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Biomedical subjects

T A Traill

Publications and source records attributed to T A Traill.

52 records · Page 3Linked to original sources
PubMed1979

Mitral stenosis with high left ventricular diastolic pressure.

Three patients with mitral stenosis are described, in whom the haemodynamic findings at cardiac catheterisation were more suggestive of left ventricular myocardial disease, in that the left ventricular diastolic pressure was high and the mitral valve gradient small. However, their echocardiograms showed abnormal wall movement during diastole characteristic of severe inflow obstruction, with slow and protracted filling, and at operation mitral stenosis was confirmed. Left ventricular wall stress was estimated throughout the cardiac cycle in one patient, and the diastolic stress-strain relation shown to be abnormal. The effects of mitral stenosis on left ventricular function are complex, and are not explicable simply by reduction in size of the mitral orifice.

Adult↗
PubMed1979

Echocardiography of atrioventricular valves in patients with univentricular heart.

M-Mode echocardiography in patients with univentricular heart allows the number and relations of the AV valves to be established. The absence of a posterior septum can be documented with some certainty and in many cases a stradding AV valve suspected. In addition, reduced amplitude of diastolic closure velocity is very suggestive of valve atresia or dysplasia. This information is of practical significance if corrective surgery is planned.

Echocardiography↗
PubMed1979

Abnormal ventricular function in patients with univentricular heart. Cineangiographic study.

In order to investigate the basis of ventricular dysfunction in patients with univentricular heart, cineangiograms of 20 patients aged between 3 weeks and 22 years were digitized frame by frame and compared with left ventriculograms of patients with other cardiac malformations. Ejection fraction was at least normal (58% to 95%) and peak rate of systolic minor axis shortening was normal in all. However in only 3 patients was the change in volume achieved by virtue of the normal change in cavity shape; in 17 the end-systolic outline was abnormally circular and shape index, 4 pi (area)/(perimeter)2, changed by less than normal (p less than 0.01). In addition, abnormalities of regional wall movement were found in 12 patients. 11 showed a consistent pattern, unlike that found in ischaemic heart disease or other congenital lesions, of delayed systolic inward movement of the antero-apical wall, associated in 9 with hypokinesis. Four of these showed secondary delay of relaxation in the same region. One patient had an isolated abnormality of isovolumic relaxation. These findings were independent of age, volume overload or degree of cyanosis, but were more common in patients with absent atrioventricular connexion. We conclude that the architectural abnormalities in univentricular hearts lead to disturbances of myocardial function which particularly affect the apex. These are detectable from an early age.

Cardiac Volume↗
PubMed1978

Regional left ventricular wall movement in hypertrophic cardiomyopathy.

Left ventriculograms of 20 patients with hypertrophic cardiomyopathy were digitised frame by frame and analysed using a contour display. Abnormalities of regional wall movement were present in 17, and included an abnormal sequence of inward movement during systole (13), regional delay in the onset of inward movement (10), and an abnormal dispersion of peak velocities (5). Diastolic wall movement was disturbed in 13, because of abnormal peak velocities in 7 and regional asynchrony in 6. Abnormal wall movement during the two isovolumic periods was rare in hypertrophic cardiomyopathy, unlike ischaemic heart disease. These disturbances may reflect underlying structural abnormalities.

Cardiomyopathy, Hypertrophic↗
PubMed1978

Detection of abnormal left ventricular wall movement during isovolumic contraction and early relaxation. Comparison of echo- and angiocardiography.

Abnormal left ventricular wall movement during isovolumic contraction and early relaxation was assessed from simultaneous apex and echocardiograms in 50 patients with ischaemic heart disease, and compared with estimates from the corresponding digitised left ventriculograms. During isovolumic contraction, a normal angiogram was accompanied by normal apex-dimension relations in 13 out of 14 cases. In 19 cases, there was angiographic evidence of discrete outward wall movement during isovolumic contraction which was associated with abnormal apex-dimension relations in 15. During isovolumic relaxation, of 14 cases who were normal angiographically, apex-dimension relations were normal also in 11, which in 36 patients with abnormal wall movement on angiogram, apex-dimension relations were abnormal in 30. Correlation was less good between echocardiographic and angiographic estimates of left ventricular minor dimension (r = 0.75), and was absent between those of peak rates of dimension change during systole and diastole. Asynchronous onset of inward wall movement and the distribution of regional abnormalities of overall wall movement amplitude were unrelated to apex-dimension relations. The apex-dimension relation is thus a sensitive and specific means of detecting abnormalities of left ventricular wall movement during isovolumic contraction and early relaxation, unaffected by other manifestation

Angiocardiography↗
PubMed1978

Left ventricular relaxation and filling in hypertrophic cardiomyopathy. An echocardiographic study.

