Constricted varicose veins for CABG.
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Coronary Artery Bypass↗
Biomedical subjects
V Parsonnet
Publications and source records attributed to V Parsonnet.
Stenting of proximal venous obstructions to maintain hemodialysis access.
PURPOSE: The purpose of the study was to evaluate the efficacy of stenting central venous obstructions in patients dependent on hemodialysis to preserve or restore central venous patency and allow for continued hemodialysis from the affected side. METHODS: Twenty-five self-expanding (17) and balloon-expandable (8) stainless steel stents were deployed in 19 patients with end-stage renal disease and central venous stenosis or occlusion. Nineteen lesions were treated: 11 subclavian and eight innominate. Twenty-two stents were initially implanted. RESULTS: Stent deployment was successful in all cases and immediately remedied the underlying cause of venous hypertension. Follow-up at up to 17 months revealed three deaths from unrelated causes, one occlusion at 3.25 months, and three restenoses at 16 days, 2.5 and 5 months, respectively, with successful implantation of three additional stents for a primary central patency rate of 68% (+/- 14%) and secondary central patency rate of 93% (+/- 7%). CONCLUSIONS: Stenting of subclavian and innominate venous stenoses and occlusions effectively corrected the underlying lesions responsible for disturbed hemodynamics and, in most cases, prolonged available hemodialysis access from the affected side. Stents seem to be valuable adjuncts in the management of failing hemodialysis access due to central venous stenosis or occlusion.
Adult↗
Report of the NASPE Policy Conference training requirements for permanent pacemaker selection, implantation, and follow-up. North American Society of Pacing and Electrophysiology.
NASPE proposes and supports the concept of a two-tracked training system in cardiac pacing. Track I training will properly train physicians for the prescription of pacemakers and the monitoring of pacemaker patients, and track II training will properly prepare physicians for the implantation of pacemakers. Regardless of specialty (cardiologist or surgeon) or training venue (cardiac pacing fellowship, cardiac electrophysiology and pacing fellowship, sabbatical or mentor sponsored training), it is recommended that these minimum standards be required for hospital credentialing. NASPE also supports the voluntary institution by training program directors of core pacing training in cardiovascular disease and cardiac electrophysiology fellowships. This core training does not in itself constitute proper track I or II training for physicians interested in adequately prescribing, monitoring, or implanting cardiac pacemakers.
Cardiac Pacing, Artificial↗
The usefulness of a stretch-polyester pouch to encase implanted pacemakers and defibrillators.
This study was undertaken to assess the effects of enclosing permanent pacemaker and ICD pulse generators in a stretch-polyester pouch prior to implantation. Follow-up of 223 patients with oversized pacemakers and with ICDs and 344 with standard-sized pacemaker pulse generators showed that the pouch was effective in decreasing the frequency of pulse generator migration and extrusion.
Defibrillators, Implantable↗
A new method for diagramming pacemaker electrocardiograms.
Advancements in technology have made paced ECG interpretation increasingly difficult. A new method for depicting the complex pacemaker/heart interactions that eliminates the extensive use of symbols and repetitious use of refractory period and rate limit information of previous methods has been devised. The method uses a framework of parallel horizontal lines drawn on grid paper underneath the ECG. The lines are spaced apart by the actual programmed values (lower rate, AV, VA intervals) of the pacemaker in question. This framework allows the simultaneous use of the horizontal and vertical directions for the diagram of pacemaker timing intervals. Also, a single representation of refractory periods, upper rate intervals, and other variables can be labeled vertically and extrapolated horizontally across the entire diagram. Single chamber, dual chamber, and rate-modulated ECGs are readily represented. The diagram is easily plotted on standard ECG paper and flexible enough to represent complex ECGs.
Atrial Function↗
Report of the NASPE Policy Conference on antibradycardia pacemaker follow-up: effectiveness, needs, and resources. North American Society of Pacing and Electrophysiology.
