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Biomedical subjects

R W DeSanctis

Publications and source records attributed to R W DeSanctis.

At least 19 recordsLinked to original sources
PubMed1996

Efficacy and safety of procainamide in preventing arrhythmias after coronary artery bypass surgery.

Arrhythmias are common after cardiac surgery and are associated with hemodynamic compromise, stroke, and prolonged hospitalization. Beta blockers prevent atrial fibrillation postoperatively, but there are few data regarding the prophylactic use of type 1 antiarrhythmic agents or the prevention of ventricular arrhythmias. Accordingly, we performed a randomized, double-blind, placebo-controlled study of the effects of oral procainamide on 100 patients undergoing elective coronary artery bypass surgery. Procainamide was received for 4 days; the dosage was adjusted for body weight. Patients receiving procainamide had a significant reduction in atrial fibrillation (16 vs 29 patient-days, p < 0.05) and ventricular tachycardia (2% vs 20%, p < 0.01). However, the incidence of atrial fibrillation was not significantly reduced (38% vas 26%). In the group achieving therapeutic serum procainamide levels, there was reduction in all measured postoperative arrhythmias. No serious cardiac or noncardiac adverse events were noted during procainamide therapy, although there was a significant increase in the incidence of nausea. We conclude that procainamide reduces arrhythmias in the early postoperative period after coronary artery bypass surgery, most prominently in patients who achieve therapeutic serum levels. This was associated with no serious cardiac adverse reactions.

Administration, Oral↗
PubMed1993

Transient left ventricular aneurysm in a patient with hypertrophic cardiomyopathy and myocarditis.

Left ventricular wall motion abnormalities, aneurysm formation, and progression to global hypokinesis have been described in patients with myocarditis and in patients with hypertrophic cardiomyopathy. We document a case of reversible aneurysm formation, cardiogenic shock, and complete recovery in a patient with myocarditis and hypertrophic cardiomyopathy. Pathophysiologic mechanisms of myocardial injury and recovery are discussed.

Aged↗
PubMed1989

Aortic dissection.

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Aortic Dissection↗
PubMed1988

Stroke following coronary-artery bypass surgery. A case-control estimate of the risk from carotid bruits.

The causes of stroke following coronary-artery bypass surgery are largely unknown. To determine whether carotid bruits increase the risk of these events, we compared 54 patients with postoperative stroke or transient ischemic attacks with 54 randomly selected control patients. Both groups were drawn from 5915 consecutive patients who had coronary bypass surgery at our hospital from 1970 to 1984. Carotid bruits were noted preoperatively in 13 patients with postoperative stroke and in 4 control patients. Case-control analysis showed that the presence of carotid bruits increased the risk of stroke or transient ischemic attacks by 3.9-fold (95 percent confidence interval, 1.2 to 12.8; P less than 0.05). This increased risk remained essentially unchanged after adjustment for potentially confounding variables in a multiple logistic regression analysis. Other factors associated with a significantly increased risk (P less than 0.05) of these neurologic deficits were a history of stroke or transient ischemic attack (odds ratio, 6.0; 95 percent confidence interval, 1.6 to 22.1), a history of congestive heart failure (odds ratio, 5.3; confidence interval, 1.6 to 17.0), mitral regurgitation (odds ratio, 4.3; confidence interval, 1.4 to 12.9), postoperative atrial fibrillation (odds ratio, 3.0; confidence interval, 1.4 to 6.7), a cardiopulmonary-bypass pump time of more than two hours (odds ratio, 2.7; confidence interval, 1.1 to 6.7), and a previous myocardial infarction (odds ratio, 2.3; confidence interval, 1.1 to 5.1). We conclude that the presence of carotid bruits increases the risk of stroke after coronary-artery bypass surgery. However, the absolute magnitude of this risk, 2.9 percent, is small and comparable to the reported risk of stroke from carotid endarterectomy.

Atrial Fibrillation↗
PubMed1987

Aortic dissection.

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Aortic Dissection↗
PubMed1986

Spectrum of conditions initially suggesting acute aortic dissection but with negative aortograms.

