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Biomedical subjects

R E Rossall

Publications and source records attributed to R E Rossall.

At least 37 records · Page 2Linked to original sources
PubMed1984

Evaluation of biventricular involvement in hypotensive patients with transmural inferior infarction by two-dimensional echocardiography.

Hypotension in inferior myocardial infarction (IMI) may be due to extensive involvement of the right ventricle (RV), left ventricle (LV), or both. We verified this hypothesis in 24 patients with IMI and hypotension (systolic blood pressure less than 100 mm Hg), within 48 hours of admission, by means of two-dimensional echocardiography (2DE). We measured the extent of regional RV and LV asynergy (akinesis and/or dyskinesis) in parasternal short-axis sections at mitral, chordal, midpapillary muscle, and low papillary muscle levels. Initial right heart catheterization revealed predominant RV dysfunction in 16 patients (group 1) and predominant LV dysfunction in eight patients (group 2). For all patients, the initial 2DE revealed: (1) biventricular asynergy involving the posterior RV, posterior LV, and posterior interventricular septum; (2) a wide range of values for the extent of asynergy (RV 21% to 90%; LV 19% to 48%); and (3) a direct correlation between peak creatine kinase levels and percentage of LV asynergy (r = 0.80, p less than 0.001) or percentage of RV plus LV asynergy (r = 0.72, p less than 0.001). Although the extent of LV asynergy was similar in the two groups (34% vs 34%, NS), the extent of RV asynergy was greater in group 1 than in group 2 (57% vs 30%, p less than 0.001). More important, the ratio of RV/LV asynergy was greater for group 1 than group 2 (1.75 vs 0.89, p less than 0.001), and this difference in ratios between the two groups was also found in 2DE studies at 10 days and 6 months. A RV/LV asynergy ratio value of 1.1 provided clear separation between the groups. Thus, the RV/LV asynergy ratio on an initial 2DE can clarify the clinical syndrome of hypotension in patients with IMI. An increased asynergy ratio might identify those patients with predominant RV involvement.

Aged↗
PubMed1984

Significance of ST-segment depression in inferior leads in patients with acute anterior infarction.

Coronary arteriographic findings in patients with acute transmural anterior infarction were studied from 33 patients (30 men and 3 women). Their ages ranged from 28 to 76 years with a mean of 50 years. In 18 patients, ST depression of less than 1 mm in leads II, III and a VF was observed and these contributed to Group A. The remaining 15 patients in whom ST depression in these leads measured 1 mm or more formed Group B. All 33 patients had significant disease of the anterior descending branch of the left coronary artery but in Group A, only 5 (28%) had significant disease of either the right coronary artery (RCA) or the circumflex (CIRC) branch of the left coronary artery (or both) whereas these added lesions were noted in 12 (80%) of the patients in Group B. This was a significant difference (p less than 0.01). The mean peak plasma creatinine phosphokinase (IU/L) in Group B (2475 +/- 1111 S.D.) was greater (p less than 0.005) than in Group A (1147 +/- 998). The mean ejection fraction of 62.6 +/- 14.1% in Group A was higher (p less than 0.001) than that in Group B (40.3 +/- 13%). There was no relation between the duration of ST-segment depression in leads II, III and a VF and the presence of RCA/CIRC stenosis. Also, no correlation was noted between the presence of collateral circulation and the development of ST-segment depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Significance of precordial ST-segment depression in acute transmural inferior infarction: coronary angiographic findings.

