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Biomedical subjects

R Virmani

Publications and source records attributed to R Virmani.

At least 325 records · Page 18Linked to original sources
PubMed1982

Suture obliteration of the circumflex coronary artery in three patients undergoing mitral valve operation. Role of left dominant or codominant coronary artery.

Three patients, two undergoing mitral valve replacement and one a mitral valve annuloplasty with a Carpentier-Edwards ring, had suture obliteration of the circumflex coronary artery. Examination of the distance of the circumflex artery from the mitral anulus in 15 specimens showed a direct correlation to the type of coronary dominance. That is, left dominance (4.1 mm, range 3 to 6.5) or codominance (5.5 mm, range 4.5 to 7.5), where the posterior descending artery arises from the circumflex, was associated with greater proximity to the mitral anulus than right dominance (8.4 mm, range 6 to 11.5). Two of our patients had left dominance and one codominance, predisposing them to circumflex injury. Factors that identify patients at high risk for such injury are therefore left dominance and codominance. Surgeons forewarned with this information can now focus on the proximal third of the circumflex--the area most predisposed to injury.

Coronary Vessels↗
PubMed1981

Type III hyperlipoproteinemia: Quantification, distribution, and nature of atherosclerotic coronary arterial narrowing in five necropsy patients.

The amount of cross-sectional area (XSA) narrowing in each 5 mm long segment of each of the four major epicardial coronary arteries was determined in each of five patients with type III hyperlipoproteinemia (HLP) and symptomatic, fatal atherosclerotic coronary disease (CAD). Four had angina pectoris; two had acute myocardial infarcts which healed, and two died suddenly. Of the four major epicardial coronary arteries, all four were narrowed 76% to 100% in XSA by atherosclerotic plaques in two patients, three were narrowed to this degree in two patients, and two were so narrowed in one patient. Three patients had severe narrowing of the left main coronary artery. The percent of 5 mm long segments of coronary artery narrowed to various degrees was as follows: 96% to 100%, 0 to 37 (mean 14); 76% to 95%, 14 to 61 (mean 35); 51% to 75%, 9 to 41 (mean 24); 26% to 50%, 0 to 42 (mean 16), and 0% to 25%, 0 to 27 (mean 11). Utilizing a scoring system of 1 to 4 for the four categories of narrowing (1 = 0% to 25%, 2 = 26% to 50%, 3 = 51% to 75% and 4 = 76% to 100% XSA narrowing), scores per 5 mm segment for each patient ranged from 2.5 to 3.9 (mean 3.1). Thus these five type III HLP patients had severe diffuse coronary narrowing by atherosclerotic plaques.

Aged↗
PubMed1981

Non-fatal healed transmural myocardial infarction and fatal non-cardiac disease. Qualification and quantification of coronary arterial narrowing and of left ventricular scarring in 18 necropsy patients.

A qualitative and quantitative analysis of the amount of myocardial scarring and the degree and extent of coronary arterial narrowing by atherosclerotic plaque in the entire lengths of each of the four major epicardial coronary arteries is described in 18 necropsy patients with healed transmural myocardial infarcts and death from a non-cardiac condition. An average of 30 per cent of the basal half and 38 per cent of the apical half of the left ventricular wall was scarred. The nine patients with clinical evidence of previous acute myocardial infarction tended to have larger left ventricular scars than the nine patients without such evidence but the difference was not significant. An average of 26 cm (51 5 mm segments) of coronary artery were examined from each patient ad 25 cm (49 5 mm segments) from each of 19 control subjects. Of 924 segments examined in the 18 patients, 292 (32%) were 76 to 100 per cent narrowed in cross-sectional area (controls = 5); 321 (35%) were 51 to 75 per cent narrowed (controls = 34%); 210 (23%) were 26 to 50 per cent narrowed (controls = 44%), and 101 (11%) were 0 to 25 per cent narrowed (controls = 17%). The extent of severe narrowing of 75 per cent or more was similar (25%) in the left anterior descending and left circumflex coronary arteries; the right was the most severely narrowed artery and the left main was not severely narrowed in any patient. Excluding, then, the left main artery, the amount of severe narrowing in the proximal and distal halves of the other three vessels was similar. The amount of severe narrowing was not related to the age at death or to heart weight, but was greater in patients with hypertension or with a history of acute myocardial infarction.

Aged↗
PubMed1980

Comparison of degrees of coronary arterial luminal narrowing determined by visual inspection of histologic sections under magnification among three independent observers and comparison to that obtained by video planimetry: an analysis of 559 five-millimeter segments of 61 coronary arteries from eleven patients.