On May 4-5, 1993, a policy conference was held in San Diego, California, under the sponsorship of the North American Society of Pacing and Electrophysiology (NASPE) to identify the fundamental goals of antibradycardia pacemaker follow-up, evaluate the effectiveness with which it achieves those goals, and formulate specific recommendations as to how it can be made more effective. The conference addressed clinical, administrative, and educational objectives, focusing on existing and potential resources for follow-up testing and the appropriate frequency of their application. The training of physicians and associated professionals engaged in follow-up also was addressed, as were regulatory and reimbursement issues. This report summarizes the conclusions and recommendations arrived at during the conference and subsequently approved by the NASPE Board of Trustees.
Bradycardia↗
Safety, feasibility and long term follow-up of a non-thoracotomy defibrillation system in patients with inducible sustained ventricular tachycardia/fibrillation.
UNLABELLED: A non-thoracotomy lead system CPI-ENDOTAK, a transvenous lead used alone or combined with a subcutaneous patch (SQ-P), was evaluated as an alternative to epicardial patches/electrodes in patients at high risk for sudden cardiac death undergoing implantable cardioverter-defibrillator (ICD) surgery. Fifty nine patients, 62 +/- 11.4 years with CAD (83.0%) cardiomyopathy (11.9%) other (5.1%), mean ejection fraction 31.8 +/- 14%, with inducible sustained VT/VF underwent testing of either lead alone or lead/SQ-P. Four configurations of NTL were tested. Fifty one patients had NTL implanted (lead alone = 60.8% and lead/SQ-P = 39.2%). Eight patients required non-NTL approaches, due to high DFT (7) or anatomic anomaly (1). DFT's were 19.1J (lead alone) and 20.8J (lead/SQ-P). Acute complications: pulmonary embolism 1, lead dislodgement 3, sensing malfunction 1. [table: see text] CONCLUSION: A NTL system using either a single transvenous lead alone or combined with SQ-P can be implanted successfully in high risk patients with a low incidence of acute complications. Non-arrhythmic survival is lowest in patients receiving defibrillation shocks. Arrhythmic survival is high in all patients.
Aged↗
Transcutaneous ultrasonography can be used to guide and monitor balloon angioplasty.
PURPOSE: Percutaneous balloon angioplasty is an accepted technique for the treatment of short segmental stenoses of the iliac and superficial femoral arteries. Some surgeons have not embraced this technique because of lack of training, unfamiliarity with radiologic equipment, or poor-quality fluoroscopy equipment in the operating room. A new technique, ultrasound-directed balloon angioplasty, enables the vascular surgeon to guide the catheter and evaluate the progress of the procedure without the use of radiographic imaging. METHODS: The new catheter is integrated externally into a standard duplex scanner. A spherical brass bead positioned on the catheter shaft in the middle of the balloon is covered with a piezoelectric material. This omnidirectional receiver is connected through a wire to a catheter interface system, which allows the exact position of the balloon to be represented on the screen of a duplex unit. The catheter is advanced under visual control with use of the scanner. RESULTS: The system has been used to perform balloon angioplasty on 21 lesions (16 superficial femoral, 3 iliac, 2 popliteal arteries) in 17 patients. Procedures in 16 patients were performed percutaneously; in an additional patient bilateral angioplasties were performed during operation. The balloon was successfully positioned in each case with use of ultrasonography alone; each procedure was confirmed by use of angiography. Angioplasty was accomplished in 16 (76%) of 21 with the ultrasound-guided catheter alone. Supplemental use of a high-pressure balloon or atherectomy device was necessary in five patients. CONCLUSIONS: This technique records physiologic and anatomic data in real time so that the progress of the angioplasty can be monitored. In three patients the inadequacy of the initial angioplasty was recognized by a persistent velocity increase but not by angiography. As a result corrective measures were taken. This new procedure allows vascular surgeons to use equipment with which they are familiar, reduces the risk of ionizing radiation and contrast nephropathy, and permits the monitoring of the angioplasty with hemodynamic parameters.
Angioplasty, Balloon↗
Chest PA and lateral.
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Defibrillators, Implantable↗
Passage of a pacemaker lead into the pericardial cavity: an unusual introducer complication.
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Electrodes, Implanted↗
Beep detection technique for immediate documentation of R wave sensing by an implanted defibrillator.
