We propose that circumstances exist in which angiography is not necessary or is unwarranted for the diagnosis and treatment of carotid arterial disease. High quality real-time B-mode ultrasonographic imaging, combined with both pulsed gated, and continuous wave Doppler analysis, shows a remarkably close correlation with the pathologic abnormality identified at operation. Scanning in the vascular laboratory not only provides quick, noninvasive, accurate assessment of the atherosclerotic disease, it can also provide plaque and blood flow detail not previously attainable. Carotid surgery can be effectively and safely performed in selected patients with the aid of ultrasonography and Doppler analysis without the need for invasive angiographic imaging.

Aged↗

PubMed1984

Risk of combined coronary artery bypass and mitral valve replacement.

During a period of 6 years and 5 months, a group of 26 men and 16 women between 53 and 80 years of age underwent combined coronary artery bypass and mitral valve replacement. All patients were catheterized preoperatively, and hemodynamic and surgical variables were noted. In accordance with the variables, operative mortality was evaluated and compared among subgroups. Eight patients died, and the factors found to adversely change successful treatment were instability of ischemia, advanced New York Heart Association functional class, severe mitral regurgitation, associated aortic regurgitation, extensive coronary artery disease, the extent of left ventricular dysfunction as estimated by left ventricular end-diastolic pressure and ejection fraction, and elevated pulmonary vascular resistance. Prolonged operative time was also significant. The only variable that did not seem to influence mortality was the pathology type of mitral valve involvement. Analysis of our data confirms the high risk of coronary artery by pass combined with valve replacement for mitral regurgitation reported by others, and it appears advisable at present to exercise caution in recommending combined coronary artery by pass and mitral valve replacement in patients with extensive coronary artery disease and advanced left ventricular dysfunction. Pre-and postoperative utilization of afterload reduction, with the use of circulatory assist devices, may prove effective in some patients, and deserves special evaluation.

Journal Article↗

PubMed1984

Surgical experience following percutaneous transluminal coronary angioplasty.

Percutaneous transluminal coronary angioplasty (PTCA) was attempted in 600 patients, 97 of which were considered unsuccessful. Review of our surgical experience in a large series of these procedures helps to confirm some facts regarding the unique interaction between these two modalities of myocardial revascularization. Serious complications are still relatively common, even when PTCA is performed in centers with broad experience. While emergency operation is not required in all major complications, about 7% of patients need immediate surgical intervention, which is usually performed on unstable patients, and thus associated with increased morbidity and mortality. The combined incidence of major complications, such as coronary dissection, occlusion, and spasms, still approaches 20% of attempts. In contrast to other studies, surgical mortality and morbidity do not appear to be higher in our series of operations on patients with complicated PTCA than in coronary bypass operations in general. This fact may attest to our practice of alerting all surgical services in anticipation of problems. Our short complication-to-operation completion time, averaging 123 minutes, may be partially responsible for the good results. We conclude that standby open-heart services for PTCA are warranted in most hospitals; however, it should not be performed in hospitals without surgeons who are experienced in the practice of open-heart surgery.

Journal Article↗

PubMed1983

Transient Q waves and reversible cardiac failure during myocardial ischemia: electrical and mechanical stunning of the heart.

Explore the source record for details and available documents.

Aged↗

PubMed1983

Coronary spastic angina in middle-aged women: a psychosomatic disorder?

Explore the source record for details and available documents.

Adult↗

PubMed1983

Internal mammary coronary artery bypass surgery: experience with 1000 cases.

A study of 813 men and 187 women who underwent internal mammary artery (IMA) bypass from 1976 to the present time is presented. In approximately 10% of patients, only the IMA was used for coronary artery bypass, and in approximately 90%, one to four saphenous vein grafts were used additionally. Hospital mortality in the series was 1.8%. The IMA, when properly selected and carefully harvested, is considered an excellent conduit for myocardial revascularization. Disadvantages include its limited application to the proximal portions of one (or two) coronary vessels, a relatively delicate and difficult anastomosis, and an allegedly high incidence of postoperative chest wall discomfort with pulmonary complications. However, this experience with IMA coronary artery bypass supports the view that it is an ideal conduit for the anterior wall when conditions permit its use.

