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Biomedical subjects

R I Hamby

Publications and source records attributed to R I Hamby.

At least 37 records · Page 2Linked to original sources
PubMed1980

Aneurysm of main left coronary artery.

A 57-year-old man presented with exertional chest pain, and was found to have a saccular, lobulated aneurysm of the left main coronary artery associated with severe atherosclerotic vascular disease. This is the third similar case reported and the first case of atherosclerotic origin. All symptoms were relieved by coronary artery bypass surgery.

Aneurysm↗
PubMed1980

Arteriography of coronary disease at clinical onset.

The coronary arteriographic anatomic findings in 491 male patients clinically symptomatic for less than six months are described. Single and multiple vessel disease was noted, respectively, in 40 and 60 percent with 6.5 percent also manifesting left main coronary disease. Our findings indicate that severe coronary artery disease is present early in the symptomatic phase and that patients presenting with initial inferior myocardial infarctions may represent a select group having an excessive frequency of severe coronary disease suitable for early angiographic detection and surgical bypass therapy.

Adult↗
PubMed1979

Atrial pacing induced left ventricular dysfunction: reversibility after aortocoronary bypass surgery.

Three patients with angina pectoris were studied before and after aortocoronary bypass surgery. Angiographic studies were performed with and without atrial pacing. Preoperative atrial pacing in all three patients resulted in angina and/or ST segment changes accompanied by regional left ventricular contractile abnormalities, decreased ejection fraction, as well as decreased left ventricular end-diastolic and stroke volumes. After surgery with all grafts patent, atrial pacing at similar heart rates did not produce an ischemic response. Left ventricular contractile pattern remained normal, and there was no change in ejection fraction though end-diastolic and stroke volumes decreased. These studies demonstrate that aortocoronary bypass surgery can abolish both the ischemic response and left ventricular dysfunction that accompany atrial pacing.

Angina Pectoris↗
PubMed1979

Late coronary bypass graft flow: quantitative assessment by roentgendensitometry.

Quantitative assessment of the flow in 45 saphenous vein aortocoronary bypass grafts in 30 patients was performed by a roentgendensitometric technique. Detalis of the technique are given. Mean graft flow for all grafts measured in the early postoperative period (two weeks) and again in the late postoperative period (six months to 3 years; average, 1.5 years) significantly decreased (72.6 +/- 34.7 to 57.4 +/- 28.6 ml/min; p less than 0.01). Mean graft diameter also significantly decreased over the same period (3.5 +/- 0.6 to 3.0 +/- 0.6 mm; p less than 0.01). Differences could not be related to graft site or to the time interval between early and late recatheterization. Changes in diameter did not correlate with changes in flow. During a 3-year follow-up, saphenous vein grafts significantly decreased in diameter and flow but still functioned adequately; and vein grafts generally remained larger than the recipient arteries. The determinant of adequacy of flow is the native coronary bed.

Absorptiometry, Photon↗
PubMed1979

Echocardiographic findings of posterior wall false aneurysm: case report and review of the literature.

A case of angiographically proven posterolateral left ventricular false aneurysm is presented. The patient underwent successful surgery. The echocardiogram revealed large echo-free spaces behind the posterior wall of the left ventricle, delineated by pericardial echoes and lined internally by extra echoes. These echocardiographic findings are consistent with false aneurysm containing a clot. This report indicates that in patients with previous infarction and distorted cardiac silhouette, echo-cardiography may be helpful in the diagnosis of true or false ventricular aneurysm.

Aged↗
PubMed1978

Unusual complications of coronary bypass surgery.

Five patients after coronary bypass surgery developed unusual complications. Three developed new apical thrombi which are thought to be due to the trauma of the left ventricular vent or deterioration of the left ventricular contraction. Significant new mitral regurgitation in one patient probably is secondary to papillary muscle dysfunction as the result of stenosis distal to anastomoses. The leakage of angoigraphic material around distal anastomatic site is due to technical error. Although these unusual complications are very rare, however, they should be considered as potential source of morbidity in asymptomatic patients who leave the hospital after bypass surgery.

