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Biomedical subjects

O Lund

Publications and source records attributed to O Lund.

At least 91 records · Page 5Linked to original sources
PubMed1989

Cardiac pathology after isolated valve replacement for aortic stenosis in relation to preoperative patient status. Early and late autopsy findings.

Autopsy was performed on 51 (65%) of 79 patients who underwent valve replacement for aortic stenosis in 1965-1973 and died 0 days to 14 years (mean 3.2 years) later. Heart weight index (HWI) at autopsy averaged 356 +/- 94 g/m2 and left ventricular wall thickness (LVWT) 19 +/- 4 mm. Macroscopic scattered streaky fibrosis (SSF) of the left ventricle was absent in 10% of the cases, slight in 31% and moderate/severe in 59%. Circumscript fibrotic scars were found in 31% and moderate/severe coronary artery disease (CAD) in 33%. All hearts were enlarged (HWI greater than 200 g/m2), primarily due to residual left ventricular hypertrophy (LVWT greater than 14 mm), which was present in 86% of cases. Both SSF and circumscript scars were unrelated to CAD. The preoperative predictability of autopsy findings was studied with multiple regression analyses. Predictive factors were as follows. For high HWI: high left ventricular end-diastolic pressure, short operation-autopsy time (O-A time) and high ECG hypertrophy score (ECG-hyp). For high LWT value: high cardiothoracic index (CTI), high transvalvular peak-systolic gradient and NYHA class II-III (vs. class IV). For moderate/severe SSF: high CTI and left ventricular failure. For moderate/severe CAD: short O-A time, narrow pulse pressure and low ECG-hyp. Although separated by valve replacement and a time span of up to 14 years, cardiac pathology at autopsy and preoperative patient/heart status were closely interrelated, thus emphasizing the significance of preoperatively impaired cardiac functional status and its relation to irreversible myocardial damage. The results advocate early operative intervention in aortic stenosis.

Aortic Valve Stenosis↗
PubMed1988

Intraaortic balloon pumping in the treatment of low cardiac output following open heart surgery--immediate results and long-term prognosis.

From 1979 through 1986, 90 patients required intraaortic balloon pumping (IABP) due to low cardiac output complicating open heart surgery. Preoperatively, functional class III or IV was present in 92%; in patients with coronary artery disease (n = 54), three-vessel or left main disease was found in 72%; patients with valvular disease (n = 37) generally had multiple surgical procedures or valve re-replacement performed. Intra-IABP mortality was 49% (n = 44) and 30-day mortality 61% (n = 55). The latter figure decreased from 75% in 1979-81 to 53% in 1985-86. Cumulative 5-year survival was 22%. Logistic regression analysis identified as independent predictors of 30 day mortality the necessity for adjuvant treatment with the more powerful "pressure drugs" isoprenaline/noradrenaline, number of DC-defibrillations, functional classes III-IV, and chronic left ventricular failure. Different combinations of these risk factors identified different patient groups with 30-day mortalities ranging from 100% to 0%. The risk factors reflected both acute cardiac failure probably due to severe ischemia and chronic failure due to advanced primary disease. Taking the high-risk composition of the material into account, a 5-year survival of 22% cannot be regarded as discouraging. Continued employment of IABP treatment in open heart surgery, using an aggressive approach coupled with individualized inotropic support, seems justified.

Adult↗
PubMed1988

Functional status and left ventricular performance late after valve replacement for aortic stenosis. Relation to preoperative data.

