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Biomedical subjects

R O Brandenburg

Publications and source records attributed to R O Brandenburg.

At least 19 recordsLinked to original sources
PubMed1998

Increased intraventricular velocities: an unrecognized cause of systolic murmur in adults.

OBJECTIVES: The purpose of this study was to determine the frequency, clinical features and echocardiographic characteristics of increased intraventricular velocities (IIVs) in patients referred to the echocardiography laboratory for systolic murmur. BACKGROUND: A subset of patients referred to the echocardiography laboratory for evaluation of a systolic murmur have IIVs in the absence of other recognized causes of systolic murmur. METHODS: We prospectively studied echocardiograms from 108 consecutive patients referred for evaluation of a systolic murmur. Clinical data were obtained from patient examinations and medical records. RESULTS: The sole explanation for systolic murmur was IIVs in 16.7% of referred patients. Compared with those without IIVs, patients with IIVs had a higher ejection fraction (EF) (58.7+/-7.8% vs. 51.1+/-12.5%, p < 0.001), percent fractional shortening (42.3+/-9.7% vs. 31.0+/-11.4%, p < 0.0001), left ventricular (LV) mass index (181+/-70 vs. 152+/-48 g/m2, p=0.046) and prevalence of hypertension (73.3% vs. 51.7%, p=0.043) and a lower prevalence of segmental wall motion abnormalities (2.2% vs. 39.3%, p < 0.001). CONCLUSIONS: Increased intraventricular velocities are a common cause of systolic murmur in this group of patients and should be included in the differential diagnosis of systolic murmurs in adults. The association of IIVs with LV hypertrophy should be a clinical consideration when these murmurs are identified.

Aged↗
PubMed1990

Monorail Piccolino catheter: a new rapid exchange/ultralow profile coronary angioplasty system.

The Monorail Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P less than .05 and fluoroscopy time 17 vs. 88 seconds P less than .001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The Monorail Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.

Angiography↗
PubMed1987

Raymond Pruitt.

Explore the source record for details and available documents.

Cardiology↗
PubMed1987

Jesse Edwards.

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Cardiology↗
PubMed1985

Cardiomyopathies and their role in sudden death.

Frequent ventricular premature complexes, complex ventricular ectopic activity and asymptomatic ventricular tachycardia are common to both hypertrophic and dilated cardiomyopathy; in both conditions, sudden death is a common occurrence. Asymptomatic young patients with hypertrophic cardiomyopathy who have a family history and a high incidence of ventricular arrhythmias have a particularly high incidence of sudden death. In patients with hypertrophic cardiomyopathy, efforts to attribute sudden death to the cardiac index, left ventricular end-diastolic pressure, left ventricular outflow obstruction, ejection fraction, age, symptomatic state and septal thickness have been unrewarding. Myocardial hypertrophy and disordered myocardial cell arrangement are the likely substrates for the development of ventricular arrhythmias in hypertrophic cardiomyopathy. Ventricular fibrillation preceded by ventricular tachycardia appears to be the terminal event in most patients who die suddenly. In some patients, cardiac asystole is the terminal event. Additional factors playing a role in the development of the substrate for sudden death in patients with hypertrophic cardiomyopathy vary in importance on an individual basis. These factors include narrowing of septal arteries and the artery to the atrioventricular node, preservation of fetal anatomy with dispersion in the atrioventricular node and His bundle, fibrosis of the sinus node, clefts in the septum, multiple atrioventricular pathways and massive myocardial infarction. Patients with dilated cardiomyopathy appear to have the highest incidence of ventricular arrhythmias of any disease yet studied. The substrate for the development of ventricular arrhythmias in these patients appears to be myocardial hypertrophy and myocardial fibrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: echocardiographic-anatomic correlation in 115 patients.

The preoperative 2-dimensional (2-D) echocardiograms of all patients less than 50 years of age in whom the aortic valve had been directly inspected by the surgeon or the pathologist or both were reviewed. From June 1977 to June 1981, 283 patients aged less than or equal to 50 years had aortic valve surgery at the Mayo Clinic: 115 (aged 1 to 50 years [mean 32]) had 2-D examinations preoperatively. The echocardiograms were reviewed blindly, and the aortic valve structure was categorized as bicuspid, tricuspid, or indeterminate. On the basis of combined surgical and pathologic inspection, 50 aortic valves were congenitally bicuspid, 60 were tricuspid, 4 were unicommissural, and 1 was quadricuspid. By 2-D echocardiography, the number of cusps was indeterminate in 29 patients (25%). When these patients were excluded, the sensitivity, specificity, and diagnostic accuracy of 2-D echocardiography for bicuspid aortic valve were 78,96, and 93%, respectively. Thus, with adequate 2-D images, echocardiography is a sensitive and highly specific technique for the diagnosis of bicuspid aortic valve.

