.

Ebstein Anomaly↗
PubMed1990

Regulation of proliferation of embryonic heart mesenchyme: role of transforming growth factor-beta 1 and the interstitial matrix.

Proliferation of atrioventricular cushion mesenchyme of the embryonic avian heart maintained in three-dimensional aggregate culture is stimulated by interaction with the interstitial matrix. Chicken serum or transforming growth factor-beta 1, which stimulates proliferation, induces matrix deposition in regions of the aggregate showing high labeling indices with tritiated thymidine. Dispersed heart mesenchyme interstitial matrix introduced into serum-free culture is incorporated into the aggregate and stimulates cellular proliferation similar to serum or transforming growth factor-beta 1. Proliferation is reversibly inhibited by the peptide Gly-Arg-Gly-Asp-Ser-Pro. It is suggested that transforming growth factor-beta 1 stimulates the production of interstitial matrix and that a sufficient stimulus for proliferation in this system is the presence of the matrix, which acts as the adhesive support for cellular anchorage.

Animals↗
PubMed1989

Hereditary long Q-T syndrome presenting as epilepsy: electroencephalography laboratory diagnosis.

Patients with hereditary Q-T interval prolongation can present with seizures, syncope, and sudden death. In 2 siblings with autosomal dominant familial long Q-T syndrome, electroencephalographic examinations performed 6 and 2 years before diagnosis included electrocardiographic tracings documenting the cardiac abnormality. A timely diagnosis of this condition may have prevented the death of 1 of these patients. Measurement of the corrected Q-T interval on electrocardiographic tracings obtained in the electroencephalography laboratory should be considered in selected patients.

Adolescent↗
PubMed1987

Subendocardial segment length shortening at lateral margins of ischemic myocardium in dogs.

The lateral borders of an infarcted area are sharply delineated in terms of perfusion, but functional impairment extends a limited distance into adjacent nonischemic myocardium. To determine the distribution of functional impairment we arrayed three ultrasonic dimension gauges to measure two subendocardial segment lengths in series. The center crystal, placed at the perfusion boundary (PB) between left anterior descending and circumflex arteries, radiated ultrasound to receiver crystals 7-17 mm to either side of the PB. The locations of the functional measurements relative to the PB were determined with myocardial blood flow (microsphere) "maps" constructed from multiple small tissue samples obtained circumferentially. On the nonischemic side of the PB, segment shortening (dL) increased from 2.00 +/- 0.37 mm during control conditions to 2.20 +/- 0.43 mm (P less than 0.05) after left circumflex coronary occlusion. Similar results were obtained in four conscious chronically instrumented dogs, supporting the conclusion that segment function adjacent to the ischemic margin is well preserved after coronary occlusion. On the ischemic side of the PB, dL decreased from 2.24 +/- 0.54 to 0.42 +/- 0.39 mm (P less than 0.01). By adding the data from the two segments in series, a combined measurement of dL across heterogeneously perfused myocardium was derived that decreased by 38% from control. The level of shortening represented an integral of normal and abnormal motion that was proportional to the mean reduction in blood flow (-44%) in all of the muscle spanned by the crystals. We conclude that subendocardial segment lengths "average" shortening in the muscle they subtend when arrayed across the perfusion boundary.

Animals↗
PubMed1987

Paradoxical hypertension after repair of coarctation of the aorta in children: balloon angioplasty versus surgical repair.

The incidence and possible causes of paradoxical hypertension were evaluated in eight children who underwent balloon dilatation and seven children who underwent surgical repair of coarctation of the aorta. Both procedures resulted in a significant reduction in the coarctation gradient. Both systolic and diastolic blood pressures increased in the surgical group after repair, whereas systolic pressures decreased and diastolic pressures remained unchanged after balloon angioplasty. In the surgical group, but not in the balloon angioplasty group, plasma catecholamines and plasma renin activity rose during the first 2 days after relief of the coarctation. The data presented in this report support the hypothesis that the sympathetic nervous system and the renin angiotensin system are important mediators of the paradoxical hypertension that occurs after surgical repair of coarctation. Furthermore, balloon angioplasty of coarctation of the aorta does not stimulate either system and thus paradoxical hypertension is not a complication of this procedure.

