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Biomedical subjects

O Lund

Publications and source records attributed to O Lund.

At least 73 records · Page 4Linked to original sources
PubMed1990

Valve replacement for aortic regurgitation: earlier operation may reduce the rate of late complications related to the prostheses.

Predictability of prosthesis- and sudden heart-related complications was examined in 121 patients who were alive 30 days after valve replacement (1965-86) for aortic regurgitation. A variety of prosthetic valves, mainly mechanical, were used. The Cox regression model was used to identify independent risk factors and to estimate the predicted freedom of events relative to combinations of these risk factors. In the following, linearized event-rates (LER) are given as number of events per 100 patient years +/- standard error. No risk factors could be identified for endocarditis (LER: 0.3 +/- 0.2) or anticoagulant-related hemorrhage (LER: 1.7 +/- 0.6). Only factors underlying deranged preoperative patient and heart status and cardioplegic method, but not the type of prosthetic valve, had predictive influence on the other complications. Predicted 10-year event-freedoms for low- versus high-risk estimate were 98% versus 46% for thromboembolism (LER: 2.1 +/- 0.6), 87% versus 68% for all prosthesis-related complications (LER: 5.0 +/- 0.8), 100% versus 0% for sudden heart-related events (LER: 2.0 +/- 0.5; myocardial infarction and arrhythmia), and 72% versus 38% for combined prosthesis- and sudden heart-related morbidity and mortality (LER: 7.0 +/- 1.0). By deciding to operate early in the course of aortic regurgitation, the rate of these complications may be "actively" reduced, and longevity and life quality of the patients improved.

Adult↗
PubMed1990

Long-term performance of Starr-Edwards silastic ball valves and St Jude Medical bi-leaflet valves. A comparative analysis of implantations during 1980-86 for aortic stenosis.

Long-term performance of Starr-Edwards silastic ball (SESB, n = 168) and St Jude Medical bi-leaflet (SJMB, n = 93) valves in patients who were alive 30 days after implantation (1980-86) for aortic stenosis was compared. Mean follow-up was 3.0 years (0.1-7.9 years). The SESB and SJMB groups differed as regards female gender (18% vs 47%, P less than 0.0001), NYHA classes III-IV (59% vs 72%, P less than 0.05), coronary artery disease (CAD, 32% vs 62%, P less than 0.01) in patients with coronary arteriography (n = 82 and n = 55, respectively), and prosthetic annulus diameter (26 +/- 1 vs 23 +/- 2 mm, P less than 0.0001). Five-year survival +/- SE in SESB vs SJMB patients was: total population, 89 +/- 3% vs 80 +/- 6% (NS); coronary arteriography population, no CAD, 90 +/- 4% vs 100% (NS), and with CAD, 71 +/- 11% vs 60 +/- 13% (NS; P = 0.01 for CAD). Five-year event-free survival +/- SE in SESB vs SJMB patients was 95 +/- 2% vs 97 +/- 2% (NS) for thromboembolism, 95 +/- 2% vs 89 +/- 4% (NS) for coumadin-related haemorrhage, 98 +/- 1% vs 99 +/- 1% (NS) for endocarditis, 98 +/- 1% vs 94 +/- 5% (NS) for paravalvular leak, 88 +/- 3% vs 79 +/- 6% (NS) for all valve-related complications, and 98 +/- 1% vs 95 +/- 4% (NS) for prosthesis replacement. Thrombotic occlusion or structural failure were not observed. No patients without CAD experienced thromboembolic events. Cox regression analyses (in both total population and coronary arteriography population) of survival as well as the various complications revealed that the type of prosthesis did not have predictive influence. CAD was an independent risk factor for thromboembolism, haemorrhage, and all valve-related complications. Previous systemic hypertension was independently predictive of haemorrhage. The SESB and SJMB prostheses showed comparable and acceptable long-term performance. Only patient-related variables, notably CAD, influenced late results. The proven durability and relatively low price of the SESB valves together with the excellent haemodynamic performance of even small-sized SJMB valves should be considered in the light of the present results.

Adolescent↗
PubMed1990

Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention.

