Biomedical subjects
Publications and source records attributed to S D Cha.
During routine coronary cinearteriography, a large, right atrial myxoma was detected in a patient with angina pectoris. It was clinically unsuspected and was found at surgery to extend partially into the left atrium.
Twelve male patients age 36-66, 8 on clinical doses of beta blocker, with old transmural myocardial infarction underwent rest and matched workload exercise before and 30 min after 20 mg sublingual nifedipine during cardiac catheterization. For the group, resting heart rate, aortic pressure, pulmonary wedge pressure, systemic vascular resistance, cardiac index, and left ventricular ejection fraction were normal. Exercise duration was 12.5 +/- 1.5 min. Comparing exercise before and after nifedipine, heart rate, cardiac index, and mean velocity circumferential fiber shortening increased, while mean aortic pressure, systemic vascular resistance, pulmonary wedge pressure, right atrial pressure, left ventricular end-diastolic volume and left ventricular end-systolic volume decreased with no significant change in double product, pulmonary arteriolar resistance and left ventricular ejection fraction. Therefore, for the range of left ventricular dysfunction in this study group and with 8 patients concurrently on beta blocker, nifedipine 20 mg s.l. produced significant improvement in hemodynamics at rest and exercise.
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The most accepted diagnostic methods of tricuspid regurgitation (TR) are the physical examinations and the evaluation of right atrial pressure. However, these methods are not consistently diagnostic, and a "silent" form of TR has been recognized. The current status of noninvasive and invasive diagnostic techniques is reviewed.
In order to calculate a magnification factor (MF), an intracardiac marker (pigtail catheter with markers) was evaluated using a new formula and correlated with the conventional grid method. By applying the Pythagorean theorem and trigonometry, a new formula was developed, which is (formula; see text) In an experimental study, MF by the intracardiac markers was 0.71 +/- 0.15 (M +/- SD) and one by the grid method was 0.72 +/- 0.15, with a correlation coefficient of 0.96. In patients study, MF by the intracardiac markers was 0.77 +/- 0.06 and one by the grid method was 0.77 +/- 0.05. We conclude that this new method is simple and the results were comparable to the conventional grid method at mid-chest level.
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To enhance the bedside diagnosis of tricuspid regurgitation, the influence of manual pressure applied below the liver on lower left sternal border murmurs was determined in 23 patients. All 23 subjects had right ventriculograms and right atrial phonocardiograms. The sign was positive in 13 cases, including 3 who were without a Carvallo sign. The application of manual pressure below the liver is a simple and valid additional maneuver for identifying the murmur of tricuspid regurgitation.
This review is an attempt to demonstrate the safety and usefulness of the simple maneuver of carotid sinus stimulation with selected subjects undergoing exercise tests. In a variety of circumstances the addition of CSP before or after treadmill walking can yield clinically relevant information relating to arrhythmias, conduction disturbances, symptoms, and pacemakers. Further applications and benefits of these combined procedures remain to be clarified and expanded for judicious application with attention to safeguards.
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To assess the progression of aortic valvular gradients (AVG) and their relation to left ventricular function, 21 patients with aortic valvular stenosis were studied sequentially by cardiac catheterization and left ventriculography. All AVG were obtained from the left ventricle to ascending aortic pullback tracings. The ejection fraction and mean velocity of circumferential fiber shortening were obtained from left ventriculograms. A new onset of syncopal episode was helpful to predict the progression of AVG in five patients, but in others the progression of aortic stenosis was generally not predictable. The left ventricular contractility of these patients was usually normal, but seven patients exhibited the progressive impairment that was not proportional to the change of AVG and was clinically unrecognized. Also, the left ventricular function may deteriorate in the absence of progression of the aortic valvular gradient. Thus, serial hemodynamic studies could be indicated in patients with mild to moderate aortic stenosis even in the absence of new symptoms and signs.
Detailed pathological studies are reported on 20 cloth-covered Beall mitral valve prostheses, which had to be removed for valve failure nine months to 10 years after implantation. Results in all patients except one indicated that there was a progressive and persistent granulomatous reaction that continued up to at least 10 years. Although the rate of tissue ingrowth into the valve decreased with time, the total volume of tissue formation increased. Cloth wear and disruption and deformity of the teflon discs was frequently seen. In these 20 valves the desired result--namely, the complete and smooth endothelialisation of the prosthesis--was certainly not achieved.