Relations between preoperative data and status at one- and 10-year control and left ventricular performance (radionuclide angiocardiography) at follow-up 10-17 years (mean 12 years) after valve replacement (1965-73) for aortic stenosis were studied. Marked improvements at one-year were noted for New York Heart Association (NYHA) functional classes, cardiothorac index (CTI), and ECG hypertrophy (Romhilt-Estes) score. One-year status did not influence that at 10 years. In 59 patients who were in NYHA class I at one year, class I was maintained in 75% of those who were in class II preoperatively, compared with 47% of those who had been in class III, and 23% of those who had been in class IV, (P less than 0.05). The same relation to preoperative level was found for patients with CTI less than or equal to 0.50 at one-year control. The ECG score did not change after the first year. Left ventricular hypertrophy (ECG score greater than or equal to 4) was present in 90% and 84% of the patients at one and 10 years, respectively. Ejection fraction (EF) and peak filling rate (PFR) at follow-up were (mean +/- SD) 65 +/- 13% and 3.14 +/- 1.05 end-diastolic volume s-1, respectively; only 13 patients had a radionuclide study within the normal range for all parameters measured. A normal study was found predominantly in patients with complete regression of hypertrophy. Multiple linear regression models incorporating preoperative data allowed calculation of predicted EF (65 +/- 9) and PFR (3.17 +/- 0.92) which did not differ from the measured values. Functional status and left ventricular systolic and diastolic performance late after the operation depended closely on preoperative status. Improvements noted at one year were only temporary in patients with preoperative advance disease. Normal left ventricular performance late after valve replacement was related to complete reversibility of hypertrophy. Our results argue for operation in minimally symptomatic patients.

Adult↗
PubMed1988

Prediction of long-term complications associated with aortic valve prostheses. A 10-17 year follow-up.

Long-term complications following implantation of aortic valve prosthesis were assessed in 139 patients who had survived greater than 30 postoperative days (maximum follow-up 17 years). Most of the prostheses were Starr-Edwards valves (38 silastic ball, SESB, and 96 cloth-covered, SECC). All patients received maintenance coumarin. The rate of thromboembolic complications was 1.6/100 patient-years, without difference between SESB and SECC valves although there were no episodes with SESB from 6 years postoperatively. The overall rate of valve-related complications (VRC)--thromboembolism, hemorrhage, endocarditis, re-replacement, etc.--was 4.2/100 patient-years. High preoperative cardiothoracic index (CTI) significantly increased the incidence of VRC. Preoperative NYHA class III-IV and high CTI similarly influenced the rate of serious VRC (= VRC excluding extremity emboli, epistaxis and subcutaneous bleeding). The valve-and-heart-related morbidity (= VRC including myocardial infarction and pacemaker requirement) was also influenced by preoperative CTI. The long-term complications thus were not exclusively attributable to the prosthesis, but also to preoperative patient-related data.

Adult↗
PubMed1988

Aortic regurgitation after surgical relief of subvalvular membranous stenosis. A long-term follow-up study.

A postoperative follow-up study of 21 cases of discrete membranous subvalvular aortic stenosis is presented. The age at operation was 6-47 (mean 16) years, and the follow-up time 0.6-16 (mean 6.7) years. Preoperatively most patients were in NYHA function class II or III and had high peak systolic pressure gradient, left ventricular hypertrophy and/or cardiothoracic index greater than 0.50. At follow-up all but six patients were in NYHA class I, the Doppler-estimated peak systolic gradient was 0-36 (mean 18) mmHg, the cardiothoracic index unchanged and the mean left ventricular hypertrophy score had declined from 4.3 to 2.3. Of 13 patients without aortic regurgitation preoperatively, eight had regurgitation at follow-up (group I) and five did not (group II). The interval to follow-up was significantly longer and the preoperative peak systolic gradient was greater in group I than in group II. Aortic regurgitation may develop even after surgical relief of discrete membranous subvalvular aortic stenosis, possibly associated with high preoperative pressure gradient and time from operation. Regular postoperative Doppler echocardiography is therefore recommended.

Adolescent↗
PubMed1987

Prediction of late results following valve replacement in aortic valve stenosis. Seventeen years of follow-up examined with the Cox regression analysis.