Predictability of prognosis was analyzed in 630 patients who were alive 30 days after valve replacement (1965-1986) for aortic stenosis. Follow-up totaled 4,072 patient-years. During the operative periods of 1965-1971 (n = 62), 1972-1976 (n = 164), 1977-1981 (n = 158), and 1982-1986 (n = 246), decreases in cardiothoracic index (0.56 +/- 0.06, 0.53 +/- 0.06, 0.52 +/- 0.06, and 0.51 +/- 0.06; p less than 0.0001), in the prevalence of functional classes III and IV (87%, 76%, 68%, and 62%; p less than 0.0001), and of left ventricular (50%, 39%, 36%, and 30%; p less than 0.05) were accompanied by improved survival (5 year/10 year +/- SE: 73 +/- 6%/53 +/- 6%, 82 +/- 3%/65 +/- 4%, 89 +/- 3%/79 +/- 4%, and 87 +/- 3%/-; p = 0.002) despite increasing age (56 +/- 9, 57 +/- 11, 59 +/- 10, and 61 +/- 11 years; p less than 0.01). A Cox regression analysis identified peak-to-peak systolic gradient (p = 0.0001; inversely related to death rate), cardiothoracic index (p = 0.0003), left ventricular failure (p = 0.0005), prosthetic orifice diameter of 15 mm or less (p = 0.001), age (p = 0.003), ventricular ectopic beats (p = 0.004), male gender (p = 0.03), and antianginal/antiarrhythmic treatment (p = 0.03) as independent risk factors. A prognostic index calculated from the final Cox model stratified the patients into eight risk groups, having observed +/- SE/predicted/expected (matched background population) 10-year survival rates of 90 +/- 7% (n = 29)/94%/91%, 84 +/- 6% (n = 61)/89%/87%, 86 +/- 3% (n = 105)/83%/81%, 75 +/- 4% (n = 165)/75%/77%, 62 +/- 6% (n = 128)/63%/74%, 51 +/- 8% (n = 84)/47%/71%, 29 +/- 9% (n = 40)/31%/67%, and 16 +/- 9% (n = 18)/14%/54% (p less than 0.000001/-/-). Excess mortality relative to the background populations prevailed predominantly in risk groups 5-8 and was mainly caused by congestive heart failure. Thus, improved long-term survival during the 22-year operative period was related to improved preoperative patient status. Earlier operation (= low prognostic index) inferred a survival rate comparable to that of a matched background population. The prognostic index was probably predominantly related to preoperative myocardial damage that caused late predictable death from congestive heart failure.

Aortic Valve Stenosis↗
PubMed1990

Late chronic hemolysis after valve replacement for aortic stenosis. Relation to residual hypertrophy and impaired left ventricular function.

The relationship between intravascular hemolysis induced by aortic valve prosteses and patient status/left ventricular (LV) function (radionuclide cardiography) was examined in 63 patients of 65 who were alive ten to seventeen years after valve replacement (1965-1973) for aortic stenosis. Serum-lactic dehydrogenase (LDH) exceeded upper reference limit in 62 patients and S-haptoglobin (HAPTO) was reduced in 62. One patient with normal LDH had reduced HAPTO and elevated plasma-hemoglobin. Anemia was noted in 4 patients (6%). S-LDH was higher in men than in women (p less than 0.05), in patients with increased ECG hypertrophy score than in those with a normal score (p less than 0.05), in patients with NYHA class II-III than in those with class I (p less than 0.05), in patients with abnormal LV function than in those with a normal radionuclide study (p less than 0.05), in patients with a pathologic Q wave in the ECG than in those without (p less than 0.05), and in patients with a Starr Edwards cloth-covered (SECC) prosthesis than in those with other types (p = 0.07). ECG hypertrophy score correlated directly with LDH (r = 0.33, p = 0.008) and inversely with LV ejection fraction (r = -0.57, p less than 0.0001), peak ejection rate (r = -0.47, p less than 0.0001), and peak filling rate (r = -0.41, p less than 0.001). Multiple linear regression analysis revealed that LDH was accounted for by ECG hypertrophy score (p = 0.001), SECC prosthesis (p = 0.04), and male gender (p = 0.05). Hypertrophic malfunctioning left ventricles may be responsible for higher degrees of turbulent flow characteristics in the vicinity of prosthetic valves in the aortic position and, by inference, explain the increased tendency toward hemolysis in these patients.

Adult↗
PubMed1990

Primary malignant non-epithelial tumours of the thoracic oesophagus and cardia in a 25-year surgical material.

