Biomedical subjects
V M Walley
Publications and source records attributed to V M Walley.
Critical anatomic dimensions for intrathoracic circulatory assist devices.
The design of totally implantable circulatory support devices must account for the anatomical constraints of the body cavity. To aid development of an implantable electrohydraulic ventricular assist device (EVAD), thoracic anatomical measurements and fit trials were performed. Various dimensions of the thoracic cavity were measured in 19 preserved and fresh cadavers. The mean left ventricle apex to chest wall distance was 2.7 +/- 0.2 cm. The mean sagittal radius of curvature at the fifth rib was 11.1 +/- 0.4 cm, and the transverse radius at the fifth rib was 9.4 +/- 0.3 cm. The mean sternal length was 18.9 +/- 1.2 cm. Using these measurements a model measuring 17.5 x 10.5 x 3.8 cm was designed. This model was placed in the chest of 11 patients undergoing open heart surgery. In one patient there was significant lung compression and in another hypotension suggesting great vessel compression. Finally, 1 of 11 patients had a short sternum and a small thorax, and the device did not fit. In conclusion, thoracic measurements may be used in the design of circulatory support devices. The model fit adequately in 73% of patient trials.
Pulmonary veno-occlusive disease and the CREST variant of scleroderma.
Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension. The authors describe a 48-year-old female with the Calcinosis-Raynaud's phenomenon-Esophageal dysmotility-Sclerodactyly-Telangiectasia (CREST) variant of scleroderma who developed acute pulmonary hypertension with pulmonary infiltrates and a normal pulmonary capillary wedge pressure. At post mortem examination typical changes of pulmonary veno-occlusive disease were found. Similarities between this and other cases in the literature suggest a possible association between the CREST variant of scleroderma and pulmonary veno-occlusive disease.
Esophageal intramural pseudodiverticulosis.
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Unusual cardiovascular localization of nonamyloid immunoglobulin deposition disease causing sudden death.
The case of a 38-yr-old man is presented in whom sudden death was attributed to coronary ostial stenosis caused by aortic intimal deposits of an amyloid-like material. Autopsy revealed wide-spread lymphocytic lymphoma with kappa light chain restriction. Histochemistry, immunoperoxidase light microscopy, transmission electron microscopy, and immunoelectron microscopy identified the coronary ostial, and massive other cardiovascular, deposits as para-amyloid of kappa light chain origin.
The University of Ottawa Heart Institute Cardiac Transplant Program: the first 100 transplants. A pathologic study of the explanted hearts.
Since 1984, 122 orthotopic heart transplants have been performed at the University of Ottawa Heart Institute. Of the 114 adult patients, 100 (87.8%) were males and 14 (12.2%) females, with mean ages of 45.8 and 47.9 yr, respectively. The hearts of these adults were pathologically diagnosed as chronic ischemic heart disease (CIHD) in 55 (48.2%), acute ischemic heart disease (AIHD) in 17 (14.9%), dilated cardiomyopathy (DC) in 30 (26.3%), valvular heart disease in five (4.4%), congenital heart disease in three (2.6%), myocarditis in three (2.6%), and other in one (0.9%) of the cases. The adult hearts (94) among the first 100 transplants were studied morphologically, to look for differences among the three major groups with clinical "end-stage" heart failure. The mean heart weights were 435, 356, and 463 gm in the CIHD, AIHD, and DC groups, respectively, with AIHD less than CIHD or DC (p less than 0.01). The ventricular wall thicknesses were similar in CIHD and DC, but the left ventricular (LV) wall thicknesses in AIHD were more than in CIHD or DC (p less than 0.01). The ventricular diameters were greater in DC than in CIHD or AIHD (p less than 0.01) and greater in CIHD than in AIHD (p less than 0.01). The mean LV cavity volumes were 158, 94, and 200 ml in CIHD, AIHD, and DC, respectively, with DC greater than in CIHD or AIHD (p less than 0.01) and CIHD greater than in AIHD (p less than 0.01). The relative differences in AIHD compared to CIHD and DC are referrable to the shorter duration of disease in the acute ischemic group.2+ off
Lambl's excrescences and papillary fibroelastomas: are they different?
OBJECTIVE: To determine if Lambl's excrescences (LEs) and papillary fibroelastomas (PFEs) differ histologically. SETTING: Materials were obtained from post mortem examinations performed at the Ottawa Civic Hospital, a tertiary care teaching hospital in Ottawa, Ontario. DESIGN AND PATIENTS: Hearts with grossly 'classic' PFEs (n = 10) or 'typical' LEs (n = 20) were examined. The patients with PFEs had a mean age of 63.5 years (range 24 to 79), similar to that of 68.1 years (range 47 to 83) for those with LEs. The LEs and PFEs were compared regarding their gross characteristics, sizes, locations and microscopic appearances. MAIN RESULTS: Lesions which were termed LEs had a similar microscopic appearance to grossly categorized PFEs; however, the LEs were smaller and broader-based. Some LEs and PFEs were microscopically indistinguishable. CONCLUSIONS: As LEs and PFEs may be virtually identical microscopically in some instances, separation of these two lesions may be artificial; however, this separation remains useful because it highlights the gross appearances, unusual locations and potential clinical sequelae of papillary fibroelastomas.
Endothelial papillary fibroelastomas arising in and around the aortic sinus, filling the ostium of the right coronary artery.
