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Biomedical subjects

R J Flemma

Publications and source records attributed to R J Flemma.

At least 37 records · Page 2Linked to original sources
PubMed1979

The spectrum of clinical manifestation of anomalous origin of the left coronary artery and surgical management.

Intercoronary collaterals play a major role in determining whether patients with the symptoms of anomalous left coronary artery will suffer infarction early in life with resultant complications or will survive to an older age before becoming symptomatic with angina. We believe that the definitive surgical treatment should be performed at the earliest age possible to avoid further damage to myocardial muscle.

Angina Pectoris↗
PubMed1978

Selection of patients for coronary bypass surgery.

We have tried to present a rational approach to selection of patients for coronary bypass surgery. An evaluation of both the anatomic and the clinical status of a patient in whom coronary arteriography has been performed, along with consideration of known results of medical and surgical forms of treatment of coronary artery disease in large series, determines which therapy is preferable. In all instances, the goal of treatment is threefold: relief of pain, preservation of myocardium and prolongation of life. In properly selected patients, pain can be relieved by surgery 90% of the time. Preservation of myocardium is a reality in some groups of patients treated surgically. Current data indicate that prolongation of life by coronary bypass surgery occurs in patients with left main coronary or triple-vessel disease, and as more data are collected, other subgroups may be included.

Coronary Artery Bypass↗
PubMed1978

Risk factors and mortality in patients with aortocoronary vein bypass operation.

Patients who died one or more years after aortocoronary bypass surgery showed, at the time of the operation, higher prevalence of hypertension, and history of smoking and had higher plasma lipid levels than the patients who survived the operation for similar periods of time. No such differences in risk factors were seen between patients who survived or have died during the first 30 days after the operation. These findings suggest that pateints with abnormal risk factors have a poorer long-term prognosis.

Aged↗
PubMed1978

Risk factors in patients undergoing a second aorta-coronary bypass procedure.

A group of 38 patients with a second revascularization procedure was studied for factors which may have contributed to the reappearance of angina after the first operation. Our data indicate that these patients usually have the first operation at an earlier age and had fewer bypasses at that time. In addition, they had inadequate control of the plasma triglyceride and cholesterol levels.

Adult↗
PubMed1978

Effect of intra-aortic balloon pumping on nutrient coronary flow in normal and ischemic myocardium.

The effects of intra-aortic balloon pumping (IABP) on myocardial flow distribution were studied in 50 dogs. Cardiac output was controlled by right heart bypass. In each dog the following parameters were measured with and without IABP during normal coronary perfusion and after regional ischemia was induced by anterior descending coronary vein flow by timed collection, and endocardial/epicardial flow ratios by a previously reported thermal washout technique. In nonischemic myocardium, IABP significantly (p less than 0.05) increased mean coronary sinus flow 11.5 percent +/- 5.8 percent (S.D.) and the mean endocardial/epicardial ratio, 17.3 percent +/- 0.28 percent. In the regionally ischemic myocardium, IABP significantly (p less than 0.05) increased mean segmental coronary vein flow 13.9 percent +/- 1.23 percent but decreased the endocardial/epicardial ratio 29.9 percent +/- 1.1 percent. We conclude that in the dog, IABP enhances subendocardial blood flow in perfused but not in ischemic myocardium. Contrary to common suppositions, the increase in collateral blood flow with IABP preferentially supplies epicardial layers in segmental ischemic zones, but may be shunted from the subendocardium.

Animals↗
PubMed1977

Late evaluation of patients undergoing valve replacement with the Björk-Shiley prosthesis.

This study analyzes 484 patients who survived mitral, aortic, or mitral and aortic valve replacement using the Björk-Shiley prosthesis from January, 1970, through December 31, 1974. Long-term follow-up of 1 1/2 to 6 1/2 years (mean, 3.67 yr) was done on 435 patients (98.2%). Eighty to 85% of the patients have improved noticeably. Thromboembolic problems occurred in 6.9%, representing 1.5 emboli per 1,000 patient-months. Anticoagulant bleeding problems occurred in 6.4% of the patients; late mortality was 15%. Actuarial survival curves showed patients at risk to 6 years having a 79% chance of survival. The same analysis according to preoperative New York Heart Association Functional Classification showed a striking reduction in survival in class IV patients. The Björk-Shiley prosthesis is a good choice for valve replacement today. Earlier diagnosis and treatment are needed to obtain better long-term survival.

Adolescent↗
PubMed1977

Prognostic considerations in the management of left ventricular aneurysms.

This report summarizes a four-year experience with 60 patients who had left ventricular aneurysm (LVA) resection and bypass of all significantly diseased coronary arteries, with an operative and late mortality of 3.3 and 8.3%, respectively. Their cardiac catheterizations were reviewed, and the only values that seemed to reflect prognosis were preoperative cardiac index and the presence of absence of septal motion. The lower the cardiac index, the less likely the patient was to do well postoperatively. There were now survivors who had lacked septal motion by left anterior oblique ventriculogram. Patients without septal motion are therefore no longer considered surgical candidates. If septal motion is present, resection of LVA carries no more risk than myocardial revascularization without LVA.

Adult↗
PubMed1977

Coronary artery surgery without global ischemia.

A simple technique for local occlusion of the coronary artery without aortic cross-clamping during the distal anastomosis has been developed. The use of this internal coronary artery occluder, which we developed, represents another step forward in myocardial protection during coronary bypass procedures.

