The activity of serum dopamine-beta-hydroxylase (DBH) was measured in 1194 asymptomatic middle-aged men with diastolic blood pressure ranging from 75 to 125 mm Hg during the baseline examination of a multifactorial intervention program for primary prevention of coronary heart disease. No correlation was present between serum DBH activity and systolic (r = -0.01, NS) or diastolic (r = +0.02, NS) blood pressure. No significant differences in serum DBH activity was observed between individuals with blood pressure in the lower, middle or upper deciles. Serum DBH activity was similar in subjects with normal blood pressure, in individuals with widely fluctuating blood pressure and in patients with fixed hypertension. The results suggest that serum DBH activity cannot be used as an aid in the diagnosis of essential hypertension of middle-aged men.

Adult↗

PubMedDate not supplied

Proceddings: The effect of autotransplantation of one lung on the regulation of respiration in the dog.

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Animals↗

PubMedDate not supplied

Heart transplant rejection treated with plasmapheresis.

The vascular element of a mixed type of rejection after orthotopic heart transplantation did not respond to steroid therapy in a 30-year-old man. Plasmapheresis was associated with the resolution of the clinical signs of rejection and the microscopic changes of vasculitis in the biopsy specimen. This case suggests that plasmapheresis may be useful in the treatment of acute vascular rejection in heart transplantation.

Adult↗

PubMedDate not supplied

Plasma atrial natriuretic factor concentration in a heart-lung transplant recipient.

Plasma concentration of atrial natriuretic factor, a polypeptide secreted by the heart, was measured in a heart-lung transplant recipient before operation and for 8 days after operation, until the patient died. Plasma atrial natriuretic factor level decreased in combination with the transplantation; after transplantation the peptide level varied within a wide range, correlating with diastolic pulmonary artery pressure (r = 0.93, p less than 0.01). The physiologic atrial natriuretic factor response to changes in right ventricular afterload thus seems to be preserved in the denervated heart.

Adult↗

PubMedDate not supplied

Multivariate analysis of operative mortality and late outcome after coronary bypass surgery.

A multivariate discriminant analysis was made to find out the variables that could offer the greatest amount of predictive power on the long term results after myocardial revascularization. A total of 202 consecutive patients who underwent CABG operation in 1981 were reviewed 5 years later. Most of the patients (76.5%) had 3-vessel disease, previous AMI (70.2%), hypertriglyceridemia (61.7%), positive family history of CAD (68.0%) elevated blood cholesterol level (48.1%), hypertension (41.9%) or were smokers (61.9%). In 48.1% of the cases IMA was used for revascularization and in the rest saphenous vein graft alone. The 5-year survival of the entire group was 87%. The late mortality was related to 3 independent variables in multivariate analysis: 1) positive family history of CAD (p less than 0.05), 2) preoperative ejection fraction less than 0.30 (p less than 0.01) and 3) revascularization without IMA (p less than 0.02). The vast majority of patients (70%) had a better NYHA class 5 years postoperatively (the 95% confidence interval was 65-77%). These patients had experienced an average improvement of 2.0 NYHA categories. Eight per cent of patients had an unaltered and 5% a worse NYHA class than preoperatively. When the patients were grouped into those having a better NYHA class and into those who had an unchanged or worse NYHA class or who had died from CAD the only variable which was associated with poorer outcome appeared to be positive family history of CAD (p less than 0.01). It can be concluded that hereditary factors, utilization of internal mammary artery in revascularization and preoperative ejection fraction are the major predictors of late outcome after CABG.

Coronary Artery Bypass↗

PubMedDate not supplied

Early and late results of surgery for atrial septal defect in patients aged over 60 years.

