Biomedical subjects
Publications and source records attributed to V M Walley.
This report describes a patient with an acute anterior myocardial infarction treated by primary angioplasty and stenting of the infarct-related artery. The patient died 48 h later and at postmortem examination, patency of the stented artery was demonstrated, despite the adverse conditions which preceded death.
False aneurysms of the left ventricle are rare complications of myocardial infarction. In this unusual case, a 57-year-old male patient had a false aneurysm, that took origin from a true aneurysm in the inferior wall, both discovered 7 years postinfarct. The aneurysms were demonstrable by ventriculography and were resected because of ventricular tachycardia.
To identify the preoperative factors that influence hospital survival after transplantation we analyzed our consecutive experience of 183 transplantations in 179 patients over a 10-year period. There were 151 male and 29 female transplant recipients ranging in age from 10 days to 70 years (mean, 48 +/- 1 years). Diagnoses included coronary disease in 110 patients, cardiomyopathy in 55 patients, valvular disease in 6 patients, and congenital heart disease in 9 patients. Seventy-seven had undergone a previous cardiac operation, and 30 patients required preoperative mechanical support. Forty patients received hearts from donors who were 40 years old or older (range, 40 to 62 years). Ischemic time was greater than 240 minutes in 32 cases, and pulmonary vascular resistance was greater than 3 Wood units in 40 patients (range, 3.1 to 10.0 Wood units). Cyclosporine induction was used in 52 patients, whereas 128 recipients received polyclonal antibody prophylaxis. There were 25 hospital deaths. Recipient diagnosis, use of mechanical support, donor age, and the immune suppression protocol were related to hospital survival according to univariate analysis. Using multiple logistic regression, only the method of immune suppression induction and the use of mechanical assists were significant independent determinants of survival. In conclusion, we believe that extended ischemic times and donor age do not adversely affect the early success of transplantation, whereas induction with immune globulin may reduce early mortality. Patients requiring mechanical support before transplantation continue to be a challenge.
To determine the long-term durability of the Ionescu-Shiley valve, we analyzed our experience with this valve at the University of Ottawa Heart Institute. To 1988, 780 patients have had aortic valve replacement (AVR = 528) or mitral valve replacement (MVR = 252). Of the aortic valves, 310 were standard profile and 218 were low profile. Of the mitral valves, 143 were standard profile and 109 were low profile. Actuarial survival at 10 years was as follows: AVR, 62% +/- 3%; MVR, 58% +/- 4%; p = 0.42. At 14 years, the results were AVR, 44% +/- 1% and MVR, 46% +/- 5%; p = 0.40. Reoperation was required in 197 patients. Structural failure was present in 85% of these valves, with leaflet tears alone in 69%, tears with calcification in 21%, and calcification alone in 10%. Leaflet tears occurred in 95% after AVR and in 78% after MVR (p = 0.006) and were seen in 95% of low-profile valves and 87% of standard-profile valves (p = 0.16). The actuarial freedom from reoperation at 10 years was: AVR, 58% +/- 3%; MVR, 62% +/- 5%; p = 0.49. At 13 years, these rates were 38% +/- 4% for AVR and 25% +/- 9% for MVR (p = 0.79). For AVR, the 10-year rate of freedom from reoperation was 57% +/- 4% for standard-profile valves and 57% +/- 8% for low-profile valves (p = 1.0). Similarly for MVR, the 10-year freedom from reoperation was 61% +/- 6% for standard-profile valves and 68% +/- 8% for low-profile valves.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
This study compared the clinical performance of the St. Jude Medical and Medtronic Hall mechanical valves in isolated aortic or mitral valve replacement. From 1984 to 1993, 349 St. Jude Medical valves (aortic 237, mitral 112) and 465 Medtronic Hall valves (aortic 272, mitral 193) were implanted in 814 patients at the University of Ottawa Heart Institute. The patients had similar preoperative characteristics. The hospital mortality rate for aortic valve replacement was 3.4% with the St. Jude Medical valve and 5.8% with the Medtronic Hall valve (p = 0.26) and the rate for mitral valve replacement was 8.9% with the St. Jude Medical valve and 11.9% with the Medtronic Hall valve (p = 0.54). Actuarial estimates of survival and freedom from complications were calculated. At 5 years the actuarial probability of survival (including hospital deaths) for aortic valve replacement was 86% +/- 3% with the St. Jude Medical valve and 68% +/- 4% with the Medtronic Hall valve (p = 0.0001) and for mitral valve replacement was 75% +/- 7% with the St. Jude Medical valve and 70% +/- 4% with the Medtronic Hall valve (p = 0.54). The most common cause of late death was cardiac failure and no deaths were caused by structural