Coronary arteriographic findings in patients with acute transmural inferior infarction were studied from 57 patients (51 men and 6 women). Their ages ranged from 28 to 72 years with a mean of 50 years. Twenty-six patients (Group A) had minimal (less than 0.1 mV) or no precordial ST-segment depression. Thirty-one patients (Group B) had precordial ST-segment depression of 0.1 mV or more. The two groups showed consistent differences in frequency of the left anterior descending artery (LAD) stenosis, multivessel disease, mean peak plasma creatinine phosphokinase (CPK, IU/L), and mean ejection fraction. For Group A vs B, these differences were: LAD stenosis, 31% vs 68%, multivessel disease, 35% vs 81%, mean peak plasma CPK, 1283 versus 1904, and mean ejection fraction, 60.5% vs 45.3%. The incidence of abnormal anterolateral and posterobasal wall motion in Group B was more (p less than 0.01 and p less than 0.05 respectively) than in Group A. All patients in Group B who had precordial ST-segment depression of 0.3 mV or greater, had LAD stenosis. There was no relation between the duration of ST-segment depression and the presence of LAD stenosis. Also, there was no correlation between the presence of collateral circulation and the development of ST-segment depression. The Group B patients tended to have more complications in the acute phase and in the follow up period (p less than 0.05) than did those in Group A. It is concluded that precordial ST-segment depression in acute inferior wall infarction is probably related to anterior injury due to LAD stenosis and these patients were shown to have more severe coronary artery disease, more depression of their ejection fractions, and more myocardial damage than patients without this finding. The earliest recorded ECG is most valuable in identifying the high risk patients. The presence of LAD stenosis in patients with inferior wall infarction who have precordial ST-segment depression of 0.3 mV or more are likely.

Adult↗
PubMed1983

The modern diagnosis of cardiac myxoma: role of two-dimensional echocardiography.

We reviewed our experience with the diagnosis of cardiac myxoma in 10 patients seen between 1960 and 1981. At surgery, large myxomas (greater than 5 cm) were found in the left atrium in 6 patients, right atrium in 3, and right ventricle in 1. The correct preoperative diagnosis was made in 9 patients: clinically in 3 and at catheterization and angiocardiography in 6. Diagnoses were falsely negative in 3/13 (23%) catheterizations and 2/10 (20%) angiocardiograms. Echocardiography (echo) was positive in 5/5 (100%). Gated blood-pool scans confirmed a right atrial myxoma in 1 patient. The interval between onset of symptoms and surgery was 30.5 months, (range, 2-120) and was not significantly different in the eras before and after echo. The age at diagnosis exceeded 40 years in 9 patients and was not significantly less in the echo era. The size and site of the tumor at surgery agreed with findings on M-mode echo (n=5) or two-dimensional (2-D) echo (n=2), but the size (85 vs. 88 cm3) and mass (81 vs. 88 g) of the tumors were similar in the 2 eras. Although 2-D echo facilitates the preoperative diagnosis of cardiac myxoma, earlier patient referral of suspicious cases for 2-D echo is still necessary.

Adult↗
PubMed1983

Persistent reduction in left ventricular asynergy in patients with acute myocardial infarction by intravenous infusion of nitroglycerin.

Intravenous nitroglycerin (NG) infusion in patients with acute myocardial infarction (AMI) has been shown to improve left ventricular function and myocardial perfusion and to decrease ischemic injury and creatine kinase (CK) indexes of infarct size. To determine whether early NG infusions in patients with AMI decreases the extent of left ventricular asynergy, we used two-dimensional echocardiography to measure asynergic segments (akinesis and/or dyskinesis) at four serial short-axis levels from base to apex (mitral, M; chordal, C; midpapillary, MP; low papillary, LP) in 22 patients with a first anterior AMI. Patients were randomized between infusions of NG (n = 11) or 5% dextrose in water (controls, n = 11) within 5.6 hr after the onset of pain. NG infusion rates were titrated to lower mean arterial pressure to an average level of 7% below control (but not below 80 mm Hg) and were maintained at this level for the duration of the infusions (39 hr). After NG, left ventricular function improved as left ventricular filling pressure decreased (p less than .005), and sigma ST on precordial ST segment mapping decreased (p less than .001). These parameters did not change in control subjects. Computed CK infarct size was smaller in the NG group than in the control group (p less than .05). Before the infusions, the mean extent of left ventricular asynergy (% left ventricular circumference) were similar in both groups: M, 18% vs 21%; C, 22% vs 23%; MP, 26% vs 24%; LP, 32% vs 29%. In addition, the computed total left ventricular asynergy (% surface area) was also similar for these two groups before therapy (25% vs 25%). There was no change in left ventricular asynergy from pretreatment values by 1 hr and 10 days among control subjects: M, 18% vs 18% vs 17%; C, 22% vs 22%; MP, 26% vs 26% vs 22%; LP, 32% vs 33% vs 33%; total 25% vs 25% vs 24% (multiple measures analysis of variance). In contrast, there was a significant decrease (p less than .001) in left ventricular asynergy from pretreatment values by 1 hr and 10 days with NG: M, 21% vs 10% vs 8%; C, 23% vs 12% vs 10%; MP, 24% vs 13% vs 9%; LP, 29% vs 14% vs 10%; total, 25% vs 12% vs 9%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1983

Right ventricular involvement in transmural inferior wall infarction: two-dimensional echocardiographic and clinical correlations.