During 25 years, 708 patients with primary malignant tumours of the thoracic oesophagus (n = 376) or cardia (n = 332) were referred to our department. Two hundred and forty-nine patients had squamous cell carcinoma and 425 adenocarcinoma. The other 34 tumours, which were primarily classified as undifferentiated carcinoma, malignant carcinoid or non-epithelial, were re-evaluated by means of a second microscopic histologic examination and immunohistologic investigation. This showed primary malignant non-epithelial tumours in seven patients (0.99%): two malignant melanomas, one leiomyosarcoma, one malignant fibrous histiocytoma in the oesophagus (1.06%), two malignant lymphomas, and one malignant melanoma in the cardia (0.90%). All but two of the patients with non-epithelial malignant tumours were 67 years of age or older, and oesophagogastrectomy was performed in all. All tumours were 5 cm or more in diameter (median, 8 cm). Distant metastases were found in three cases. Five died of postoperative complications, one of cancer recurrence 7 months after the operation, and one of an unrelated cause without cancer recurrence 16 months postoperatively. Except for two of the melanomas, the diagnosis was not established until histologic examination of the surgical specimen was performed and, for the third melanoma and the malignant fibrous histiocytoma, not until the present re-evaluation. The characteristics of these seven tumours are discussed, and the importance of obtaining a correct diagnosis from endoscopic biopsy specimens is emphasized.

Adenocarcinoma↗
PubMed1990

Risk factors for early and late outcome after surgical treatment of native infective endocarditis.

Cardiac valve replacement was performed on 76 patients with acute or subacute native infective endocarditis. The 30-day mortality/5-year survival (%/% +/- SE) was 18/67 +/- 7, after aortic valve replacement (n = 50), 6/82 +/- 10 in the mitral group (n = 18) and 38/63 +/- 17 after double valve replacement (n = 8): NS/NS. In patients with destruction and/or abscess of the anulus (DESAB), which was commonest in the aortic group, the corresponding figures were 31/48 +/- 10, compared with 10/81 +/- 6 in the other patients (p less than 0.05/less than 0.01). Atrioventricular block and complete bundle branch block were commoner in the former group. When the time from onset of fever to operation was 1-6 months (n = 50), the 5-year survival was 79 +/- 6% compared with 51 +/- 10% (p less than 0.05) when that time was less than 1 month (n = 14) or greater than 6 months (n = 12). Logistic regression analysis showed NYHA class III-IV and DESAB to be independent risk factors in 30-day mortality, which was 3.8% when neither, and 46.2% when both of these factors were present (p less than 0.01). Cox regression analysis identified NYHA class IV (p less than 0.0001), calcified mitral valve or anulus (p = 0.001), DESAB (p = 0.01), male gender (p = 0.02), supraventricular arrhythmia (p = 0.04) and vegetations on the diseased valve (p = 0.05) as independent determinants of overall long-term mortality. Patients with none (n = 6), any one (n = 16), any two (n = 28), any three (n = 20), any four (n = 6) or any five (n = 2) of these risk factors (none had 6) had respective 30-day/5-year survival rates (% +/- SE) of 100/100, 94 +/- 6/94 +/- 6, 89 +/- 6/85 +/- 7, 75 +/- 10/43 +/- 13, 67 +/- 9/17 +/- 15 (at 1 year) and 0/0 (p less than 0.0001). Identification of independent risk factors permitted stratification of the patients into subgroups with prognosis ranging from 100% 5-year survival to 0% 30-day survival. Surgical treatment of native infective endocarditis should be undertaken before cardiac disability is advanced or infective destruction of the anulus, notably of the aortic valve, becomes evident.

Adult↗
PubMed1990

Independent predictors of operative mortality and postoperative complications in surgically treated carcinomas of the oesophagus and cardia--is the aggressive surgical approach worthwhile?