failure. The 5-year probability of freedom from bleeding after aortic valve replacement was 99% +/- 1% with the St. Jude Medical valve and 95% +/- 2% with the Medtronic Hall valve (p = 0.06) and after mitral valve replacement 99% +/- 1% with the St. Jude Medical valve and 97% +/- 2% with the Medtronic Hall valve (p = 0.37). The 5-year probability of freedom from thromboembolism after aortic valve replacement was 88% +/- 4% with the St. Jude Medical valve and 81% +/- 3% with the Medtronic Hall valve (p = 0.08) and after mitral valve replacement was 85% +/- 7% with the St. Jude Medical valve and 77% +/- 5% with the Medtronic Hall valve (p = 0.17). Reoperation was uncommon and there were no cases of structural valve failure. The 5-year actuarial estimate of freedom from reoperation therefore for aortic valve replacement was 99% +/- 1% with the St. Jude Medical valve and 96% +/- 2% with the Medtronic Hall valve (p = 0.09) and for mitral valve replacement was 98% +/- 2% with the St. Jude Medical valve and 95% +/- 3% with the Medtronic Hall valve (p = 0.40).(ABSTRACT TRUNCATED AT 400 WORDS)
Explore the source record for details and available documents.
OBJECTIVE: To describe the clinical and pathological features of a patient with probable cardiotoxicity related to a newer chemotherapeutic agent, DuP-941. PATIENT AND METHODS: A 42-year-old woman with metastatic breast carcinoma treated with only DuP-941 developed, and died of, heart failure for which no other explanation was apparent. RESULTS: Clinically the patient's heart failure resembled that associated with anthracycline cardiotoxicity, as did the pathological features seen at autopsy. CONCLUSION: DuP-941 is a new chemotherapeutic drug that may supplant some uses of the anthracyclines because the former may have less cardiotoxicity. This report suggests that in some cases DuP-941 may have cardiotoxic effects as well.
This study was undertaken to examine the morphological basis for noncalcific cusp thickening in 20 standard-profile Ionescu-Shiley bovine pericardial cardiac valvular bioprostheses (16 aortic, four mitral) with primary valve failure due to cusp tears. The patients included 17 males and three females, with a mean age of 52.0 years; their valves had been implanted for a mean of 105.8 months. All cases had variable degrees of "plasma insudation" without correlation to identifiable patient parameters. This was accentuated in individual valves in the cusp with the most extensive tears. In addition, the three valves with the thickest cusps were grossly distorted by massive deposits of amyloid (identified as AL-amyloid in two index cases studied). Two other valves had incidental amyloid deposits, identifiable only by electron microscopy. Amyloid involvement of pericardial bioprostheses has not been previously reported. The literature pertaining to amyloid involvement and plasma insudation of bioprostheses is reviewed.
The objective of this study was to examine for any relationship between the sites of papillary muscle insertion in left ventricular free wall (LVFW) and the site of LVFW rupture postinfarct. Twenty-five consecutive patients with LVFW rupture (12 men and 13 women, mean age 72.3 yr, range = 48 to 93) at the University of Ottawa Heart Institute during the period of July 1, 1988 to 1992 were studied. Clinical charts were reviewed, and the Formalin-fixed hearts were re-examined grossly and microscopically. Each patient died of tamponade or after surgery for tamponade. Eight (32%) of the 25 infarcts were anteroseptal or anterior, 11 of 25 (44%) were lateral, and 6 of 25 (24%) were inferior or inferoseptal. Four (16%) of the 25 infarcts were less than 2 days old, 9 of 25 (36%) were 2 to 5 days old, and 12 of 25 (48%) were 5 to 10 days old. A separate pre-existent and healed infarct was noted in 36% of patients; however, rupture adjacent to these areas of old infarct occurred in only 8% of cases. In 15 of 25 (60%) cases, free wall rupture occurred in the lateral wall between and at the level of the two papillary muscles. In a further 5 of 25 (20%) cases, the rupture was beside one of the papillary muscles but in anterior or posterior walls. In 20 of 25 (80%) cases, the endocardial tear associated with the LVFW rupture was within 1 cm of the base of one of the papillary muscles as they inserted in LVFW.(ABSTRACT TRUNCATED AT 250 WORDS)
There has been a great deal of attention given to the development of post-transplant arteriopathy in the cardiac transplant patient. Preexisting donor heart disease may be of equal importance in the development of allograft failure due to ischemia. The case of a 64-year-old female who received the heart of a 52-year-old female is reported. Death of the recipient occurred due to intraoperative complications. Despite normal pretransplant coronary angiography, autopsy found severe atherosclerotic coronary artery disease in the donor heart. This case report illustrates some of the limitations of angiography in the detection of coronary artery lesions in donor hearts.