We used two-dimensional echocardiography to assess asynergy in the right (RV) and left (LV) ventricles in 34 selected patients with electrocardiographic evidence of acute transmural inferior myocardial infarction (IMI) 40 +/- 3 (SE) h from the onset of pain. We measured the extent of asynergy, defined as akinesis and/or dyskinesis, for RV and LV in 4 short axis sections and computed asynergy for both ventricles. The incidence of asynergy was 100% in the inferior LV, 76% in the inferior ventricular septum and 76% in the inferior RV. We found a direct correlation between peak creatine phosphokinase levels and LV asynergy (R = 0.71) or (RV + LV) asynergy (R = 0.72). The asynergy and right heart catheterization data correlated with clinical findings in 4 subgroups identified on the basis of hypotension (systolic blood pressure less than 100 mmHg) and pulmonary congestion, (confirmed radiographically): 1A, extensive biventricular asynergy (32% RV, 32% LV) with hypotension and congestion (N = 10); 1B, predominant RV asynergy (49% RV, 26% LV) with hypotension but no congestion (N = 5); 2A, predominant LV asynergy (7% RV, 26% LV) with congestion (N = 10); 2B less extensive biventricular asynergy (15% RV; 16% LV) and uncomplicated IMI (N = 9). Hypotension identified a high risk group (N = 15) prone to complications and death. The extent of RV asynergy was the third strongest discriminator for hypotension, next to systolic blood pressure and jugular venous pressure. The extent of LV asynergy was the strongest discriminator for pulmonary congestion. Among hypotensive patients, the RV/LV asynergy ratio was the strongest discriminator for pulmonary congestion, being significantly greater in those without congestion than in those with congestion (2.2 vs 1.0, P less than 0.001). The increased RV/LV asynergy ratio may be a useful index for predicting predominant RV infarction in IMI.

Aged↗
PubMed1982

Infective endocarditis: surgical treatment of 41 patients.

Forty-one patients with infective endocarditis were treated surgically at the University of Alberta Hospital, Edmonton, between 1961 and 1980. Their ages ranged from 10 to 67 years and the male to female ratio was 4:1. A wide variety of organisms were cultured but gram-positive organisms predominated. Bicuspid aortic valves, normal valves and valves affected by rheumatic heart disease, were the most common sites of infection. The aortic valve was most frequently involved. The onset of left ventricular failure was the major indication for surgery. The overall mortality at 30 days was 19.5%. The mortality after 30 days was 9.8%. Eleven of 12 patients who died had left ventricular failure preoperatively. The mortality in patients who had valve replacement during the first 4 weeks of infection did not differ from those who had valve replacement after 4 weeks of infection. Hemodynamic studies following operation in six patients showed that pulmonary arterial and wedge pressures had returned to normal levels. Nineteen of 26 patients who were followed up were asymptomatic. One had a malfunctioning prosthesis, one chronic heart failure and one had reoperation for paravalvular leak. Four patients diet during the follow-up period. The authors conclude that all patients with infective endocarditis who suffer left ventricular failure should have prompt valve replacement regardless of the duration of antibiotic therapy.

Adolescent↗
PubMed1980

Acid-base changes after cardiorespiratory arrest in the dog.