During the 25 years 1960-84, 657 patients were operated on for carcinomas of the thoracic oesophagus (n = 347) or gastric cardia (n = 310). Resection was carried out in 514 (78%) and oesophagogastrostomy in 481 (73%). Overall operative mortality (defined as death within 30 days) was 19% (n = 122). Pulmonary complications developed in 167 patients (25%), cardiovascular complications in 100 (15%), and anastomotic leakage and mediastinitis in 36 (6%). After radical resection of a localised tumour (n = 144), or non-localised tumour (n = 224), pallative resection (n = 146), or exploration (n = 143), the operative mortality and five year cumulative survival were 10% and 26%, 15% and 8%, 27% and 0, and 24% and 0, respectively (p less than 0.01 and p less than 0.0001). Using logistic regression analysis several variables were found to be independent predictors of operative mortality, pulmonary complications, cardiovascular complications, and anastomotic leakage. The predictor variables reflected both general preoperative status of the patients, preexisting cardio-pulmonary diseases, stage of the cancer, and surgical procedures. Based on the final logistic regression models the patients were stratified into risk groups (12 for operative mortality, pulmonary complications, and cardiovascular complications, and eight for anastomotic leakage). Operative mortality varied from 0 to 80%, pulmonary complications from 3 to 100%, cardiovascular complications from 0 to 100%, and anastomotic leakage from 0 to 50% (p less than 0.0001 in each case). Given the high operative mortality and complication rates, and the low five year survival rate after palliative procedures or exploratory operations, a more selective surgical approach seems warranted. Patients likely to have a good response should be identified before operation.

Adult↗
PubMed1990

Risk stratification and long-term results after surgical treatment of carcinomas of the thoracic esophagus and cardia. A 25-year retrospective study.

During 25 years (1960 to 1984), 657 patients (aged 22 to 91, mean 66 years) were operated on for carcinomas (squamous cell, n = 230; adenocarcinoma, n = 399; anaplastic, n = 28) of the thoracic esophagus (n = 347) or gastric cardia (n = 310). Esophagogastrectomy was accomplished in 514 patients, of whom 94% (n = 481) had an "inkwell" esophagogastrostomy performed. The hospital mortality rate (less than or equal to 30 days) was 19% and the 5-year cumulative survival rate was 9% +/- 1% (standard error). A Cox regression analysis enabled a detailed risk stratification of the patients. T, N, and M class and age were the strongest predictor variables. The general status of the patients, including pulmonary disease, also had a strong prognostic influence. Eight risk groups were identified having 1-year and 5-year survival rates of 71%/41% (n = 35), 69%/24% (n = 80), 47%/11% (n = 125), 30%/6% (n = 139), 12%/0% (n = 105), 6%/0% (n = 71), 2%/0% (n = 57), and 0%/0% (n = 45) (p less than 0.0001). Hospital mortality (from 6% to 42%) and complication rates increased significantly from the low-risk to high-risk groups. Comparisons with survival rates of background populations matched to each of the first four risk groups indicated that the benefit of surgical treatment may be underestimated if only patient survivals are judged. Use of modern endoscopic and noninvasive tests may yield a reliable TNM classification without surgical exploration. Given the extremely poor prognostic outlook together with high hospital mortality and complication rates of the four last risk groups, an aggressive surgical approach with resection whenever possible can no longer be regarded rational. Selection for surgical treatment should be based on a detailed risk estimation that takes into account both TNM classification and general patient status.

Adenocarcinoma↗
PubMed1990

The influence of coronary artery disease and bypass grafting on early and late survival after valve replacement for aortic stenosis.