Adult↗
PubMed1978

Significance of new Q waves after bypass grafting: correlations between graft patency, ventriculogram, and surgical venting technique.

New postoperative electrocardiographic Q waves have been described in eight of 40 per cent of patients undergoing bypass grafting for coronary artery disease. Various theories have been proposed to explain these new Q waves. Correlations of new Q waves to vein bypass occlusion, prolonged pump time or aortic cross-clamping time are controversial. Indeed, whether or not the appearance of new postoperative Q waves means real transmural myocardial infarction is not clear. We report herein our experience with postoperative Q waves in 56 patients with vein bypass grafts and the relationship of new Q waves to ventricular venting, graft patency, and the postoperative ventriculogram. Our observations indicate that: (1) Not all Q waves are due to occlusion of the saphenous bypass grafts (as noted by others). (2) A certain percentage of new Q waves may not reflect true transmural myocardial infarction, especially when all the vein grafts are patent and the postoperative ventriculograms show improvement. (3) Some new Q waves reflect true transmural infarction due to occlusion of grafts or of distal coronary arteries with deteriorated left ventriculograms. (4) The high incidence of new Q waves in patients with ventricular vents is probably due to direct myocardial trauma at the apex of the left ventricle.

Adult↗
PubMed1978

Results of aortocoronary bypass grafting in patients with subendocardial infarction: late follow-up.

Twenty-eight patients with subendocardial infarction (Group A) were compared with 28 patients with unstable angina (Group B) and 28 with stable angina (Group C) matched for age and sex. The three groups did not differ in prevalence of diabetes, hypertension, old infarction or duration of disease. There were no significant differences in number of diseased vessels, coronary score, abnormal left ventricular wall motion or left ventricular end-diastolic pressure. Angiograms performed 2 weeks postoperatively revealed closure of 3 of 31 grafts (16 patients) in Group A, closure of 3 of 34 grafts (17 patients) in Group B and closure of 6 of 50 grafts (22 patients) in Group C (differences not significant). Postoperative angiograms showed improved wall motion in 37 percent of Group A, 53 percent of Group B and 36 percent of Group C (differences not significant). Postoperative new Q waves appeared in one hospital in Group A and in two patients in Groups B and C. There were no hospital or late deaths. In a mean follow-up period of 29 months, 68 percent of patients in Group A, 61 percent in Group B and 54 percent in Group C were asymptomatic. Thus, bypass grafting was performed with similarly low mortality and morbidity in patients with subendocardial infarction and in those with angina; more than one third of postoperative angiograms in the three groups showed improved wall motion; and late follow-up studies demonstrated functional improvement in the majority of patients in all three groups.

Angina Pectoris↗
PubMed1978

Renal arteriovenous fistula masquerading as severe valvar heart disease.

Two patients with renal arteriovenous fistulae are described, who presented in high output failure. Murmurs were detected in these patients on routine physical examination years before, and when cardiac failure ensued they were assumed to have decompensated valvar heart disease. Full investigation revealed the arteriovenous fistulae and both patients made a good recovery after surgical ligation.

Aged↗
PubMed1978

Survival after coronary surgery.

A 4.4 year follow-up study has been done on a previously reported group of 200 consecutive patients who underwnet coronary bypass. The yearly mortality rate has been 1% (8/200 in 4 years). Our total group of 1,038 surgically treated patients has had an operative mortality rate of 1.3%, and an early graft patency rate of 89.6% has been recorded in the 60% of patients consenting to restudy. These results are compared to natural history studies with and without angiography. Comparison with recent prospective randomized studies of patients with chronic stable angina and those with unstable angina suggests that a low operative mortality rate and optimal technical performance are necessary to improve the survival rate of patiens with symptomatic obstructive coronary disease.

Adult↗