1. To assess the non-respiratory acid-base disturbance which results from cardiorespiratory arrest experiments were performed on anaesthetized dogs, and circulatory arrest was established either by inducing ventricular fibrillation or by complete occlusion of the great veins. 2. In the first series of experiments (group A) the period of cardiorespiratory arrest was limited to 2.0-3.5 min. It was shown that the nonrespiratory component of the ensuing acid-base disturbance as expressed by the non-respiratory pH was small: in the nine episodes of circulatory arrest after occlusion of the great veins there was a mean reduction in the non-respiratory pH or 0.04 pH unit (range 0.025-0.055), and in seven episodes of ventricular fibrillation the mean reduction was 0.024 pH unit (range 0-0.055). 3. In the second series of experiments (group B) the period of cardiorespiratory arrest was varied from 3.0 to 11.0 min. It was found that the degree of non-respiratory acidaemia was correlated with the duration of arrest but the magnitude of these changes was not large.

Acid-Base Equilibrium↗
PubMed1978

Hypothermic coronary perfusion for myocardial protection during aortocoronary bypass.

Numerous methods have been used in an attempt to prevent myocardial injury that results from the interruption of aortic flow during cardiac operations. The authors describe a relatively simple means of inducing cardioplegia during coronary bypass surgery by coronary perfusion with cold lactated Ringer's solution through the aortic root. When the results following the employment of hypothermic coronary perfusion for intraoperative cardioplegia were compared with those obtained without its use, the procedure was found to confer a degree of intraoperative myocardial protection and appeared to lead to a decrease in intraoperative myocardial infarction, subendocardial ischemia and intraoperative mortality.

Coronary Artery Bypass↗
PubMed1978

Myocardial protection during aortic valve replacement: normothermia versus hypothermia.

The operative results in 32 patients who underwent aortic valve replacement with aortic occlusion and normothermic myocardium (group 1) were compared with 54 similar patients in whom the myocardium was protected by hypothermic coronary perfusion through the aortic root (group 2). The operative mortality and the incidence of heart failure, subendocardial ischemia and myocardial infarction were the same in the two groups. The maximal concentrations of cardiac enzymes after operation in group 2 patients were significantly lower than those in group 1. The postoperative cardiac performance was significantly different in that only 5.6% of group 2 patients required inotropic agents after operation compared with 25% of group 1 patients. The patients in group 2 were easier to defibrillate after cardiopulmonary bypass.

Adult↗
PubMed1977

Long-term survival after tricuspid valve replacement. Results with seven different prostheses.

The experience with tricuspid valve replacement (TVR) with seven different prostheses, alone or combined with replacement of other valves, in 73 patients (64 rheumatic and nine nonrheumatic) between 1964 and March, 1975, at the University of Alberta Hospital has been reviewed. Early and late mortality rates in rheumatic patients were 41 and 23 percent, respectively (36 percent being alive after a mean of 5.6 years), compared to 33 and 11 percent, respectively, in the nonrheumatic patients (56 percent being alive after a mean of 2 years). Of all survivors, 88 percent were functionally improved. Among the rheumatic patients: (1) 88 percent had organic tricuspid disease; (2) of the 39 patients with tricuspid insufficiency who underwent corrective mitral surgery 7 years before TVR, the tricuspid insufficiency had progressed over the 7 years; (3) the number of patients with tricuspid insufficiency had increased (39 versus 59) over the same 7 year period; (4) a high early mortality rate was encountered in those who were preoperatively in New York Heart Association (N.Y.H.A.) Class IV, or who had cardiomegaly, or pulmonary hypertension, or poor ventricular function, or organic disease, or reoperation; (5) the percentages of survivors with different prostheses were: Starr-Edwards, 31 percent; Beall-Surgitool, 14 percent; Kay-Shiley, 46 percent, Björk-Shiley, 50 percent; Lillehei-Kaster, 100 percent; Cutter-Smeloff and Wada-Cutter, nil. Among the nonrheumatic patients, two with the Cutter-Smeloff, two with the Beall-Surgitool, and one with the Lillehei-Kaster were alive after 14, 37, and 15 months, respectively. Among all survivors of TVR, late thrombus and pannus developed on both ball and disc prostheses (Starr-Edwards, two; Cutter-Smeloff, one; Lillehei-Kaster, one). These findings suggest that TVR should be performed earlier in rheumatic patients to reduce the operative mortality rate and that the Lillehei-Kaster prosthesis is probably most suitable for TVR.

Adolescent↗
PubMed1977

Surgical treatment of Ebstein's anomaly.