A technique is described for follow-up clinic evaluation and documentation of R wave detection by an implanted defibrillator that emits audible tones upon magnet application whenever an R wave or other signal is sensed. A circuit comprising an electret microphone, an instrumentation amplifier, a high-pass filter, and an envelope detector is used to generate a signal that may be plotted together with a surface-lead electrocardiogram on a two-channel strip-chart recorder. The resulting plot documents the sensing function of the implanted device and serves as an indication of optimal magnet position. Alternatively, the beep detector output could be used to trigger the inscription of fiduciary markers on a single-channel strip-chart recorder equipped with an auxiliary input for this purpose.
Defibrillators, Implantable↗
The Bilitch Registry.
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Defibrillators, Implantable↗
North American Society of Pacing and Electrophysiology policy statement. The NASPE/BPEG defibrillator code.
A new generic code, patterned after and compatible with the NASPE/BPEG Generic Pacemaker Code (NBG Code) was adopted by the NASPE Board of Trustees on January 23, 1993. It was developed by the NASPE Mode Code Committee, including members of the North American Society of Pacing and Electrophysiology (NASPE) and the British Pacing and Electrophysiology Group (BPEG). It is abbreviated as the NBD (for NASPE/BPEG Defibrillator) Code. It is intended for describing the capabilities and operation of implanted cardioverter defibrillators (ICDs) in conversation, record keeping, and device labeling, and incorporates four positions designating: (1) shock location; (2) antitachycardia pacing location; (3) means of tachycardia detection; and (4) antibradycardia pacing location. An additional Short Form, intended only for use in conversation, was defined as a concise means of distinguishing devices capable of shock alone, shock plus antibradycardia pacing, and shock plus antitachycardia and antibradycardia pacing.
Defibrillators, Implantable↗
Early emergent coronary bypass after failed angioplasty.
Emergency CABG for failed coronary angioplasty was required in 3.3 percent of 1,625 consecutive patients undergoing angioplasties. Twenty-six percent of the patients died in the perioperative period. Efforts must be concentrated on identifying PTCA failure prior to cardiogenic shock.
Aged↗
Cardiac transplantation in New Jersey.
Heart transplantation is an effective treatment for end-stage congestive heart failure resulting in a one-year survival of 80 percent and a return to normal function in 90 percent of survivors. Refinements in the pre- and postoperative medical management of transplant recipients portend further benefits.
Actuarial Analysis↗
Early emergent coronary bypass after failed angioplasty.
Emergency CABG for failed coronary angioplasty was required in 3.3 percent of 1,625 consecutive patients undergoing angioplasties. Twenty-six percent of the patients died in the perioperative period. Efforts must be concentrated on identifying PTCA failure prior to cardiogenic shock.
Angioplasty, Balloon, Coronary↗
Survey of cardiac pacing in the United States in 1989.
A survey of physicians who implant permanent cardiac pacemakers was conducted to identify practice patterns related to pacemaker-implantation frequency, hospital and implantation-facility characteristics, indications for pacing and pulse-generator replacement, preferences regarding device types, pacing modes, follow-up methods and frequency, and type and frequency of pacing-related complications. Questionnaires were sent to 11,414 potential physician respondents and 6 pacemaker manufacturers. Implanters' opinions were solicited regarding such issues as the importance of various device features and capabilities, the appropriateness of practice guidelines, and the efficacy of quality-assurance measures. In 1989, 89,445 primary pacemaker implantations and 21,055 pulse-generator replacements were performed by approximately 7,919 physicians at about 3,400 U.S. centers. Typically, a pacemaker manufacturer's sales representative played an active role in 80% of cases. Since the last survey, which examined pacing practices in 1985, primary implantations of dual-chamber pacemakers increased from 22 to 32%, and the proportion of adaptive-rate pacemakers increased from 1 to 40% of primary implants. The "typical" implanter used bipolar electrode systems in 90% of cases, single-chamber pacemakers in 70%, and the introducer method in 95% of lead placements. Significant differences in practice patterns were found among subsets of the survey respondents. Surgeons tended to work alone, use simpler, single-chamber pacemakers, and leave follow-up to others. Electrode stability tended to be better among implanters in nonacademic environments. The quadrennial survey continues to provide useful information on an easily identifiable and traceable patient population, but the process would be greatly simplified by the adoption of a "universal" reporting system such as that used in Europe.
Adult↗
Modified technique of internal mammary artery harvest.
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Dissection↗