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Biomedical subjects

W A Stinson

Publications and source records attributed to W A Stinson.

8 recordsLinked to original sources
PubMed1999

Reliability of transthoracic echocardiography in the assessment of aortic valve morphology: pathological correlation in 178 patients.

OBJECTIVE: To examine patient characteristics affecting the utility of transthoracic echocardiography in determining aortic valve morphology, particularly for the diagnosis of congenital bicuspid aortic valve (BAV). DESIGN: A retrospective comparison of preoperative echocardiographic determination of aortic valve morphology with pathological findings of the explanted valves. SETTING: A tertiary referral centre. PATIENTS: Consecutive patients who had aortic valve replacement between July 1994 and April 1996, and had preoperative echocardiograms. RESULTS: Of 313 patients, 181 (58%) had preoperative echocardiography. Three of the valves were excluded because they were too fragmented for pathological determination of valvular morphology. In the remaining 178 patients, aortic valvular morphology was determined by echocardiography in 104 (58%). Multivariate analysis showed that echocardiography was successful less often in women (odds ratio 0.44, P = 0.03) and in patients with densely calcified valves (odds ratio 0.69, P = 0.02), whereas age had no effect (odd ratio 0.99, P = 0.42). In those with adequate echocardiographic images, echocardiography had both a high sensitivity (0.92) and a high specificity (0.96) for the diagnosis of BAV. CONCLUSIONS: Echocardiography is a useful tool for the diagnosis of BAV, although suboptimal images may pose a problem in many patients, particularly women and patients with heavily calcified valves. When adequate images are obtained, transthoracic echocardiography can reliably identify aortic valvular morphology in most patients.

Aged↗
PubMed1998

Implantable cardioverter-defibrillators and the pathologist: comment and cautionary notes.

This paper briefly reviews the components of, the clinical uses of, the techniques to place, and the complications related to implantable cardioverter-defibrillators (ICDs). Information useful in the specific identification of ICDs is presented. A series of recommendations for the autopsy examination or postmortem explantation of ICDs by the pathologist is given. Because of the serious risk of injury to the pathologist possible with postmortem discharges of ICDs which have not been deactivated, and because of the risk of device explosion if the ICD is incinerated, a number of cautionary notes are provided. A brief case with occurrence of accidental postmortem discharge of an active ICD is also presented.

Accidents, Occupational↗
PubMed1995

Postinfarct cardiac free wall rupture: the relationship of rupture site to papillary muscle insertion.

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)

Aged↗
PubMed1994

Tissue fragments recovered at cardiac surgery masquerading as tumoral proliferations. Evidence suggesting iatrogenic or artefactual origin and common occurrence.

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.

Adult↗
PubMed1994

Cicatricial changes in a Ionescu-Shiley bioprosthesis.

The mitral Ionescu-Shiley standard-profile prosthesis of a 53-year-old woman who had it placed 12 years previously is described. The observed cicatricial retraction of one of the bioprosthesis' cusps is unusual, and it contributed to the bioprosthetic dysfunction which necessitated this valve's replacement.

Aortic Valve↗
PubMed1991

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.

Adolescent↗