Endothelial papillary fibroelastomas are rare endocardial and usually valvular lesions, most often found incidentally at autopsy. Occasionally these lesions cause clinical sequelae by embolizing to the heart and brain, or (in the case of valvular ones) by intermittent prolapse into a coronary artery. Papillary fibroelastomas arising in the right coronary ostium, and filling the origin of the right coronary artery are described. Other similar but smaller lesions were found on the surrounding aortic intima. To our knowledge, these are the first such lesions to be described. The case is reviewed in the context of previously published literature on the subject.
Paradoxic air embolism in the absence of an intracardiac defect.
A 58-year-old man experienced paradoxic air embolism with passage of air from the systemic venous to the systemic arterial circulation with subsequent stroke and death. No intracardiac shunt was present. Pulmonary fibrosis concomitant with severe pulmonary arterial hypertension appears to have been responsible for the air traversing the pulmonary capillary bed. This unusual outcome of a complicated central venous catheterization must be borne in mind and guarded against in similar patients.
Patterns of failure in Hancock pericardial bioprostheses.
A series of Hancock pericardial valve bioprostheses was reviewed for cases of primary valve failure. Thirteen mitral and 10 aortic valve explants were recovered from 21 adult patients. Mitral valves had been in place for a mean of 56.4 months, and aortic valves for 53.8 months. All valves failed with cusp tears from stents (with a mean of 1.7 for mitral valves and 2.6 for aortic valves) in a predictable pattern, suggesting that wear and stress at cusp stitch sites are important in their pathogenesis. The topography of these tears is illustrated as are the less common associates of primary failure, such as calcification, fibrosis, and thrombosis. Similarities and differences of this valve's failure compared with that of the Ionescu-Shiley pericardial valve are discussed.
Coronary artery compression at orthotopic cardiac transplantation.
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A study of the sequential morphologic changes after manual coronary endarterectomy.
Manual coronary endarterectomies heal in the long-term by a poorly understood process of myofibrointimal proliferation. A retrospective analysis of detailed cardiovascular pathologic examinations of 51 patients dying at varying intervals after endarterectomy provides insight into the sequence of this proliferative response. Twenty-one patients died within 7 days, 6 at 8 to 30 days, 3 at 31 days to 6 months, 4 at 6 months to 5 years, and 17 at more than 5 years after endarterectomy. The observations made suggest that the denuded arterial surface heals after the fibrin-platelet mural thrombus that covers it is organized and is replaced by fibrosis and myofibroblast proliferation. In unusual cases proliferation is exuberant, resulting in significant restenosis, an outcome in which recurrent atherosclerosis contributes to only a minor degree. This is the first series in which the sequential reparative changes at varying times after manual coronary endarterectomy have been studied.
Regurgitation of fat and marrow emboli into coronary veins during resuscitation.
Three groups of patients were examined at autopsy for the presence of fat and marrow emboli in the lungs, heart, and other organs. Group 1 was composed of patients with massive pulmonary thromboembolism and attempted cardiopulmonary resuscitation; group 2, patients with pulmonary thromboembolism and without attempted cardiopulmonary resuscitation; and group 3, patients without pulmonary thromboembolism and with attempted cardiopulmonary resuscitation. The results confirm that pulmonary fat and marrow emboli are frequent in those patients who are resuscitated. A novel observation is the finding of multiple coexistent cardiac venous emboli in those resuscitated patients who have pulmonary artery obstruction with pulmonary thromboemboli. These findings suggest that these emboli regurgitate from the right side of the heart to the coronary sinus and cardiac veins in cases of pulmonary artery hypertension.
Commissural fusion in an Ionescu-Shiley bioprosthesis: an unusual cause of valvular stenosis.
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Erosion and perforation of a cusp by nodular calcification: an unusual cause of insufficiency in a congenital bicuspid aortic valve.
Aortic valve insufficiency may occur in a number of backgrounds. A unique etiology is illustrated in a 53-year-old man with terminal cardiac failure due to ischemic heart and aortic valvular disease. Nodular calcification complicated a congenital bicuspid valve and caused erosion through a valve cusp, producing a chronic cusp defect and valvular insufficiency.
Anatomic correlations of the long-axis views in biplane transesophageal echocardiography.
The number of views obtainable during transesophageal echocardiography (TE) has been limited by the fixed position of the transducer at the end of the probe. This has confined standard TE studies to short-axis tomography of the heart and aorta. Recently, a biplane TE probe has become available that is capable of both long- and short-axis imaging. This study prospectively assessed the application of the long-axis plane of the biplane probe in providing complementary long-axis views in ambulatory patients. Six standard long-axis views could be obtained and were compared with corresponding anatomic sections to illustrate anatomic relations and facilitate structure identification. The long-axis views provide a better appreciation of the 3-dimensional nature of cardiac anatomy and function, especially in demonstrating the relation of vertically aligned structures.
Late morphologic findings after coronary endarterectomy.
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Death at cardiac catheterization: coronary artery embolization of calcium debris from Ionescu-Shiley bioprosthesis.
The case described is a death due to embolization of calcium debris from a bioprosthesis, dislodged at cardiac catheterization. As more bioprosthetic valves are implanted, and more of them fail long-term with calcification, such complications of the invasive study of these valves may be expected.