Between 1963 and 1983, 55 patients presented to our hospital with a clinical picture that suggested aortic dissection but with aortograms that were interpreted as negative for that entity. In 4 patients, the aortographic findings subsequently proved to be false negative. The remaining 51 patients had the following diagnoses: myocardial infarction in 9 patients; aortic regurgitation in 5; thoracic nondissecting aneurysm in 4; musculoskeletal pain in 4; mediastinal tumor in 4; pericarditis in 3; acute coronary insufficiency in 3; cholecystitis in 2; miscellaneous in 3; and unknown in 14. The clinical features in these patients were compared with those of 125 patients with true aortic dissection. Three features were significantly more prevalent in patients with than without dissection: prior systemic hypertension, pain for 24 hours or less, and migratory pain. Patients without dissection were younger than those with distal dissection and had significantly less systemic hypertension, posterior thoracic pain and migratory pain. Patients without dissection had significantly less frequent congestive heart failure, pulse deficits and aortic regurgitation, and more frequent hypertension and pain for more than 24 hours than patients with proximal dissection. This study defines the actual differential diagnosis of aortic dissection at our hospital, the frequency of false-negative aortographic findings and contrasts the clinical features of patients with and without dissection.

Age Factors↗
PubMed1984

Long-term survival of patients with treated aortic dissection.

Retrospective data on the treatment of aortic dissection at the Massachusetts General Hospital from 1963 to 1978 are reported. During this period, 160 patients with spontaneous aortic dissection were treated by definitive medical or definitive surgical therapy. Patients were classified according to type (proximal versus distal) and duration (acute versus chronic) of dissection. Long-term follow-up (mean 48 months, range 1 to 147) was available in 156 cases. Hospital and late survival in each of the categories of dissection were evaluated in relation to those features of the dissection itself and of the subsequent therapy that correlated with ultimate survival. Results show that: 1) chronic presentation was the most significant determinant of both hospital and late survival; 2) in acute dissection, prognosis was determined largely by the presence or absence of major complications, regardless of ultimate therapy; the only complication without adverse effect on survival was aortic insufficiency; 3) late survival after discharge from the hospital was similar for patients with all types of dissection and modes of therapy; and 4) the incidence of late complications from aortic dissection was lower than previously reported. Thus, the success of early definitive medical and surgical treatment was sustained on long-term follow-up.

Acute Disease↗
PubMed1982

Circumflex coronary artery aneurysm visualized by real-time cross-sectional echocardiography. A possible sequelae of previously unrecognized coronary arteritis in the adult.

Real-time cross-sectional echocardiography disclosed an aneurysm of the circumflex branch of the left coronary artery in an asymptomatic 30-year-old man. Plain chest roentgenogram showed an abnormal silhouette along his left heart border. He also was found to have an abnormal contraction pattern of the posterolateral wall of the left ventricle and a reduced left ventricular ejection fraction. Left ventricular and coronary angiography showed a similar impairment in left ventricular function and occlusion of the circumflex branch of the left coronary artery. Surgery and pathologic examination confirmed the presence of the aneurysm. The echocardiographic characteristics of this lesion and the left ventricular contraction abnormalities suggest the possibility that it resulted from a remote episode of coronary arteritis. Real-time cross-sectional echocardiography, by virtue of its ability to provide visualization of structures along the posterior border of the heart as well as information about regional wall motion, may be of considerable value in localizing and defining lesions occurring in this area.

Adult↗
PubMed1982

The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts.

In an attempt to improve upon the reported long-term patency rates of 65% to 85% for saphenous vein coronary artery bypass grafts (CABG), a prospective randomized trial comparing warfarin, aspirin, and placebo treatment in post-CABG patients was carried out. From an initial group of 216 patients, 161 patients remained in the study, and vein graft patency was determined in 111 patients (220 grafts) from 1 to 47 months postoperatively. There was a trend toward better cumulative graft patency in patients given warfarin, but the results did not achieve statistical significance. Improved results with warfarin were most marked among patients who were restudied within 24 months of CABG operation, in most instances because of the development of recurrent angina pectoris. There were four major bleeding complications of warfarin therapy, including one death, over 2,108 patient-months. Since most of the occlusive changes in vein grafts appear in the first 6 to 12 months, any effect of antithrombotic therapy will be most evident in the early postoperative period, with greatly reduced impact with long-term administration. Results of this study suggest that short-term antithrombotic therapy deserves further assessment in prevention of vein graft occlusion in the first year or two following a CABG operation. This potential benefit must be evaluated in the context of the recognized bleeding complications of warfarin therapy.

Adult↗