Angioplasty, Balloon↗
PubMed1986

Direct measurement of inner and outer wall thickening dynamics with epicardial echocardiography.

Simple geometric models of the left ventricle and indirect experimental measurements suggest that the inner myocardial wall contributes the largest fraction to total wall thickening. We measured transmural differences in regional wall thickening directly, using an epicardial M mode echocardiographic transducer (6 mm diameter, 5 MHz) placed on the anterior free wall of the left ventricle. Wall thickness was partitioned into inner and outer regions by inserting a waxed, 3-0 suture at different depths within the wall. The suture was used as an intramural echo target that was imaged simultaneously with the endocardium to determine inner and outer fractional contribution to total wall thickness. Data were collected in open-chest dogs at rest, during inotropic stimulation with isoproterenol, and during right heart bypass, which was used to vary cardiac output and preload. Results obtained with this method demonstrated that systolic wall thickness was nonuniform at rest and during each intervention. The fractional contributions to total wall thickening of the inner, middle, and outer thirds of the myocardial wall were estimated from the data to be 58%, 25%, and 17%, respectively. The experimental findings corresponded closely to theoretical predictions, supporting the conclusion that a gradient of thickening exists across the myocardial wall, with the inner portion of the wall contributing the largest fraction to total systolic thickening.

Animals↗
PubMed1986

The distribution of functional impairment across the lateral border of acutely ischemic myocardium.

To evaluate the degree and lateral extent of dysfunction in nonischemic myocardium adjacent to ischemic muscle, we measured systolic wall thickening with sonomicrometers during circumflex coronary occlusion in 12 anesthetized, open-chest dogs. The locations of the wall thickness measurements relative to the perfusion boundary were determined with myocardial blood flow (microspheres) maps constructed from multiple, small tissue samples. Five minutes after circumflex occlusion, systolic wall thickening in the central ischemic zone decreased from 3.00 +/- 0.61 (mean +/- SD) mm to -0.61 +/- 0.36 mm (P less than 0.01). In nonischemic myocardium greater than 10 mm from the perfusion boundary, systolic wall thickening increased from 2.56 +/- 0.57 to 3.24 +/- 0.72 mm (P less than 0.01). In nonischemic myocardium within 10 mm of the perfusion boundary, systolic wall thickening was slightly but significantly reduced compared with control (2.72 +/- 0.80 to 2.44 +/- 0.79 mm, P less than 0.05), supporting the concept of regional dysfunction in nonischemic myocardium at the lateral borders of an ischemic area. Sigmoid curves were fitted to the data to model changes in wall thickening as a continuous function of distance from the perfusion boundary. This allowed estimation of the extent of dysfunction into nonischemic myocardium which averaged less than 8 mm (approximately 30 degrees of endocardial circumference) at one border. The level of functional impairment in this zone was relatively modest, and systolic wall thickening in the immediate border area was reduced more than 50% from control only in tissue characterized by a blood supply of mixed ischemic and nonischemic origin. We conclude that a functional border zone exists lateral to an acutely ischemic area, but measurement of regional function produces relatively small exaggeration of the size of the acutely ischemic zone if severe reduction in mechanical performance is used to define the extent of the ischemic area.

Acute Disease↗
PubMed1985

Dissociation between epicardial and transmural function during acute myocardial ischemia.

The relationship between epicardial and transmural function (measured with sonomicrometers) was examined in 13 anesthetized open-chest dogs. Systolic wall thickening was used as a standard of integrated transmural function to compare with epicardial function measured as segment shortening parallel to surface fibers. Three levels of coronary inflow restriction were produced by using decrements in systolic wall thickening as an index of changes in the transmural distribution of myocardial blood flow (microspheres) in myocardium perfused by the left anterior descending artery (anterior-apical group, n = 7) or circumflex artery (posterior-basal group, n = 6). Levels 1 and 2 were characterized by reductions in systolic wall thickening of 35% and 80%, respectively, and marked decreases in deep myocardial blood flow. In the subepicardium, myocardial blood flow was minimally affected at levels 1 and 2 and there was no change in posterior-basal epicardial segment shortening, but anterior segment shortening decreased significantly (by 21% and 37%, respectively). At level 3 myocardial blood flow was reduced transmurally, producing systolic wall thinning and marked epicardial dysfunction in both groups. Parallel epicardial segment shortening underestimated the extent of transmural dysfunction in both groups at levels 1 and 2 but the degree of underestimation was greatest in the posterior-basal group. Anterior-apical segment shortening was impaired at levels 1 and 2, whereas posterior-basal segment shortening was unaffected, suggesting that significant regional variability exists in the epicardial response to nontransmural ischemia.