Coronary Artery Bypass↗
PubMed1976

Atherosclerosis of the internal mammary artery.

To better evaluate the incidence of atherosclerosis in the internal mammary artery (IMA), 215 IMA segments from routine postmortem examinations were evaluated microscopically. Significant atherosclerotic narrowing was seen in 9 patients (4.2%). No patient had more than a 50% reduction in lumen diameter. The degree of incipient atherosclerosis correlated well with age, hypertension, diabetes, and peripheral vascular disease.

Adult↗
PubMed1976

Factors predictive of perioperative myocardial infarction during coronary operations.

The diagnosis of perioperative myocardial infarction (PMI) in our patients was based upon electrocardiography, vectorcardiography, and postoperative enzyme changes. A group of 303 patients operated on between January and September, 1972, formed the basis of this study. Three groups were identified from among these patients. Group A was composed of 90 consecutive patients in whom MI was excluded by all criteria. Group B comprised 25 patients with proved MI and yielded the 8% incidence of MI among our patients. Group C included 34 patients with triple-vessel disease who did not sustain MI. Significantly more patients sustaining MI had preinfarction angina and severe coronary artery disease. The incidence of MI was also higher in patients with diffuse disease and those in whom the lesions could not be totally bypassed. A statistical correlation with longer pump runs and periods of anoxia was obtained. There was some suggestion that the preoperative location of the hypokinetic segment determined the site of MI in patients.

Angina Pectoris↗
PubMed1976

Heart disease indicators in patients with aortocoronary bypass operation.

The incidence of cardiovascular disease risk factors and other indicators of cardiac impairment were studied in 478 patients prior to their aortocoronary vein bypass operation and 194 patients who had angiographic examination but did not undergo the operation because the clinical and coronary angiographic findings were not considered serious enough to warrant the bypass procedure. The patients referred for surgery had higher plasma cholesterol and triglyceride levels (259 and 219 vs 233 and 180 mg/100 ml), tended to be older (53 vs 49 years) and had more extensive occlusive disease (occlusion score 200 vs 70) than the group without the operation. There was little difference in the proportion of smokers (81 vs 83%) or prevalence of hypertension (33 vs 30%). In comparison with 9,964 participants of a local health screening program, both patient groups had markedly higher prevalence of smoking, hypertension, chest pain and previous myocardial infarcts.

Cholesterol↗
PubMed1976

Surgery for congenital heart disease in the adult.

A total of 205 adults with a variety of congenital heart lesions underwent operation for total correction of their defects. Operative and long-term mortality were 3 and 4 percent, respectively. There has been only one operative death in the past five years (85 patients). While most defects were repaired with good hemodynamic and symptomatic improvement, the three lesions associated with the worst results were cyanotic tetralogy of Fallot, severe pulmonic stenosis complicated by atrial septal defect, and ostium primum atrial septal defect. Myocardial failure due to end-stage myocardial fibrosis was the major cause of operative mortality. Myocardial fibrosis and irreversible pulmonary changes seemed to be the two factors limiting operative correctio

Adolescent↗
PubMed1976

Reduction of blood usage in open heart surgery.

A series of 142 adult patients undergoing open-heart surgery were studied. All known blood-conservativing methods were utilized in an attempt to use as little blood as possible. Hemodilution, autologous transfusion, prevention of wasting of blood, and management of postoperative anemia were the measures employed. An average of 2.66 units of blood were given per patient during the entire hospital stay. Twenty patients were not given any blood at all. The patients were removed from cardiopulmonary bypass without difficulty when the hematocrit reading was in the high teens or low twenties. Later in the postoperative period the patients seemed to progress without difficulty with hematocrit readings of 22 to 25 percent.

Blood Transfusion↗
PubMed1975

Topical myocardial cooling. An intensive laboratory investigation.

To better understand efficacy of topical cooling in myocardial protection, three groups of 12 dogs each were studied. Group 1 dogs had systemic cooling to 30 C; group 2 had cooling to 30 C and outside cooling of left ventricle; group 3 was cooled in the same way as group 2 was but also had inside of left ventricle topically cooled. Measurements were taken of left ventricular function curves, regional blood flow distribution to the subendocardium, sequential pH, PCO2, PO2, and lactate and serum glutamic oxaloacetic transaminase (SGOT) levels. Lower midseptal and subendocardial temperature (means, 11 and 7 C, respectively) in group 3 correlated with higher survival and greater preservation of left ventricular function. Lower levels of SGOT and lactate in coronary sinus efflux, and higher regional flow to subendocardium postoperatively, also correlated with minimal evidence of subendocardial necrosis in group 3 dogs. Rapid of cooling of subendocardium was noted as achieving maximum preservation of left ventricular function.

Animals↗
PubMed1975

Left ventricular aneurysmectomy in a child. Treatment of anomalous left coronary artery.

Anomalous origin of the left coronary artery from the pulmonary artery with development of a massive left ventricular aneurysm in a 23-month-old child is described. Operative treatment included ligation of the anomalous origin, ventricular aneurysmectomy, and a saphenous vein bypass graft to the anterior descending coronary artery. The principles of ventricular aneurysm resection used in adults are applicable to small children with this complication of anomalous coronary artery origin.

Age Factors↗