The influence of coronary artery disease and bypass grafting on survival after valve replacement for aortic stenosis (1975 to 1986, N = 512) was analyzed. Mean follow-up for 30-day survivors was 5.1 years (0.1 to 12.9 years). A total of 205 patients had coronary angiography performed: 122 did not have coronary artery disease, 55 with coronary artery disease underwent bypass grafting, and 28 with coronary artery disease did not. Early mortality rates (less than or equal to 30 days)/5-year cumulative survivals (standard error) were 4.1%/86% (4%), 3.6%/68% (8%), and 17.9%/51% (13%), respectively (p less than 0.05/p less than 0.01). Triple vessel/left main stem disease was more prevalent in patients with coronary disease who underwent bypass grafting (47%) than in those who did not (14%; p less than 0.05). Multivariate analysis revealed that right ventricular failure and omission of bypass grafting in patients with coronary artery disease were independent determinants of early mortality. A Cox regression analysis identified coronary artery disease and aortic valve gradient as determinants of mortality after hospital dismissal, which was not influenced by bypass grafting. On the basis of a coronary artery disease score (positive predictive value for coronary artery disease of 66%) developed on the patients with angiography, 307 patients without angiography were divided into 234 with a low score and 73 with a high score. Early mortality rates/5-year survivals (standard error) were 6.4%/86% (2%) and 16.4%/67% (6%), respectively (p less than 0.01/p less than 0.001). Autopsy revealed stenotic or occlusive coronary artery disease in 92% of 12 early deaths in the group with a high coronary artery disease score and in 33% of 15 in the group with a low score (p less than 0.01). Left ventricular failure and a high coronary artery disease score were independent determinants of early mortality, whereas cardiothoracic index, a high coronary artery disease score, and left ventricular failure were independent predictors of death after hospital dismissal. Despite more severe coronary artery disease, bypass grafting reduced early mortality to a level comparable with that of patients without coronary artery disease, contrasting with a high early mortality rate for unbypassed coronary artery disease. Coronary artery disease increased the late mortality rate, which was not modified by bypass grafting. In the group without angiography, undiagnosed and unbypassed coronary artery disease probably increased both early and late mortality. Coronary angiography should be performed in all adult patients with aortic stenosis, and those with significant coronary artery disease should undergo bypass grafting concomitant with valve replacement.

Aortic Valve Stenosis↗
PubMed1989

[Right ventricular myocardial infarction. Prognostic significance of ST elevation in right chest leads V3R-V7R in patients with acute inferior/posterior myocardial infarction].

The prognostic significance of ST-elevation greater than or equal to 1 mm in right chest leads V3R-V7R during inferior/posterior acute myocardial infarction (AMI) was evaluated in 86 consecutive patients with their first inferior/posterior AMI, and compared with the prognosis for 72 patients with first anterior AMI. At follow-up, the maximum observation time was 3.0 years (mean 1.8 years). A total of 49 patients died. Using Cox multivariate analysis, ST-elevation in right chest leads during inferior/posterior AMI was found to be an independent predictor of the prognosis in patients surviving the initial ten days after infarction (n = 129). For these patients, the cumulative survival was better after inferior/posterior AMI with ST-elevation in V3R-V7R (n = 25) compared with; (1) all other infarcts (n- 104, p = 0.05), (2) inferior/posterior AMI without ST-elevation in these leads (n = 45, p = 0.09), and (3) anterior AMI (n = 59, p = 0.08).

Adult↗
PubMed1989

Time-related changes in characteristics of prognostic significance in carcinomas of the oesophagus and cardia.

During 25 years (1960-84) 657 patients were operated on for squamous cell carcinomas (n = 230), adenocarcinomas (n = 399) or anaplastic carcinomas (n = 28) of the thoracic oesophagus or cardia. The male:female ratio was 2.8:1 and the mean age was 66 years (range 22-91 years). Oesophagogastrectomy (n = 514) was performed whenever technically possible. From the first (1960-64) to the last (1980-84) 5-year period the proportion of adenocarcinomas increased from 56 to 78 per cent (P less than 0.001), poorly differentiated cancers increased from 34 to 65 per cent (P less than 0.0001), and stage III-IV tumours increased from 72 to 88 per cent (P less than 0.05). Five-year cumulative rates(s.e.) were 11(3) per cent for operations during 1960-69 (n = 262), 8(2) per cent during 1970-79 (n = 256) and 3(2) per cent during 1980-84 (n = 139; P less than 0.05). Hospital mortality rates (less than or equal to 30 days) and 5-year cumulative survival rates(s.e.) were 6.5 per cent and 36(7) per cent (n = 46) for stage I, 14.0 per cent and 21(4) per cent (n = 114) for stage II, 17.8 per cent and 5(1) per cent (n = 258) for stage III and 23.8 per cent and 3(1) per cent (n = 239) for stage IV tumours (P less than 0.05 and P less than 0.001). Well differentiated (n = 70) cancers, those of medium differentiation (n = 239) and poorly differentiated cancers (n = 348) had 5-year survival rates(s.e.) of 24(5), 10(2) and 5(1) per cent, respectively (P = 0.0007). Squamous cell carcinomas had a better prognosis than adenocarcinomas, even after stratification according to location of primary tumour. The 657 patients who underwent surgery constituted 50 per cent of a total of 1316 cases with cancer of the oesophagus and cardia reported from our catchment area during the study period. Frequency of surgery decreased with age. The annual incidence (number per 100,000 inhabitants aged 20 years or more) of adenocarcinomas of the lower oesophagus and cardia doubled to 5.9 in 1980-84, while that of squamous cell carcinomas tended to decrease (to 2.9). A successive worsening of long-term survival after surgery was explained by significant changes in cancer characteristics having pronounced prognostic significance. Over the 25 years the carcinomas changed towards the present pattern where poorly differentiated adenocarcinomas of the lower third of the oesophagus and cardia in stages III-IV have become predominant.