The accuracy of determining degrees of luminal narrowing of 559 histologic sections from 61 human coronary arteries was evaluated by visual inspection under magnification (light microscopy) by three independent observers, and the results were compared to those obtained by video planimetry. With the per cent of cross-sectional area narrowing divided into four categories (0 to 25, 26 to 50, 51 to 75, and 76 to 100), both the extent of agreement between each independent observer and video planimetry, i.e., the accuracy of visual inspection under magnification and the extent of agreement among the independent observers, interobserver agreement, evaluated by the Kappa (K) statistic, were excellent. With a K value of 50 per cent indicating reasonably good agreement and values of greater than or equal to 70 per cent indicating strong agreement, the K values between the results of light microscopy and video planimetry by three observers were 61, 67, and 75 percent, respectively, and the extent of interobserver agreement was 72 per cent.

Arteriosclerosis↗
PubMed1979

Thrombocytosis, coronary thrombosis and acute myocardial infarction.

Clinical and morphologic findings are described in a 22 year old man with prolonged thromboyctosis, and coronary and splenic arterial thrombi causing myocardial and splenic infarcts. The absence of preexistent extensive coronary atherosclerosis, the presence of thrombus in more than one epicardial artery and in multiple intramural coronary arteries, the presence of arterial thrombosis in a noncoronary artery (splenic) and the absence of another apparent cause of the arterial thromboses are evidences that the intraarterial clotting in this patient was related to the severe thrombocytosis. A reveiw of the reported cases of vascular occlusion associated with thrombocytosis indicates that thrombi have infrequently been confirmed as the mechanism of the vascular occlusion. Although the frequency of vascular thrombi in patients with thrombocytosis has not been established, it is clear that vascular thrombosis can be a consequence of thrombocytosis and, as demonstrated by the present patient, that the coronary artery may be the site of the vascular occlusion, a heretofore unconfirmed event.

Adult↗
PubMed1978

Aschoff bodies at necropsy in valvular heart disease. Evidence from an analysis of 543 patients over 14 years of age that rheumatic heart disease, at least anatomically, is a disease of the mitral valve.

Among 543 necropsy patients over age 14 years with severe chronic valvular heart disease, Aschoff bodies were found in 11 patients (2%). The ages of the 11 patients ranged from 18 to 68 years (avg. 38), and nine had had a history of acute rhematic fever earlier in life. Clinically, nine of the 11 patients had mitral stenosis with or without dysfunction of one or more other cardiac valves, one had isolated aortic regurgitation, and one had both mitral and aortic regurgitation. All 11 patients had diffuse fibrous thickening of the mitral valve leaflets, and all but one had diffuse anatomic lesions of at least one other cardiac valve. No patient with anatomic lesions limited to the aortic valve had Aschoff bodies. Thus, among patients with chronic valvular heart disease, Aschoff bodies, the only anatomic lesion pathognomonic of rheumatic heart disease, indicate diffuse anatomic lesions of the mitral leaflets and usually also anatomic lesions of one or more other cardiac valves. The functional mitral lesion is usually stenosis.

Adolescent↗
PubMed1978

Twisting of an aorta-coronary bypass conduit: a complication of coronary surgery.

Twisting of an aorta-coronary bypass conduit was observed at necropsy in each of three patients. Three twists (540 degrees) just distal to the aortic anastomosis caused total obstruction of the bypass conduit to the left anterior descending coronary artery in one patient. A single twist (180 degrees) occurred in a bypass conduit in each of the othe two patients. Obviously, prevention of graft twisting is essential for successful bypass grafting.

Aged↗
PubMed1977

Aschoff bodies in operatively excised atrial appendages and in papillary muscles. Frequency and clinical significance.

Among 481 patients undergoing various mitral valve operations, Aschoff bodies were found in 40 (21%) of 191 operatively excised left atrial appendages, in four (2%) of 273 operatively excised left ventricular papillary muscles (1 per patient), and in one (6%) of 17 patients with both left atrial appendage and papillary muscle operatively excised. Of the total of 45 patients with Aschoff bodies, 44 preoperatively had mitral stenosis, and only one, a 10-year-old boy, had pure mitral regurgitation. Sinus rhythm was present in 38 (84%), and atrial fibrillation in seven (16%). Perioperatively, only one of the 45 patients with Aschoff bodies had clinical or laboratory stigmata compatible with acute rhematic fever, and 58% had an illness compatible with acute rheumatic fever at any time.

Adolescent↗