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Biomedical subjects

R Leachman

Publications and source records attributed to R Leachman.

12 recordsLinked to original sources
PubMed1986

Flow characteristics of coronary balloon catheters.

The popularity recently achieved by balloon angioplasty of coronary arteries is limited by the risk of reocclusion of the stenotic segment addressed. Sudden reocclusion leads frequently to an acute coronary syndrome (acute myocardial infarction, hypotension, arrhythmias) that requires emergency surgery and also leads to permanent myocardial damage of various degrees. Preliminary data has recently become available to suggest that prolonged balloon inflations could be an important tool in attaining optimal early and late results of angioplasty. These considerations have resulted in renewed interest in peripheral coronary perfusion during balloon coronary angioplasty. The most critical limiting factor to the distal perfusion of blood is the inner lumen of the balloon catheters, which are relatively small. We present laboratory data regarding the pressure/flow ratios of different balloon catheters.

Journal Article↗
PubMed1985

Safety of outpatient cardiac catheterization.

In this study, we compared the procedure-related complications of inpatient and outpatient cardiac catheterization when performed at the same institution by the same group of cardiologists. The majority of the studies were done using a brachial arterial cutdown approach. The mean age, sex, cardiac diagnosis, mean left ventricular ejection fraction, and the distribution of coronary arterial lesions were similar in both groups. There were relatively more patients in the New York Heart Association's class 4 in the inpatient group (p less than 0.01). In the outpatient group (676 patients), there were no major complications, and the rate of minor complications was 1 percent. In the inpatient group (1,106 patients), the rate of major complications was 0.4 percent and of minor complications 1.4 percent. The rates of major, minor, and total complications were statistically similar between the two groups. In the outpatient group the presence of left main coronary arterial disease, triple-vessel coronary disease, a left ventricular ejection fraction less than 30 percent, or a history of a recent myocardial infarction did not alter rates of complications. The hospital-related cost of the procedure on an outpatient basis was 26 percent less than on an inpatient basis. Our findings indicate that outpatient cardiac catheterization, using a brachial cutdown approach, is safe even in a higher risk subgroup of patients and provides significant financial savings.

Adolescent↗
PubMed1983

Type A behavior, self-involvement, and coronary atherosclerosis.

Prior to coronary angiography, 150 men were assessed for Type A behavior using the structured interview and two questionnaire measures. The results show no relationship between Type A behavior and extent of coronary artery disease (CAD). A second finding is that the number of self-references (I, me, my) derived from speech in the structured interview correlated positively with the number of previous myocardial infarctions and the extent of CAD; self-references correlated negatively with time on the treadmill and catheterization ejection fraction. Multiple regression analyses show self-references to remain a significant correlate of extent of disease when controlled for age, blood pressure, cholesterol, and Type A behavior.

Adult↗
PubMed1983

Streptokinase thrombolysis in acute myocardial infarction: a turning point.

The initial anatomic findings of angiography during acute myocardial infarction, as well as the techniques used for selective coronary streptokinase infusion, are presented in this report. Preliminary evaluation of streptokinase infusion studies seems to indicate that revascularization of coronary arteries occluded during myocardial infarction is quickly and easily achievable and could constitute the treatment of choice; however, critical questions still remain to be answered. Recanalization rates vary from 75 to 90% in the different, usually small, series. The time of recanalization seems critical to the salvage of ventricular myocardium; e.g., recanalizations accomplished before a time lapse of 3 to 4 hours appear to limit infarct size, whereas, results appear doubtful after that time. The early mortality rate is similar to that of patients not treated with streptokinase, but the mortality at 1 month and 6 months is apparently in favor of the treated group. While thrombolytic agents may not turn out to be the panacea that some researchers have expected, recent experience has greatly contributed to the understanding of the pathophysiology of myocardial infarction and the critical importance of the time factor in planning therapy.

Journal Article↗
PubMed1982

Myocardial rupture after myocardial infarction. Detection by multi-gated image-acquisition scintigraphy.

Myocardial rupture following infarction usually is an acute and dramatic event. Rarely, it may take a subacute course, allowing surgical treatment. We report herein a case of subacute rupture of the heart in a 54 year old patient with acute myocardial infarction. The rupture was diagnosed by the appearance of a radiopaque halo around the heart during radionuclide ventriculography. The patient subsequently underwent surgical resection of a large anterolateral aneurysm and a 2 inch long rupture of the myocardium and survived. Clinical suspicion, prompt diagnosis, and surgical intervention are important in the management of this relatively unusual complication of infarction.

Heart Aneurysm↗
PubMed1981

Early experience of transluminal coronary angioplasty (TCA) by the brachial artery (the Sones technique in transluminal angioplasty).

Sixteen transluminal coronary angioplasty procedures (TCA), eight right coronary artery (RCA) and eight left anterior descending coronary artery (LAD), by the brachial artery cut-down approach, were attempted with 9/16 (56%) immediate successes and 2/16(12%) early recurrences. The procedure success rate for RCA obstructive lesions, 6/8 (75%) was greater than for LCA obstructions, 3/8 (38%). In six unsuccessful procedures the balloon catheter could not be advanced into the lesion, and in one unsuccessful procedure dissection of the coronary artery proximal to the lesion occurred. The brachial (Sones) technique for transluminal coronary angioplasty permits the use of softer guiding catheters for selective probing and approach to the coronary lesion but may be more likely to induce coronary spasm. Complete and high-resolution pre TCA angiograms with multiple views to disclose the exact anatomy of the coronary artery and its lesion is essential to ensure successful dilatation.

Adult↗
PubMed1976

[Anomalous origin of the left coronary artery from the pulmonary artery (author's transl)].

The case of a three year-old child with anomalous origin of the left coronary artery from the pulmonary artery is presented. He had a clinical picture and an electrocardiographic pattern of antero-lateral myocardial infarction that suggested a cardiac malformation. Once the diagnosis was established by cardiac catheterization and coronary arteriography, the defect was successfully correted by transplanting the anomalous coronary vessel to the aorta. The clinical, electrocardiographic and angiographic features of the anomaly are given.

Aorta↗