Adenocarcinoma↗
PubMed1989

Prognostic significance of right ventricular infarction diagnosed by ST elevation in right chest leads V3R to V7R.

The prognostic significance of electrocardiographic "extensive right ventricular infarction" diagnosed by ST elevation greater than or equal to 1 mm in right chest leads V3R to V7R during inferior/posterior infarction was evaluated in 158 consecutive patients with first anterior (n = 72) or inferior/posterior (n = 86) myocardial infarction. At follow-up the maximum observation time was 3.0 years (mean 1.8 years). A total of 49 patients died; 96% due to cardiac causes. Twelve patients (8%) died during the first 24 hours of admission. Ten-day mortality was 18% (n = 29). Using Cox multivariate analysis ST elevation in right chest leads during inferior/posterior infarction was an independent predictor of prognosis in patients surviving the initial 10 days after infarction (n = 129). For these patients the cumulative survival was better after inferior/posterior infarction with ST elevation in V3R to V7R (n = 25) compared with (1) inferior/posterior infarction without St elevation in these leads (n = 45, P = 0.09), (2) anterior infarction (n = 59, P = 0.08), and (3) all other infarctions (n = 104, P = 0.05). Infarct size estimated by the peak serum enzyme values was similar in these groups. Thus, electrocardiographic extensive right ventricular infarction predicts a good prognosis in patients alive 10 days after infarction. Compared with infarcts of similar size but with another location the prognosis is better, probably due to concomitant smaller left ventricular infarction with better left ventricular function following infarction.

Adult↗
PubMed1989

Isolated mitral valve replacement. With Carpentier-Edwards bioprosthesis :independent risk factors for long-term survival and prosthesis failure.

From 1976 through 1986, 188 patients (female/male ratio: 2/1, age 20-77 years, mean 58 years) with isolated mitral valve disease underwent valve replacement using the Carpentier-Edwards porcine bioprothesis (CEPB). Nine hospital deaths (4.8%) were excluded from further analysis. Follow-up was 0.2-11.3 years (mean 5.2 years); preoperatively, 74% had atrial flutter/fibrillation, and 75% were in NYHA-classes III-IV. All patients were put on life-long coumadin treatment. Preoperative predictability of long-term survival and prosthesis-related complications was examined using Cox regression analysis. Five preoperative variables were found to have independent predictive value as regards long-term survival: myxomatous degeneration of the valve (p = 0.002), chronic regurgitation (p = 0.003), age (p = 0.004), NYHA-class III-IV (p = 0.05), and atrial flutter/fibrillation (p = 0.05). A prognostic index calculated form the final Cox model identified six risk groups (I-VI) having cumulative 10-year survivals +/- SE of: I (n = 9) 100%, II (n = 10) 90 +/- 9%, III (n = 30) 73 +/- 10%, IV (n = 70) 51 +/- 9%, V (n = 43) 17 +/- 10%, and VI (n = 17, 7-year survival) 16 +/- 13% (p less than 0.0001). The incidence of late valve-related complications (%/patient-years) were: hemorrhage, 1.2; thromboembolism, 0.5; Endocarditis, 1.0; paravalvular leak, 0.2; and primary tissue failure, 1.5. Previous closed comissurotomy adversely influenced the occurrence of hemorrhage, while calcified mitral annulus were predictive of endocarditis. Younger age (less than or equal to 45 years) had a strong predictive influence of primary tissue failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioprosthesis↗
PubMed1989

Early and late prognosis after valve replacement in aortic regurgitation. Preoperative risk stratification and reasons for a more aggressive surgical approach.