To assess the risks and benefits attending the surgical repair of atrial septal defect in the elderly the case histories of all patients operated on at the age of 60 years or more were reviewed and follow-up study, including cardiac catheterization, was performed. A total of 17 patients (12 females and 5 males) were identified. The left-to-right shunt ratio averaged 2.7. Fifteen patients had abnormally high systolic (greater than 30 mmHg) or mean (greater than 20 mmHg) pulmonary artery pressure and the pulmonary arterial resistance was elevated (greater than 1.5 units) in eight. One patient died shortly after surgery (operative mortality, 6%) and major postoperative complications were found in four additional patients (24%). Three months after surgery the effort capacity had improved by at least one class in all survivors. After an average of 8.2 years follow-up 12 patients were alive. Ten of them felt better than preoperatively. Eight agreed to cardiac catheterization. The pulmonary blood flow was markedly decreased in all (means, 5.6 l/min postoperatively, vs 11.2 l/min preoperatively) even though a hemodynamically significant shunt persisted in two patients. The mean pulmonary artery pressure had decreased in all who were hypertensive before operation (mean, 25 mmHg vs 33 mmHg). It had slightly increased in patients who had normal pulmonary pressure preoperatively (mean, 27 mmHg vs 19 mmHg). The pulmonary arterial resistance was higher than before surgery in all except one patient (mean, 2.2 units vs 1.5 units).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

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Constrictive pericarditis following coronary bypass reoperation. Fibrotic pericardium and a foreign body reaction.

A 65-year-old male patient underwent two bypass operations because of coronary artery disease. After the second operation he developed congestive heart failure with breathlessness, ankle swelling, hepatomegaly and poor exercise tolerance. Echocardiographic and haemodynamic findings were characteristic of constrictive pericarditis. Pericardiectomy was performed three months after the second operation. The retrosternal space was replaced with fibrotic, patchy hyalinic tissue, and the pericardium was thick and rigid. Histologically, the thickened pericardium showed dense fibrosis and foreign-body granulomas with large multinuclear giant cells and irregular crystals. This report indicates that foreign body reaction following coronary artery bypass operation may result in constrictive pericarditis with severe heart failure.

Aged↗

PubMedDate not supplied

Effect of addition of magnesium to potassium-containing fluorocarbon cardioplegic preparations. An experimental study.

The effect of magnesium on potassium fluorocarbon cardioplegia was studied in 20 rabbits. Isolated hearts with ascending aortas were perfused with oxygenated and cooled (+4 degrees C) fluorocarbon solutions. In 10 experiments, the solution contained 20 mmol/l of potassium, in 10 further experiments, 20 mmol/l of potassium and 15 mmol/l of magnesium. Ultrastructural preservation of the myocardium was studied using transmission electron microscopy. In addition, the cation contents of the myocardium were studied by flame atomic absorption spectrophotometry (calcium, magnesium) or electrothermal atomic absorption spectrophotometry (copper). After 120 minutes of ischaemia, areas of moderate or severe ultrastructural myocardial cell damage were observed in both groups but severe damage was more extensive and commoner in the group with no access to magnesium. Preservation of the capillary endothelium was also worse in that group. There was a highly significant increase in magnesium content, a decrease in calcium content and an increase in the magnesium/calcium ratio following magnesium-potassium fluorocarbon infusion. The copper content remained unchanged. A protective effect of magnesium was observed. The electrolyte content of cardioplegic solutions also alters the electrolyte content of the myocardium. This may be important in reperfusion.

Animals↗

PubMedDate not supplied

Experience with arm veins as aorto-coronary bypass grafts.

In a series of 1,000 coronary bypass operations 15 patients received arm vein grafts. In these cases the saphenous veins were either absent or inadequate and the mammary arteries alone were not sufficient for multivessel coronary revascularization. Altogether, 34 coronary anastomoses were performed with 16 arm vein grafts; additional coronary endarterectomy was needed in four instances. Together with mammary artery or saphenous vein grafts these patients each had, on the average, 3.6 coronary anastomoses. There was no operative mortality and no complication related to the arm vein grafts. Postoperatively all the patients were free of angina pectoris. A follow-up angiogram (mean 1.4 years postoperatively) showed a patency rate of 87% for arm vein grafts. A frequent finding was an uneven diameter of the grafts. In three patients aneurysmal dilatation (of 8.3 to 9.8 mm in diameter) was revealed. Although the patency rate to date is satisfactory, our experience is too limited in time numbers to judge long term durability.