Echocardiograms showing left ventricular cavity and mitral valve cusps simultaneously were recorded in 36 patients, apex cardiograms being obtained in 26 of them. These were digitised and continuous plots made of left ventricular dimension, its rate of change, and anterior mitral leaflet velocity, and were compared with those in 20 normal subjects. Peak mitral diastolic closure rate was reduced to 120 +/- 80 mm/s, compared with normal (250 +/- 60 mm/s). Peak rate of increase of dimension was normal (13.4 cm/s), though the pattern of filling was disturbed, with the duration of rapid filling prolonged in 5, and shortened in 15, suggesting restriction. Mitral valve opening, normally synchronous with minimum dimension, was delayed by a mean of 76 ms, and during this period there was an abnormal increase in dimension. Dimension also increased by 50 +/- 25 per cent of the total diastolic excursion before the 'O' point of the apex cardiogram compared with 21 +/- 7 per cent in normals, and the timing of peak rate of increase of dimension was delayed by 50 +/- 20 ms instead of being synchronous with the 'O' point as normal. None of these findings correlated with the reduction in peak mitral diastolic closure rate. Noninvasive methods thus show that relaxation may be abnormal in hypertrophic cardiomyopathy. Delay in mitral valve opening and disturbances in the rate, duration, and co-ordination of wall movement during filling suggest the presence of segmental abnormalities of left ventricular function.

Adolescent↗
PubMed1978

Diastolic changes in left ventricular wall thickness studied by echocardiography.

In order to study factors influencing posterior wall thickness during diastole, echocardiograms showing the septum, mitral valve and posterior wall endocardium and epicardium in 15 normal subjects and 49 patients with heart disease were digitized. Maximum wall thickness, minimum cavity dimension and the onset of mitral valve opening are normally synchronous, and an early period of rapid wall thinning, at a peak rate of 10.7 +/- 1.7 cm/sec corresponds closely to rapid filling. In patients with ischaemic heart disease the peak rate and duration of rapid thinning were normal, but thinning preceded mitral valve opening (mean 50 msec). In 11 of 17 patients with hypertrophic cardiomyopathy the peak rate of thinning was reduced and in 2 it was increased. There was a close correlation between the peak thinning rate in this group and the peak rate of increase in dimension. In mitral stenosis peak thinning rate was frequently reduced but in some patients was normal, with the reduced rate of increase in cavity dimension maintained by reversal of septal movement. We conclude that rapid thinning is an intrinsic property of the ventricular wall which is normally associated with rapid filling, but which may be dissociated from filling by asynchronous relaxation or inflow obstruction, or may be modified by myocardial disease.

Cardiomyopathy, Hypertrophic↗
PubMed1978

Regional abnormalities of left ventricular wall movement during isovolumic relaxation in patients with ischemic heart disease.

In order to study events during isovolumic relaxation, left ventricular angiograms of 120 patients with ischemic heart disease were digitized frame by frame, and compared with those of 15 normal subjects. In patients with ischemic heart disease, abnormal inward movement of endocardium occurred in areas supplied by narrowed coronary arteries. When these involved the free wall, they were due to abnormal wall thickening rather than to inward movement of epicardium. Since the volume of the ventricle was constant, they were accompanied by compensatory outward movement of endocardium elsewhere, due to premature thinning. Identical abnormalities were demonstrated in 80 patients by M-mode echocardiography, and in individual patients, agreement with angiography was good. These abnormalities were aggravated by TNT administration, and were unaffected by isometric stress. In approximately half, they were associated with abnormalities of isovolumic contraction. They appear to represent the behavior of regions of the left ventricle with partial loss of function due to previous ischemic injury.

Cineangiography↗
PubMed1977

Echocardiographic assessment of left ventricular filling after mitral valve surgery.

In order to investigate the functional effects of mitral valve surgery, echocardiograms showing left ventricular dimension were recorded and digitised in 14 normal subjects and 129 patients after mitral valve surgery. Measurements were made of peak rate of increase of dimension (dD/dt) and duration of rapid filling, studies on left ventriculograms in 36 patients having shown close correlation between these values and changes in cavity volume. In 14 patients with mitral stenosis, peak dD/dt was reduced to 7-2 +/ 1-5 cm/s, and filling period prolonged to 330 +/- 65 ms, compared with normal (16-0 +/- 3-2 cm/s, and 160 +/- 50 ms, respectively), and after mitral valvotomy, these values improved significantly (10-4 +/- 2-7 cm/s and 245 +/- 55 ms). Characteristic abnormalities were found in 67 patients with mitral prostheses. Values for the Björk-Shiley (10-5 +/- 4-2 cm/s and 180 +/- 80 ms) and Hancock (10-3 +/- 3-7 cm/s, 245 +/- 80 ms) values were similar, and both superior to the Starr-Edwards (7-4 +/- 3-0 cm/s, 295 +/- 105 ms). Results after mitral valve repair in 30 cases were not significantly different from normal (14-4 +/- 5-0 cm/s, 170 +/- 50 ms). Values outside the 95 per cent confidence limits for the valve in question allowed diagnosis of value malfunction in 18 cases. The method is value in comparing different operative procedures and in following up patients after mitral valve surgery.