A total of 122 patients (mean age: 55 years, range 20-75 years) were alive 30 days after isolated aortic valve replacement (AVR) performed in 1965-73 for aortic valve stenosis (AS). Cold chemical Bretschneider cardioplegia was used in all operations. The maximum follow-up was 17 years, mean 9 years. The 10-year cumulative survival +/- SE was 63 +/- 4%. Twenty-one preoperative clinical, invasive and valve-related variables were entered into a Cox regression analysis. Variables with independent predictive value regarding long-term survival were: Left ventricular failure (regression coefficient: b = 1.078, p less than 0.0002), age (b = 0.749, p less than 0.009), pulse pressure (b = -0.663, p less than 0.02) and cardio-thoracic index (CTI) (b = 0.603, p less than 0.04). Based on these variables, a prognostic index with 16 different risk groups was made. In the "best" group (n = 8), the observed 10-year survival +/- SE was 88 +/- 11%, compared to 13 +/- 12% for the "worst" group (n = 8). Multivariate analysis of complication-free survival showed that the total valve-related complication-rate (VRC) (4.2/100 pat.-yrs) was influenced by valve type (Starr-Edwards ball valves, n = 118, versus Lillehei-Kaster and Smeelof-Cutter valves, n = 4) and CTI. The valve- and heart-related events (VRC together with late myocardial infarctions and pacemaker implantations, 6.5/100 pat.-yrs) depended on CTI and previous myocardial infarction. No predictors of thromboembolism (1.6/100 pat.-yrs) or coumarin-related hemorrhage (1.8/100 pat.-yrs) could be identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Pulmonary embolism: long-term follow-up after treatment with full-dose heparin, streptokinase or embolectomy.

The study comprises 74 patients alive 30 days after the start of treatment of pulmonary embolism with heparin (n = 32), streptokinase (n = 22) or embolectomy (n = 20). The cumulative 5-year survival was 100% in the embolectomy group, compared to 75 +/- 7% (SE) in the medically treated patients (p less than 0.05). Cancer caused 78% of the late deaths. At follow-up 0.5-8.7 years after treatment the treatment groups were indistinguishable as regards right-sided heart catheterization data, pulmonary artery rest-obstruction, right ventricular diameter and wall thickness, ventilatory function and ECG changes. The embolectomized patients were in a more favourable NYHA classification level than the medically treated. Chronic pulmonary artery hypertension was found in 75% of patients with greater than or equal to 3 anamnestic recurrent embolic episodes before diagnosis compared to 8% of patients with less than or equal to 2 recurrent episodes (p less than 0.001). Patients with irreversible cardiocirculatory shock before embolectomy all had abnormal pulmonary vascular resistance (greater than 1.5 mmHg/l/min), depressed ventilatory function and more than 25% reduced pulmonary perfusion at follow-up. The major prognostic factors thus were cancer, the number of recurrent episodes and the degree of cardiocirculatory affection in the acute event. Although the embolectomized patients were the most affected initially, they had a good prognosis. This led us to extend our indications for embolectomy to include all patients with central emboli, irrespective of the degree of cardiocirculatory impairment.

Adolescent↗
PubMed1987

Primary malignant pericardial mesothelioma mimicking left atrial myxoma. Case report.

In a 32-year-old man with clinical and echocardiographic signs mimicking left atrial myxoma, thoracotomy revealed a highly malignant pericardial mesothelioma with an intraatrial pendulous extension and haemorrhagic pericardial exudate. CT scanning of the thorax is useful when an intracavitary cardiac mass is associated with pericardial exudate and/or with suspected extracavitary involvement.

Adult↗
PubMed1987

Clinical improvement and long-term survival after surgical treatment of postinfarction left ventricular aneurysm.

Left ventricular aneurysmectomy was performed on 45 men and 12 women (mean age 57 years) during a 12-year period. The hospital mortality was 14% and the cumulative 5-year survival 57% +/- 9 (SE). Of 35 survivors, 33 underwent a follow-up study (mean 28 months post-operatively). The mean cardiothoracic index fell from 0.58 +/- 0.08 (SD) to 0.51 +/- 0.04 and the mean left ventricular ejection fraction (EF) improved from 0.30 +/- 0.08 to 0.38 +/- 0.01 (both changes significant). Echocardiographic parameters showed no significant improvement in left ventricular function. The NYHA classification was I or II in 85% of the patients at follow-up, but in only 23% preoperatively. Preoperative EF greater than or equal to 0.30 was associated with 76% +/- 16 (SE) cumulative 5-year survival as compared with 31% +/- 12 when EF had been less than 0.30. In view of these results, left ventricular aneurysmectomy should be recommended for all symptomatic patients.

Adult↗
PubMed1987

Determinants of long-term survival after isolated aortic valve replacement: a 10- to 17-year follow-up.

