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Biomedical subjects

W C Roberts

Publications and source records attributed to W C Roberts.

At least 487 records · Page 27Linked to original sources
PubMed1981

Coronary artery disease in the Hurler syndrome. Qualitative and quantitative analysis of the extent of coronary narrowing at necropsy in six children.

The amount of cross-sectional area luminal narrowing in each 5 mm segment of each of the four major epicardial coronary arteries (right, left main, left anterior descending and left circumflex) is described at necropsy in six children (aged 3 to 16 years) with the Hurler syndrome. In five patients at least one of the four major coronary arteries was narrowed 76 to 100 percent, and in four of these five patients all four major arteries were narrowed to this extent. Of the 24 major coronary arteries in the six patients, 17 (71 percent) were narrowed 76 to 100 percent at some point. A total of 182 segments were examined from the 24 major coronary arteries, and the extent of narrowing was as follows: 96 to 100 percent, 14 (8 percent); 76 to 95 percent, 61 (34 percent); 51 to 75 percent, 59 (32 percent); 26 to 50 percent, 39 (21 percent) and 0 to 25 percent, 9 (5 percent). By applying a score of 1 to 4 to each 5 mm segment according to its category of narrowing (1 = 0 to 25 percent; 2 = 26 to 50 percent; 3 = 51 to 75 percent and 4 = 76 to 100 percent), the 182 segments had a total score of 570 and a mean score of 3.2, indicating that each segment was narrowed an average of about 67 percent in cross-sectional area. Thus, narrowing of the major epicardial coronary arteries at necropsy is usually diffuse and severe in the Hurler syndrome, which is the cause of the most severe coronary narrowing in childhood.

Adolescent↗
PubMed1981

Fatal cardiac arrest during cardiac catheterization for angina pectoris: analysis of 10 necropsy patients.

Data on 10 patients with angina pectoris and fatal cardiac arrest during cardiac catheterization were analyzed to determine the circumstances of death and the severity and distribution of the coronary arterial narrowing. Nine patients died during attempted coronary angiography, and the remaining patient during right-sided cardiac catheterization. At least three of four major epicardial coronary arteries were narrowed 76 to 100 percent in cross-sectional area by atherosclerotic plaques in all 10 patients. Seven of these patients had this degree of narrowing of the left main coronary artery by plaque, and two additional patients had severe (more than 75 percent) narrowing of the left main coronary artery by thromboembolic material superimposed on small atherosclerotic plaques. Among 354 five mm long segments of the left main, left anterior descending, left circumflex and right coronary arteries in eight patients, the percent narrowing to various degrees in cross-sectional area by atherosclerotic plaques was as follows: 96 to 100 percent, 9; 76 to 95 percent, 49; 51 to 75 percent, 23; 26 to 50 percent, 13; and 0 to 25 percent, 6. With use of a scoring system of 1 to 4 for the amount of narrowing in each 5 mm segment (1 = 0-25 percent, 2 = 26 to 50 percent, 3 = 51 to 75 percent and 4 = 76 to 100 percent), the mean score per 5 mm segment for the group was 3.34. Thus, patients with angina pectoris who die during cardiac catheterization have particularly severe and diffuse coronary atherosclerosis and usually severe narrowing of the left main coronary artery.

Adult↗
PubMed1981

Effect of chronic hypercalcemia on the heart. An analysis of 18 necropsy patients.

