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Biomedical subjects

R E Rossall

Publications and source records attributed to R E Rossall.

47 records · Page 3Linked to original sources
PubMed1975

Long-term survival after aortic valve replacement using Smeloff-Cutter prosthesis.

The long-term prognosis of 187 consecutive patients who received single aortic valve replacement using Smeloff-Cutter prosthesis was studied. Of the 163 patients who survived the operation, a long-term follow-up (up to eight years) was obtained in 153 patients (95%). A total of 34 patients (22%) died during the follow-up period. Including the hospital mortality, the actuarial survival rate of our patients with Smeloff-Cutter prosthesis was 0.69 after the fifth year and 0.611 after the eighth year of follow-up. This is similar to the actuarial survival rate of patients with Starr-Edwards prosthesis but it appears significantly better than the expected survival rate of symptomatic patients with aortic stenosis treated without surgery. Thus, this result supports the contention that aortic valve surgery in properly selected patients can prolong life expectancy in addition to relieving symptoms in patients with aortic valve disease. The majority of surviving patients reported to have improved (88%) since the operation and to be symptom free (82%).

Aortic Valve↗
PubMed1975

Intraventricular blocks in acute myocardial infarction.

The electrocardiograms and clinical records of 171 patients with a first recognized myocardial infarction (AMI) were reviewed in order to study the incidence and clinical significance of intraventricular blocks (IVB), especially hemiblocks, when other conditions which could have influenced the prognosis were excluded. Patients with left anterior hemiblock had higher SGOT levels (p less than 0.01), higher incidence of arrhythmias (p less than 0.01) and congestive heart failure (p less than 0.01) compared to the control group without IVB. Isolated left posterior hemiblock was infrequent and did not appear to influence the course of AMI. Bundle branch and bifasicular blocks were associated with the highest incidence of complications and mortality (47 percent), but these patients were older (p less than 0.01) and also had higher SGOT levels than the control group (p less than 0.05). To some extent, mortality and incidence of complications appeared to be related to the degree of myocardial damage, which in turn produced the IVB rather than to the conduction abnormality itself.

Acute Disease↗
PubMed1974

Ruptured aneurysms of sinuses of Valsalva.

At least one additional cardiac lesion was present in 18 consecutive patients with ruptured aneurysms of the sinuses of Valsalva who were investigated between 1956 and 1973 at the University of Alberta Hospital. Clinical diagnosis was made in 78% (14/18) of the patients. Confirmation at cardiac catheterization, operation or autopsy was obtained in all but one. The main sites of rupture were the right ventricle (seven cases), right atrium (five) and left ventricle (five). Fifty percent (9/18) are alive and well following prompt operative repair, an average of 8.2 years later (range, six months to 15 years). Replacement of the aortic valve was associated with a high mortality (50% early, 13% late, total 63%) which could be explained by the higher operative risk in this group of very ill patients. Eight patients (44.4%) had had bacterial endocarditis prior to presentation and this may have played a significant role in the rupture of the sinus of Valsalva aneurysm.

Adolescent↗
PubMed1970

Hemodynamic changes following correction of severe aortic stenosis using the Cutter-Smeloff prosthesis.

Twelve patients with pure or dominant stenosis were studied before and after aortic valve replacement (Cutter-Smeloff). The changes in cardiac output and A-V O2 difference were small and insignificant, but exercise stroke volume increased from 72 to 96 ml after the surgery. The aortic peak systolic gradient was 92 +/- 29 mm Hg before and 4 +/- 9.8 mm Hg after surgery. The PA wedge pressure, taken as a measure of the LV diastolic pressure, decreased from 18 mm Hg to 12 mm Hg at rest and 30 mm Hg to 16 mm Hg on exercise. The PA pressures also decreased from 37/18 (mean, 26) to 28/11 (17) mm Hg at rest, and 61/31 (43) to 41/17 (27) mm Hg on exercise, but the PA and PA wedge pressures maintained their tendency to increase in a linear manner with oxygen consumption (Vo2) on exercise after surgery. As a result of decreased wedge pressure, the pulmonary vascular resistance also decreased significantly afterward. The adequacy of cardiac output at rest and on exercise expressed by cardiac output as the linear function of Vo2 improved toward the normal (values before operation, CO = 2.78 + 0.0069 Vo2, r = 0.84; after operation, CO = 3.80 + 0.0062 Vo2, r = 0.91). The exercise factor (delta CO/delta Vo2) or the regression coefficient, however, was similar before and after surgery. The hemodynamic result was satisfactory although some abnormalities of the left ventricular function persisted after operation.