From 1965 through 1986 136 patients underwent valve replacement for aortic regurgitation. Mean age was 50 years and male:female ratio 3.7:1. Hospital mortality (HM, less than or equal to 30 days) varied with NYHA classes and digitalis/diuretics treatment (D/D):I (n = 80) 0%, II without D/D (n = 17) 0%, II with D/D (n = 21) 5%, III (n = 55) 7%; and IV (n = 35) 29% (p less than 0.01). Long-term survival was examined for 121 patients who were alive 30 days postoperatively. Five- and 10-year cumulative survival +/- SE were 80 +/- 4% and 66 +/- 6%, respectively. No late deaths were noted for NYHA class I and NYHA class II without D/D; NYHA class II with D/D had survival characteristics comparable to NYHA class III with 10-year survivals of 60%. Patients with acute regurgitation (endocarditis, n = 35) had a 10-year survival +/- SE of 88 +/- 5% compared to 57 +/- 7% for chronic regurgitation (p = 0.05). A Cox regression analysis revealed that ventricular ectopic beats, chronic regurgitation, left ventricular failure, and right ventricular failure were independent risk factors. Presence and different combination of these risk factors identified 5 risk groups (A-E) with 10-year survivals of:A (n = 16) 100%; B (n = 50) 75%; C (n = 37) 63%; D (n = 15) 27%; and E (n = 3) 0% (p less than 0.0001). Minimally symptomatic patients without preoperative medical treatment for congestive heart failure had superior survival characteristics compared to those who received treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Changing electrocardiographic findings in pulmonary embolism in relation to vascular obstruction.

Electrocardiographic (ECG) findings in 87 consecutive patients with from minor to massive pulmonary embolism are presented. ECG changes suggestive of acute right ventricular strain defined as the occurrence of complete (c) or incomplete (inc) right bundle branch block (RBBB), an SIQIIITIII pattern, inverted T waves in the second and third precordial leads and/or an increase in the frontal QRS axis of 20 degrees C or more were found in 71 patients (82%). The prevalence of c and inc RBBB and the increase in frontal QRS axis correlated with the extent of embolization (angiographic or scintigraphic score), while the appearance of the SIQIIITIII pattern did not. No patient with a vascular obstruction of two thirds or more had an ECG free of signs of right ventricular strain. In 9 of 11 embolectomized patients with c RBBB, c RBBB disappeared within 24 h postoperatively. Among patients with an embolization of 45% or more, those with c RBBB had a shorter symptom duration, fewer embolic episodes and a lower pulmonary artery pressure than those without c RBBB. As ECG abnormalities were transient and changing in nature, serial ECG recordings are recommended. Pronounced ECG signs of right ventricular strain should, as they may reflect both massive and short-lasting vascular obstruction, arouse the suspicion of pulmonary embolism suitable for embolectomy.

Adolescent↗
PubMed1989

Late cardiac deaths after isolated valve replacement for aortic stenosis. Relation to impaired left ventricular diastolic performance.

Sixty-three patients took part in a follow-up study ten to seventeen years after valve replacement for aortic stenosis. Data obtained were used to predict cardiac deaths (n = 14) occurring in the following three-year period. The degree of residual left ventricular (LV) hypertrophy correlated inversely with indices for LV systolic and diastolic performance (radionuclide cardiography). A logistic regression (LR) model had a positive predictive value for cardiac deaths of 100% (10/10) with 8% (4/53) false negatives. Evaluating LV performance indices exclusively, LR analysis showed that only peak filling rate had independent predictive value. Subnormal and normal LV ejection fractions were associated with equal three-year cardiac death rates (29%). Depressed LV function was related to residual hypertrophy. Impaired diastolic performance was the prime predictor of cardiac deaths.

Adult↗
PubMed1989

Emergency embolectomy in a patient with massive pulmonary embolism during second trimester pregnancy.

Emergency pulmonary embolectomy was performed successfully on a patient in her second trimester of pregnancy. The patient had severe right ventricular failure due to obstruction of 85% of the pulmonary arterial circulation. Three months after embolectomy she was delivered of a normal infant. The problem of significant but misinterpreted or overlooked clinical and electrocardiographic signs of pulmonary embolism is discussed. Thrombolytic therapy during pregnancy imposes considerable risk of bleeding with deleterious effects on both mother and fetus. In our opinion, emergency embolectomy during extracorporeal circulation is the best treatment in case of massive emboli during pregnancy.

Adult↗