Adolescent↗
PubMed1983

Clinical follow-up study of paroxysmal supraventricular tachyarrhythmias after operative repair of a secundum type atrial septal defect in adults.

Adults with isolated secundum atrial septal defect (ASD) may present with paroxysmal atrial tachyarrhythmias. The clinical course of these rhythmic disturbances after correction of the ASD is unknown. Of 188 patients aged 44 years old or older with isolated ASD, 27 (14%) (mean age 52.7 years, range 44 to 71) had documented paroxysmal atrial tachyarrhythmias preoperatively: 16 had paroxysmal atrial fibrillation, 2 had atrial flutter, and 9 had supraventricular tachycardia. Among these 3 groups, there were no differences in age, sex, New York Heart Association class, duration of preoperative symptoms, mean right atrial and pulmonary arterial pressures, shunt size, atrial size, or follow-up period. After operative repair, follow-up data were available in all patients for a mean of 12 years (range 1.5 to 25). Of the 16 patients with preoperative paroxysmal atrial fibrillation, 14 (88%) continued to have increasingly frequent paroxysmal atrial fibrillation, culminating in sustained atrial fibrillation. In 1 of the 2 patients with paroxysmal atrial flutter, sustained atrial fibrillation developed. Of the 9 patients with preoperative paroxysmal supraventricular tachycardia, 5 had no further episodes of this arrhythmia postoperatively.

Aged↗
PubMed1983

Infective endocarditis--a 25 year overview of diagnosis and therapy.

Diagnosis and management of infective endocarditis have significantly changed in the past 25 years. Improved bacteriologic techniques have allowed detection of cases of infective endocarditis caused by unusual organisms. Bactericidal therapy has become available for patients with gram-negative endocarditis and antimicrobial therapy has improved. Echocardiography has become an important diagnostic and management aid, and cardiac valve replacement has dramatically improved the outlook for many patients.

Anti-Bacterial Agents↗
PubMed1982

Partial atrioventricular canal defect in adults.

Between March 1955 and March 1981, 52 adult patients (age 20 years or older) with partial atrioventricular canal (PAVC) were examined at the Mayo Clinic. Forty patients were in New York Heart Association (NYHA) functional class I or II. The ECG showed right bundle branch block with left-axis deviation in 48, first-degree atrioventricular block in 33 and atrial fibrillation in nine. Preoperative catheterization was done in 37 patients; the mean pulmonary resistance index was 2.8 U.m2, and the mean pulmonary-to-systemic flow ratio was 3.0. Forty-seven patients underwent operation; two required mitral valve replacement. There were three operative deaths (6.4% operative mortality) and two late deaths. All surviving patients were in NYHA class I or II. No patient required subsequent permanent pacemaker implantation. We conclude that repair of PAVC in adults may be performed at low risk and may improve patient longevity and functional status.

Adult↗
PubMed1981

The natural history of idiopathic dilated cardiomyopathy.

Between 1960 and 1973, a total of 104 patients at the Mayo Clinic had a diagnosis of idiopathic dilated cardiomyopathy on the basis of clinical and angiographic criteria; these patients were followed up for 6 to 20 years. Twenty-one percent of the patients had a history of excessive consumption of alcohol, 20 percent had had a severe influenza-like syndrome within 60 days before the appearance of cardiac manifestations and 8 percent had had rheumatic fever without involvement of cardiac valves several years before; thus, possible etiologic risk factors of infectious-immunologic type may be important. Eighty patients (77 percent) had an accelerated course to death, with two thirds of the deaths occurring within the first 2 years. Twenty-four patients (23 percent) survived, and 18 of them had clinical improvement and a normal or reduced heart size. Univariate analysis at the time of diagnosis revealed three factors that were highly predictive (p less than 0.01) of the clinical course: age, cardiothoracic ratio on chest roentgenography and cardiac index. Systemic emboli occurred in 18 percent of the patients who did not receive anticoagulant therapy and in none of those who did; thus, anticoagulant agents should probably be prescribed unless their use is contraindicated.

Alcohol Drinking↗
PubMed1980

Evaluation of cardiac murmurs.

We have attempted to review the evaluation of cardiac murmurs as we approach the patient in the office setting. It is obvious that although the character and location of the murmurs themselves are a clue to the genesis of the murmur, it is only by combining the history with a complete cardiovascular examination that we can truly establish the origin of the murmur in virtually every patient. If we combine these findings with selective noninvasive tests, then we will need to resort to the more expensive and invasive studies only on a selective basis.

Adolescent↗