Adult↗
PubMed1967

Bacterial endocarditis occurring after open-heart surgery.

A review was made of 520 patients who survived cardiopulmonary bypass for repair of congenital or acquired heart disease between 1956 and 1965. The incidence of early and late bacterial endocarditis was 2.7%, a figure which was higher than the reported incidence in the pre-bypass era but comparable to the experience reported by others. When those patients who had ball-valve prostheses inserted were considered separately, endocarditis was found to have occurred in 3.9%. The most common infecting organism was Staphylococcus albus (nine of 14 cases). Twelve of the 14 patients died, most often from complications of the infection, such as disruption of patches and prosthetic valves. The infections were difficult to control and in three patients recurred from one to three times. There was no apparent source of infection. Six patients developed infections six to 45 months after operation; the remaining eight had proved endocarditis within two months of operation. With one possible exception, treatment with antibiotics appeared to be ineffective in eradicating the infection unless foreign material was removed from the heart.

Adult↗
PubMedDate not supplied

Subacute left main coronary stenosis following percutaneous transluminal coronary angioplasty.

Subacute left main coronary stenosis following percutaneous transluminal coronary angioplasty (PTCA) is an uncommon but recognized complication of the procedure. This report describes a case of left main coronary stenosis, which occurred 6 months following PTCA of an angulated, eccentric, proximal (adjacent to the left main stem) left anterior descending artery stenosis. Angiographically demonstrated morphology of complicated coronary stenosis adjacent to the left main coronary artery may represent a risk factor threatening major complications of PTCA. Detailed evaluation of angiographic coronary anatomy may improve patient selection and reduce the likelihood of such complications.

Angioplasty, Balloon↗
PubMedDate not supplied

A simple and economical equipment arrangement for percutaneous transluminal coronary angioplasty.

A simple and economical equipment arrangement for percutaneous transluminal coronary angioplasty (PTCA) for USCI system is described. The arrangement will provide for immediate deflation when required with a short deflation time. Cardiac catheterization laboratories performing a large number of angioplasties could benefit from its low cost and convenience.

Angioplasty, Balloon↗
PubMedDate not supplied

The value of sum of ST segment depression in 12-lead electrocardiogram in relation to change in heart rate during exercise to predict the extent of coronary artery disease.

The present study was planned to investigate whether the sum of ST segment depression in 12-lead electrocardiogram (sigma STD) in relation to change in heart rate (delta HR) during exercise, sigma STD/delta HR index, could be utilized to predict the extent of underlying coronary artery disease. Two hundred and twenty-six consecutive patients were included in this study, 191 men and 35 women, aged 28-74 years (mean 56). Patients were classified into two groups. Group I consisted of 165 patients with either no coronary disease, single or double vessel disease. Group II included 61 patients with triple vessel or left main stem stenosis. It was found that the sigma STD/delta HR index at 25 mm. beat-1 X min. 10(2) provided the best separation between Groups I and II patients. All but 3 of the 61 patients in Group II had a sigma STD/delta HR index greater than 25. In contrast, all but 4 of the 165 patients in Group I had an index less than 25. The sensitivity, specificity and positive predictive value in the identification of Group II patients by using the index were 95%, 98% and 94% respectively. Utilization of ST segment depression of greater than or equal to 2 mm in a VF alone as a test criterion for the recognition of Group II patients had a low sensitivity (41%), specificity (88%) and positive predictive value (56%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