Photosensitizing drugs are selectively taken up by lipid-rich lesions such as atheromatous plaque which when exposed to light render the drugs cytotoxic. However, skin photosensitivity which persists for many weeks is a significant side effect. We investigated the cytotoxicity of a new photosensitizing drug, the benzoporphyrin derivative BPD verteporfin (Quadra Logic Technologies), which does not have this deleterious side effect. Vascular smooth muscle cells (VSMC) from normal human mammary and diseased human coronary arteries were grown in culture from explants and characterized with respect to their growth rates. The sensitivity to BPD with and without light was assessed by measuring viability after treatment. The lethal dose of drug for 50% viability loss (LD50) for BPD with light was approximately 12.5 ng/ml for mammary artery, with 52 +/- 8% cell survival (n = 6). The coronary artery VSMC from all patient sources, although differing significantly in growth rate, had a survival of 44 +/- 6% (n = 12) at the same concentration of BPD used for the mammary artery SMC (p = NS). Our results established the LD50 for BPD using human arterial sources of SMC and showed that the growth rates of the cells did not affect the cytotoxicity of the drug.
Information about the surgical management of fibrous skeleton endocarditis is incomplete, as the vast majority of current literature describes the isolated repair of either the aortic or the mitral annulus, the combination rarely being addressed. Annular destruction, in the presence of endocarditis, demands extreme ingenuity for surgical treatment and cure. We describe and illustrate the Konno procedure for replacement of both infected mitral and aortic valves and repair of mycotic ventricular septal defects.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The entity described in the literature as a "distinctive cardiovascular lesion" resembling histiocytoid hemangioma and more recently referred to as "mesothelial/monocytic incidental cardiac excrescence" may not be a true proliferative lesion. Rather, it may represent an artefact produced by suctioning of the pericardial cavity during cardiac surgery. This hypothesis was explored by comparing two index cases of cardiac histiocytoid hemangioma-like lesions (HLLL) to (a) the contents of extracorporeal bypass pump (ECBP) filters in 22 random cardiac surgical cases, and (b) material adherent to mediastinal and pericardial drains in 15 random post-cardiac surgery cases. In 18 of the 22 ECBP filter cases (82%) and two of the 15 postsurgery cases (13%), tissue fragments indistinguishable from the HHLL index cases were identified. These filter and drain fragments had light microscopic, immunohistochemical, and ultrastructural features identical to those of the index cases, as well as to the HHLLs described in the literature. In neither index case, nor in the study patients, were any proliferative lesions identified at surgery. Three study cases subsequently came to autopsy, and no proliferative lesions were found. This and other evidence strongly suggest that these lesions not only are artefactual, but also are a common occurrence. They are likely produced during cardiac surgery by the cardiotomy suction, with compaction of friable mesothelial strips, other tissue debris, and fibrin into tumor-like fragments that may be transported around the operative site on the suction tip.
Electronmicroscopy and electron probe energy dispersive X-ray analysis studies have substantially contributed to our understanding of the various gastrointestinal tract melanoses. The nature of the pigment granules which occur in the various melanoses is discussed; their pattern of distribution in melanosis coli, melanosis ilei, melanosis duodeni and melanosis oesophagi is summarized and current knowledge of the aetiology and pathogenesis of these conditions is reviewed. Brief mention is also made of other examples of lipofuscin pigmentation, and a case of haemosiderosis ilei is described.