Animals↗
PubMed1978

Body temperature and 5-hydroxytryptamine during early postnatal maturation in mice.

A relationship between the maturational increases in body temperature and brain indoleamines has been explored through altering brain 5-hydroxytryptamine (5-HT) content. Effects on body temperature at approximately constant ambient temperature (about 24 degrees C) have been studied following pharmacological manipulations in mice up to 16 days postpartum. Administration of 5-hydroxytryptophan (5-HTP) to increase 5-HT levels was associated with decreased body temperature throughout the maturational period. Depletion of 5-HT with p-chlorophenylalanine (p-CPA) was associated with increased body temperature at all ages studied, although 5-HT depletion was less effective in young animals than in older animals. The drug NSD-1034 acts at a different enzymatic step, and is effective in both central and peripheral tissues to reduce 5-HT and norepinephrine (NE) levels. NSD-1034 decreased body temperature up to 10 days of age; however, the effect was reversed at about 14 days, and the drug increased body temperature significantly in 16-day-old animals. These results suggest a role for 5-HT in the mechanisms of heat production in early postnatal life.

Animals↗
PubMedDate not supplied

Test characteristics of a level I or II fetal ultrasound in detecting structural heart disease.

At the University of California Davis Medical Center, a screening fetal ultrasound examination (level I or II) incorporates a comprehensive segmental evaluation of the fetal heart. This study evaluated the reliability of the fetal ultrasound exam in the detection of abnormal heart anatomy. Our retrospective study reviewed results of 614 antenatal patients that had a screening fetal ultrasound exam. All patients subsequently underwent a detailed targeted fetal cardiac ultrasound exam performed by a pediatric cardiac sonographer and reviewed by a board-certified pediatric cardiologist. Of these 614 patients, 60 fetuses had structural heart disease by the targeted fetal exam. The screening fetal ultrasound exam correctly identified 55 of the 60, with 5 false negatives (8.3% false-negative rate) and 1 false positive (1.7% false-positive rate). Our study suggests that if a screening fetal ultrasound exam incorporates a segmental evaluation of the fetal heart it can reliably detect abnormal heart anatomy. At our institution a targeted fetal cardiac exam is now used to confirm and provide detailed assessment of the heart anatomy when a screening fetal exam is positive for heart disease.

California↗
PubMedDate not supplied

Absent pulmonary valve with tricuspid atresia or severe tricuspid stenosis: report of three cases and review of the literature.

Absence of the pulmonary valve occurs usually in association with tetralogy of Fallot and occasionally with an atrial septal defect or as an isolated lesion. Very rarely it occurs with tricuspid atresia, intact ventricular septum, and dysplasia of the right ventricular free wall and of the ventricular septum. We present the clinical, anatomic, and histologic findings of a new case, and for the first time, the data from two patients with absent pulmonary valve and severe tricuspid stenosis, who exhibited similar histologic findings. We also reviewed the clinical and anatomic data of 24 previously published cases and compared them with the new cases. In all three new cases, the myocardium of the right ventricle was very abnormal. In the two cases with tricuspid stenosis, large segments of myocardium were replaced with sinusoids and fibrous tissue. In the case with tricuspid atresia, the right ventricular free wall contained only fibroelastic tissue. The ventricular septum in all three patients showed asymmetric hypertrophy and in two of the three patients, multiple sinusoids had replaced large segments of myocardial cells. The left ventricular free wall myocardium and the walls of the great arteries were unremarkable. Our data indicate that myocardial depletion involving the right ventricular free wall and the ventricular septum and its replacement by sinusoids and fibroelastic tissue occur not only in cases of absent pulmonary valve with tricuspid atresia but also in cases of absent pulmonary valve with tricuspid stenosis. The degree of myocardial depletion varies and is more severe when the tricuspid valve is atretic.

Fatal Outcome↗