Fifty-nine patients were studied who had severe tricuspid regurgitation which was confirmed by right ventriculography and during surgery in order to determine the incidence of clinical, radiologic, and hemodynamic clues of severe tricuspid regurgitation. Eighty-eight percent of patients had Carvallo sign alone or in combination with pulsatile liver or prominent jugular venous V waves, and the classic triad was present in 42 percent. Most patients had enlargement of the right atrium on chest x-ray film. The classical "ventricularization" pattern of right atrial pressure was seen in 30 percent, prominent V waves with rapid Y descents were present in 37 percent, and normal contour of right atrial waves with normal mean pressure was seen in 33 percent. The inspiratory maneuver was helpful to induce the ventricularization pattern or prominent V waves with rapid Y descents especially in patients with normal right atrial pressure waves. In conclusion, right ventriculography is a sensitive and accurate method for detecting and quantitating tricuspid regurgitation in the absence of the diagnostic physical findings.
A 54-year-old female with rheumatic heart disease was found to have a mass in the left ventricle by echocardiography and angiography. Subsequently, giant Lambl's excrescences of papillary muscle and aortic valve were confirmed by operation and pathologic examination. Possible complication from cardiac catheterization could be avoided by the utilization of echocardiography prior to catheterization.
Intracardiac phonocardiograms were obtained from the right atrium in order to study the relation between the clinical signs of tricuspid regurgitation, intracardiac murmurs and the degree of regurgitation demonstrated on right ventriculography with use of a preshaped catheter. In five patients with no heart disease, right ventriculograms showed no evidence of tricuspid regurgitation and intracardiac phonocardiograms in the right atrium demonstrated no murmur. Among 35 patients with valvular heart disease, a Carvallo sign (increased intensity of systolic murmur during inspiration) was present in 19 and absent in 16. All 19 patients with a Carvallo sign had variable degrees of tricuspid regurgitation on right ventriculography, and intracardiac phonocardiograms were positive for tricuspid regurgitation in 18. Among 16 patients with an absent Carvallo sign, neither right ventriculography nor intracardiac phonocardiography was indicative of tricuspid regurgitation in 5. Five patients had 1+ regurgitation and the intracardiac phonocardiogram was positive in three of these five patients. The other six patients showed 3+ to 4+ regurgitation and the intracardiac phonocardiogram was positive for tricuspid regurgitation in all. In conclusion, (1) the Carvallo sign is a reliable indicator of tricuspid regurgitation but its absence does not rule it out, and (2) right ventriculography using a preshaped catheter and intracardiac phonocardiography are useful in detecting clinically unrecognized tricuspid regurgitation.
To evaluate right ventricular function following mitral valve replacement, we studied 84 patients with isolated mitral valve disease with the use of first-pass radionuclide angiography before, 1 week after, and up to 1 year after operation. The right ventricular ejection fraction for the entire group improved from 29% +/- 11% to 43% +/- 10% (p less than 0.001) at 1 week. This increase was maintained at 3 months (41% +/- 10%) and up to year after operation (40% +/- 12%). The improvement was found not to be influenced by either the type of valvular lesion or the presence and/or level of pulmonary hypertension. When the patients were grouped according to the type of prosthetic valve placed at operation, the right ventricular ejection fraction increased in all patients within 1 week of operation, with sustained improvement at 3 months postoperatively. Thereafter, it began to decline in patients receiving a Carpentier bioprosthesis while being maintained in those patients who received disc valves. Further analysis revealed that those patients who receiving the larger Carpentier bioprostheses had a greater deterioration of right ventricular function than those receiving the smaller Carpentier valves. Left ventricular function in the entire group was normal preoperatively (62% +/- 16%) and was unchanged at 1 week (60% +/- 16%) and a 1 year (59% +/- 16%) after operation.
Because previous attempts to diagnose and quantitate tricuspid regurgitation (TR) by angiography have been unreliable, 60 patients with mitral or combined mitral and aortic valve disease had right ventriculography using a special preshaped catheter. A clinical diagnosis of TR was confirmed in 45% of the patients with moderate and severe TR. A pansystolic murmur increasing in intensity with inspiration, a pulsatile liver, and a prominent CV wave in the jugular veins when present together were specific for severe TR but were seen in only 30% of the patients with severe TR but were seen in only 30% of the patients with severe TR (3+ or 4+). Ventricularization of the right atrial pressure contour was specific for severe TR but was seen in only 40% of the patients with severe TR. A normal right atrial mean pressure (RAP) did not exclude TR, but a rise in RAP or an unchanged RAP with deep inspiration was seen in all patients with TR. Similar findings were observed in two patients with severe pulmonary hypertension who had no TR. There was no relation between the magnitude of this rise in RAP, the degree of pulmonary hypertension, and the severity of TR. The use of a special preshaped catheter tends to avoid the induction of premature beats, and right ventriculograms with a preshaped catheter may be useful in diagnosing TR.
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