Aged↗

PubMedDate not supplied

Coronary endothelial damage after crystalloid cardioplegia.

There is considerable clinical experience to suggest that damage to the myocardium during ischaemic arrest can be prevented by cardioplegic solutions. However, very little is known about the effects of these cardioplegic solutions on the coronary endothelium. The effects of three different cardioplegic solutions on the coronary endothelium are reported here. Preservation of the myocardium was studied with biochemical assays. Blood cardioplegia did not damage the coronary endothelium. Crystalloid cardioplegia caused disappearance of the endothelial cells and gross deformity of the flow surface. The addition of albumin to the crystalloid solution preserved most of the endothelial lining. Preservation of the myocardial high energy compounds seemed to be dependent only on the cooling effect of the cardioplegia and not on the composition of the solution. There was no correlation between high energy compounds and endothelial changes. The present study favours the use of cold blood cardioplegia which preserves both the coronary endothelium and the myocardial energy sources during ischaemic cardiac arrest.

Albumins↗

PubMedDate not supplied

Pulmonary vasodilatory properties of prostaglandin E1 are blunted after experimental single lung transplantation.

BACKGROUND: Pulmonary dysfunction and right heart failure are still a common clinical problem after single lung transplantation. METHODS: In this study we investigated the pulmonary vasodilatory properties of prostaglandin E1 in pigs during the first 4 hours after left lung allotransplantation. With the use of extracorporeal circulation and total right heart bypass, the right and left pulmonary arteries could be individually perfused and the drug effect in each lung separately analyzed either at equal blood pressures or at equal blood flows in the pulmonary arteries. Twelve animals received in a randomized double-blind fashion either saline solution or an increasing prostaglandin E1 infusion (10, 25, 50, and 100 ng/kg/min; 15 minutes each). After a drug-free period of 75 minutes, the infusion schedule with 25, 50, and 100 ng/kg/min was repeated. RESULTS: During the first part of the study the highest dose of prostaglandin E1 decreased the mean systemic arterial pressure by 25%, but an almost similar decrease occurred in the control animals. During the second infusion period a 28% decrease was observed only in the animals treated with prostaglandin E1. None of the infusions was able to decrease pulmonary vascular resistance. Instead prostaglandin E1 diverted two thirds of the pulmonary blood flow toward the native lung, and this diversion manifested itself as an earlier improvement of the arterial oxygen tension in the drug-treated animals. The end-tidal carbon dioxide values measured from each lung corresponded to those from the common expiratory limb of the system, but there was a distinct gradient in the range of 14 to 20 mm Hg between the arterial and end-tidal carbon dioxide values. CONCLUSIONS: We conclude that prostaglandin E1, in doses tolerated by the systemic circulation, is ineffective in the treatment of the increased pulmonary vascular resistance after single lung transplantation.

Alprostadil↗

PubMedDate not supplied

Endothelialitis and accelerated arteriosclerosis in human heart transplant coronaries.

We have analyzed the autopsy material of 11 cardiac allograft recipients, whose grafts became nonfunctional less than 1 year after transplantation. All patients had received routine triple-drug immunosuppression. Two of these patients showed accelerated transplant arteriosclerosis; the graft loss was associated with strong intimal proliferative response affecting the first-order and second-order intramuscular branches of the major coronary vessels. Histologic evidence showed only a slight inflammatory reaction in the vascular adventitia. The media was mostly intact, and the internal elastic lamina showed occasional breaks. A very prominent inflammatory reaction was noted in the subendothelial space in the intima. Immunohistochemistry with monoclonal antibodies revealed that the luminal part of the intima was invaded by anti-leukocyte common antigen and anti-UCHL1 positive T lymphocytes, whereas the abluminal part consisted mostly of anti-smooth muscle alpha-actin-positive smooth muscle cells. We call this subendothelial accumulation of lymphocytes endothelialitis. The suggestion has been made that accelerated arteriosclerosis may be associated with cyclosporine treatment. Correlation with the recipient's cytomegalovirus status in this study suggests that cytomegalovirus infection may contribute to the development of endothelialitis and accelerated arteriosclerosis in heart transplant recipients.

Adult↗