Neither the role of surgery in Ebstein's anaomaly nor the surgical procedure of choice for its correction are clearly defined. Whether or not the artrialized right ventricle, which plays a major role in the functional abnormalities, should be obliterated in all cases remains unresolved. Of the 26 patients with Ebstein's anomaly seen at the University Hospital between 1953 and 1975, four were treated surgically at this center. All had closure of the atrial septal defect, reconstruction of a tricuspid annulus in the normal position, and insertion of a tricuspid prosthesis and an epicardial ventricular pacemaker. The two patients who also had the atrialized chamber obliterated improved dramatically. Thus, obliteration of the atrialized right ventricle appears to be associated with a better operative result.

Adolescent↗
PubMed1976

Coarctation of the aorta in adults.

Thirty-six patients, 19 men and 17 women, presented at age 18 or older between 1952 and 1974 with coarctation of the aorta. Of the 14 (39%) who had associated cardiovascular disease, 12 had aortic stenosis or insufficiency or both. Three patients had infections-two, endocarditis (aortic valve) and one, endarteritis. Three of the seven patients who did not undergo an operation are alive, two at more than 50 years of age. Five patients had myocardial infarctions, two at 35 years of age. Twenty-nine (80%) had operations; in eight instances the patient was over age 40. All 18 patients undergoing repair of isolated coarctation survived, while only 7 of the 11 patients with associated cardiovascular lesions who underwent repair recovered. Aortic valvular disease and myocardial infarction are serious complicating factors in coarctation of the aorta.

Adolescent↗
PubMed1976

Long-term survival after isolated replacement of mitral valve with ball-valve prosthesis.

In 111 patients whose diseases mitral valve was replaced with a ball-valve prosthesis the actuarial survival rate, including the hospital mortality of 10.8%, was 66% after 5 years and 59% after 8 years of follow-up. This suggests that in patients with moderate or severe symptoms due to mitral valve disease, replacing the valve can prolong life. However, in patients with no cardiac symptoms or with sinus rhythm and mild symptoms, it is doubtful that mitral valve replacement can prolong life, for the prognosis in these patients is favourable without operation.

Female↗
PubMed1976

The assessment of function of left ventricle and patency of aorta-coronary bypass after operation. A study of systolic time intervals.

The effect of aorta-coronary bypass surgery on left ventricular function was evaluated in 39 patients by cardiac catheterization and recording of the systolic time intervals (STI) before and an average of 4.5 months following myocardial revascularization. All patients were in sinus rhythm, had normal QRS intervals on the electrocardiogram, and had taken no medication for at least 3 weeks prior to the study. The STI was unchanged postoperatively in patients with the following characteristics: freedom from angina; heart rate not more than 15 beats greater than the preoperative level; all grafts patent; and no progression of disease in coronary arteries. Deterioration in left ventricular function after operation as represented by shortened left ventricular ejection time, (LVET) prolonged pre-ejection period (PEP), and increased ratio of PEP/LVET was found in patients with the following characteristics: persistent angina; heart rate more than 14 beats faster than the preoperative level; occlusion of any grafts; progression of disease in the coronary arteries; evidence for postoperative myocardial infarction. Worsening of left ventricular performance as determined by STI was more apparent in patients with occluded grafts and no collateral circulation than in those with occluded grafts and collateral circulation which may have offered protection against ischemia. These investigations supported the use of STI in assessing changes in left ventricular function after coronary bypass and, by inference, in assessing the status of the graft.

Adult↗
PubMed1975

An unusual case of recurrent left atrial myxoma.

In a patient who had a calcified left atrial myxoma resected, recurrence developed 31 months later. Although complete radical resection of the recurrent tumour presented a special problem, the patient survived the second operation. The tumour recurred again and the patient had two episodes of cerebral embolism 1 1/2 and 2 years later, respectively, and died 3 1/2 years after the second operation. The erythrocyte sedimentation rate correlated with the size of the tumor, and the recurrent tumour seemed to grow more rapidly than the primary tumour. Experience with this case and a review of the nine reported cases of recurrent left atrial myxoma suggest that a radical approach is necessary at the primary operation.

Autopsy↗