Adolescent↗
PubMed1975

The treatment of digoxin overdosage.

A case of digoxin overdosage is presented in which hemodialysis and forced diuresis were employed in the treatment. Hemodialysis was found to be ineffective in removing significant amounts of the drug and additional experimental work using a dog confirmed that forced diuresis failed to alter the rate of digoxin excretion.

Animals↗
PubMedDate not supplied

Persistent pulmonary hypertension after heterotopic heart transplantation: a case report.

Right-sided failure occurring in the donor heart immediately after transplantation is primarily caused by increased recipient pulmonary artery pressure and resistance and represents one of the leading causes of perioperative mortality associated with orthotopic heart transplantation. After transplantation pulmonary hypertension gradually declines, returning to near normal levels within 30 days of transplantation. This article describes a case report of the persistence of pulmonary hypertension after heterotopic heart transplantation. The heterotopic position was utilized because of marked elevation of the pulmonary artery resistance (18 Wood units) calculated at the time of operation. Cardiac catheterization data-obtained during the subsequent 6 months of follow-up showed persistent elevation of pulmonary artery pressure and pulmonary vascular resistance. The patient, however, clinically continues to feel well and remains asymptomatic without signs of right-sided heart failure. Indications, suggested advantages, and demonstrated disadvantages of heterotopic heart transplantation are discussed.

Adult↗
PubMedDate not supplied

Diagnosis of acute cardiac rejection with antimyosin monoclonal antibody, phosphorous nuclear magnetic resonance imaging, two-dimensional echocardiography, and endocardial biopsy.

A cervical heterotopic cardiac allograft model was used to compare noninvasive techniques with endocardial biopsy diagnosis of rejection. The transplant procedure was performed in eight dogs (12 to 16 kg), with a mean ischemic time of 83 minutes. Beginning on the day of the operation each allograft was evaluated daily by palpation, two-dimensional echocardiography, phosphorous nuclear magnetic resonance spectroscopy, and septal endocardial biopsy. At specific intervals after the operation, antimyosin monoclonal antibody (Fab fragment) with an indium-111 label was administered for subsequent gamma camera imaging. Rejection was clinically evident by 2 to 8 days with a mean of 3.5 days. Endocardial biopsy demonstrated moderate to severe rejection by 2 to 4 days. Two-dimensional echocardiography demonstrated early loss of wall thickening dynamics in all allografts. Although subtle changes were evident early in some transplants, these findings were not consistent. After recovery from hypothermic ischemia, evaluation of high energy phosphate metabolites with phosphorous nuclear magnetic resonance spectroscopy showed a progressive decrease in phosphocreatine during mild to moderate rejection, dropping to 30% to 40% of baseline levels with severe rejection. Antimyosin antibody uptake directly correlated with endocardial biopsy rejection scores (R2 = 0.97). With mild to moderate rejection, mean total counts and corrected counts were 222,704 and 112,648, respectively, and were significantly different (p less than 0.05) from baseline counts (135,537 and 58,530) without rejection. As a preliminary finding in untreated acute rejection, both antimyosin antibody and phosphorous nuclear magnetic spectroscopy detected changes consistent with mild to moderate rejection, which usually preceded echocardiographic evidence for injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Arteriolar vasculitis on endomyocardial biopsy: a histologic predictor of poor outcome in cyclosporine-treated heart transplant recipients.

The histologic pattern of severe, potentially lethal cardiac rejection in transplant recipients who are treated with cyclosporine may be difficult to distinguish from mild or moderate rejection. The purpose of this study was to determine whether specific histologic abnormalities seen on endomyocardial biopsy could identify which histologic patterns of rejection are associated with progression to graft dysfunction or graft failure. We performed a blinded, retrospective analysis of endomyocardial biopsies from our initial 19 transplant recipients. Group 1 was composed of five patients who developed graft failure or dysfunction after transplantation. Group 2 was composed of the remaining 14 patients with normal hemodynamics and function at heart catheterization 1 year after transplantation. Seventeen histologic parameters were semiquantitatively graded, and comparisons between the two groups were made with the Student's t test. Of the 17 parameters, only arteriolar vasculitis was significantly increased in group 1 versus group 2 biopsies (p = 0.002). Arteriolar vasculitis was identified in four of five patients in group 1 and was unique to group 1. Of 53 group 1 biopsies, eight patients had foci of arteriolar vasculitis and were seen up to 88 days before graft failure. Therefore the finding of arteriolar vasculitis on endomyocardial biopsy may identify high risk rejection episodes in transplant recipients who are treated with cyclosporine.

Adult↗