During a 9-year period from January 1965 through December 1973, we performed isolated aortic valve replacement (AVR) for aortic stenosis (AS) or aortic regurgitation (AR) in 165 patients. All operations were done during total cardiac arrest using chemical cardioplegia according to the method of Bretschneider. The prostheses used were predominantly Starr-Edwards caged ball valves. One hundred thirty-nine patients were alive 30 days after operation. The 5-, 10-, and 15-year cumulative survival rates (+/- SE) were 78 +/- 4%, 62 +/- 4%, and 29 +/- 9%, respectively. In comparison to a sex- and age-matched control population, our patients had an excess mortality in the first postoperative year and again after the twelfth year. Patients who underwent AVR in 1972 and 1973 had better results than those who had operations in 1965 through 1971 (p < 0.05); the 1972-1973 patients had 5- and 10-year survival rates of 81 +/- 5% and 72 +/- 5%, respectively. The 1-year survival rate was 91% for patients with AS and 71% for those with AR (p < 0.05). In AS patients, long-term survival was adversely affected by a history of left ventricular failure, inclusion in NYHA functional class IV, cardiothoracic index of >/= 0.56, cardiac index of < 3.0 L/min/m(2), age > 55 years, previous myocardial infarction, systemic pulse pressure of </= 40 mm Hg, mean left atrial pressure of >/= 15 mm Hg, and mean pulmonary artery pressure of >/= 24 mm Hg. In AR patients, an adverse prognosis was associated with left ventricular failure, syncope, age >/= 60 years, and NYHA class IV status. These results indicate that, in both AS and AR patients, operation should be performed early, before severely limiting symptoms and signs arise.

Journal Article↗
PubMed1986

Treatment of pulmonary embolism with full-dose heparin, streptokinase or embolectomy--results and indications.

The results of treatment of pulmonary embolism with heparin (n = 34), streptokinase (n = 28) or embolectomy (n = 25) are presented. The treatment groups represented different degrees of embolization with acute embolic scores (possible maximum: 20, mean +/- SD): 5 +/- 4, 9 +/- 3 and 13 +/- 3, respectively (p less than 0.0001). The post-treatment embolic score (mean +/- SD) for patients with acute massive central emboli (score greater than or equal to 9) was: 6 +/- 4 (n = 7) and 3 +/- 2 (n = 15) in the streptokinase and embolectomy groups, respectively, (p less than 0.01). The hospital mortality was 6% (n = 2), 21% (n = 6) and 20% (n = 5) in the heparin, streptokinase and embolectomy groups, respectively (p less than 0.05). The 5-year cumulative survival (+/- SE) was 68% +/- 10, 64% +/- 10 and 80% +/- 8, respectively (p: NS). The relative survival (hospital and late deaths, observed/expected) stratified according to acute embolic score showed the best results in the embolectomy group. Systolic pulmonary artery pressure greater than 60 mmHg was found in cases with a duration of symptoms greater than 7 days and/or with greater than or equal to 25 anamnestic recurrent embolic episodes before diagnosis, indicative of a gradual increase in pulmonary artery pressure and of partly organized non-lyseable emboli. Embolectomy carried a low risk of complications (8% with cerebral reduction). Streptokinase treatment was associated with serious complications (18% with cerebral reduction/fatal hemorrhage). Pulmonary embolectomy should be recommended in all cases with emboli in the main branches of the pulmonary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Scintigraphy and angiography in pulmonary embolism.

In 14 patients with acute pulmonary embolism, pulmonary artery angiography was made within 6 h after ventilation-perfusion scintigraphy. The extent of embolization was evaluated by an embolic score system with a maximum value of 20 in cases of complete bilateral occlusion. The perfusion scintigraphic and pulmonary angiographic embolic scores correlated (r = 0.47), but the paired values differed (p less than 0.05). Exclusion of four cases with non-complete obstructing emboli in the main branches of the pulmonary artery rendered the differences of the paired scores not significant, with mean scintigraphic and angiographic scores of 9.7 and 10.1, respectively (r = 0.79). The four cases with non-complete obstructing central emboli had mean scores with the scintigraphic and angiographic method of 9.0 and 16.2, respectively (p less than 0.01), implying that the scintigraphic method may underestimate the degree of embolization in cases with non-complete obstructing central emboli.

Angiography↗