Journal Article↗

PubMed1983

Sequential internal mammary-coronary artery bypass.

Since April, 1977, a total of eight patients have undergone sequential bypass grafting of the internal mammary artery (IMA) to the coronary arteries at our institution. The indication for this newly described procedure was either insufficient supply of adequate veins (four patients) or the presence of a diseased aortic wall (two patients). Operative procedures included left IMA bypass to the left anterior descending (LAD) artery and its major diagonal branch in six patients; to the obtuse marginal branch and distal circumflex artery in one patient; and to two consecutive sites on the LAD in one patient. All patients became angina-free after operation for a follow-up period lasting up to 6 years. Recatheterization studies were performed in four patients, in all of whom the IMA sequential grafts were found patent. We believe that IMA sequential grafting is an important option available to the cardiac surgeon in managing some patients with coronary artery disease.

Aged↗

PubMed1982

Coronary artery spasm with sinus node dysfunction and syncope.

In a 55-year-old man, attacks of spontaneous angina were associated with dizziness and syncope. Holter ECG monitoring disclosed evidence of sinus node dysfunction. Dizziness and syncope were corrected by a permanent ventricular demand pacemaker. Coronary cineangiography showed spontaneous, severe, diffuse spasm in a dominant left coronary artery and localized spasm in a nondominant right coronary artery. The patient died of pump failure shortly after cardiac catheterization. An autopsy disclosed only minimal coronary atherosclerosis. This patient's condition shows that (1) coronary spasm may cause sinus node dysfunction, dizziness, and syncope, (2) severe spasm that involves all the coronary artery branches may be fatal, and (3) severe spasm occur in minimally diseased coronary arteries confirmed by pathologic examination.

Arrhythmia, Sinus↗

PubMed1976

Multifascicular block in cardiomyopathy. Incidence, localization by His bundle study and prognosis.

Of 70 patients with cardiomyopathy, nine (13%) had bifascicular block: right bundle branch block with left anterior hemiblock in four, right bundle branch block with left posterior hemiblock in two, and left bundle branch block with left anterior hemiblock in three. Isolated left bundle branch block was present in four, isolated left anterior hemiblock in 13, and isolated left posterior hemiblock in one. No isolated right bundle branch block was found. Five of the patients with bifascicular block were evaluated by His bundle electrocardiography and atrial pacing. Block in the His-Purkinje system (prolonged HV interval) was present in four and atrioventricular conduction (AH interval) was normal in all five. Despite a common prolongation in intraventricular conduction, short term prognosis seems to be favorable since: (1) none had spontaneous progression to more advanced block or experienced Stokes-Adams attacks for an average follow-up period of at least 42 months, and (2) with atrial pacing, one-to-one atrioventricular conduction persisted to rates up to 150/min in all patients with no further prolongation of HV interval.

Adult↗

PubMed1976

Striking electrocardiographic changes associated with pheochromocytoma. Masquerading as ischemic heart disease.

A patient with pheochromocytoma presented striking electrocardiographic changes mimicking ischemic heart disease at one time and acute pulmonary embolism at other times. Diffuse left ventricular hypokinesia was demonstrated in the presence of normal coronary arteries. Following removal of the pheochromocytoma, the electrocardiographic abnormalities disappeared.

Blood Pressure↗

PubMed1975

Hemoglobin S-C disease presenting as acute pneumonitis with pulmonary angiographic findings in two patients.

Acute illness characterized by fever, cough, chest pain and pulmonary infiltrates on chest film is characteristic of patients witb sickle cell anemia and with sickle-C disease. The underlying hemoglobinopathy is usually recognized in the former, but because patients with sickle-C disease as a rule have less severe anemia and fewer, less severe crises their abnormal hemoglobin may not be detected until adolescence or adulthood. Acute pulmonary illness in such patients may therefore present a diagnostic dilemma for the unwary. Two cases are presented to highlight this point. Pulmonary angiographic findings in patients with sickle cell states might add information about the pathogenesis of this disorder since vascular occlusion appears to play a major role. Pulmonary angiograms in the two patients we describe documented the presence of localized abnormalities of perfusion. In one, the presence of filling defects in medium-sized arteries suggests intravascular thromboembolism.

Acute Disease↗