Certain clinical and morphologic cardiac observations are described in 18 necropsy patients, aged 33 to 58 years (mean 45 years) (14 women), with chronic hypercalcemia (11.6 to 34.4 mg/dl [19.4]) from one to nine years (mean five years). Primary hyperparathyroidism was present in nine patients and secondary hyperparathyroidism in the other nine (of renal origin in seven). Cardiac valve anular and coronary arterial calcific deposits were present in 10 patients (Group I) including four (mean age 51 years) with considerable narrowing of two or three of the four major epicardial coronary arteries. None of the other eight patients (Group II) had cardiac valve anular or cuspal calcific deposits; only two had coronary calcific deposits, small in each, and none had significant coronary luminal narrowing. Calcium was in the media ("medial calcinosis"), with or without intimal deposition, of the coronary arteries in five patients. Comparison of the patients in Group I to those in Group II disclosed similar mean ages, durations of hypercalcemia and serum calcium levels, but significantly (p less than 0.05) higher mean total serum cholesterol levels (216 versus 163 mg/dl) and heart weights (426 versus 320 g). This study demonstrates that chronic hypercalcemia is associated with accelerated deposition of calcium in the cardiac anuli and valvular cusps, in the media and intima of the coronary arteries and in individual myocardial fibers (dystrophic calcification), and that coronary intimal calcification may be associated with or produce luminal narrowing, especially in patients with serum total cholesterol levels over 200 mg/dl. Thus, chronic hypercalcemia may be viewed as a "risk factor" to accelerated coronary atherosclerosis.

Adult↗
PubMed1981

Coronary arterial disease in systemic lupus erythematosus; quantification of degrees of narrowing in 22 necropsy patients (21 women) aged 16 to 37 years.

The degrees of cross-sectional area luminal narrowing by atherosclerotic plaques of each 5 mm long segment of each of the four major (right, left main, left anterior descending and left circumflex) epicardial coronary arteries in 22 necropsy patients (age 16 to 37 years, 21 women) with systemic lupus erythematosus (SLE) was determined, and the findings were compared to those in 13 control subjects. Of 623 coronary segments (5 mm long) in the patients with SLE, 80 (13 percent) were narrowed 76 to 100 percent (controls = 0 of 431 segments); 125 (20 percent), 51 to 75 percent (controls = 6 percent); 273 (44 percent), 26 to 50 percent (controls = 31 percent). Of the 22 patients with SLE, 10 had one or more of the four major coronary arteries narrowed 76 to 100 percent in cross-sectional area, and 12 patients had lesser degrees of narrowing similar to that in the 13 control subjects. The 10 patients with SLE and severe coronary narrowing compared to the 12 patients with SLE and no severe (greater than 75 percent) coronary narrowing had significantly higher (1) mean values of total serum cholesterol (382 versus 290 mg/dl), (2) mean systolic/diastolic systemic arterial pressures (175/119 versus 151/93 mm Hg), (3) frequencies of mitral valvular disease (seven of 10 patients versus none of 12 patients) and (4) frequencies of pericardial adhesions (seven of 10 patients versus three of 12 patients).

Adolescent↗
PubMed1981

Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart.

Certain clinical and necropsy findings are described in 16 young (aged 15 to 33 years) patients who received greater than 3,500 rads to the heart five to 144 months before death. All 16 had some radiation-induced damage to the heart: 15 had thickened pericardia (five of whom had evidence of cardiac tamponade); eight had increased interstitial myocardial fibrosis, particularly in the right ventricle; 12 had fibrous thickening of the mural endocardium and 13 of the valvular endocardium. Except for valvular thickening, the changes were more frequent in the right side of the heart than in the left, presumably because of higher radiation doses to the anterior surface of the heart. In six of the 16 study patients and in one of 10 control subjects, one or more major epicardial coronary arteries were narrowed from 76 to 100 percent in cross-sectional area by atherosclerotic plaque; one patient had a healed myocardial infarct at necropsy and one died suddenly. In 10 patients and in the 10 control subjects, the four major epicardial coronary arteries were examined quantitatively: 6 percent of the 469 five millimeter segments of coronary artery from the patients were narrowed from 76 to 100 percent (controls = 0.2 percent, p = 0.06) and 22 percent were narrowed from 51 to 75 percent (controls = 12 percent). The proximal portion of the arteries in the patients had significantly more narrowing than the distal portions. The arterial plaques in the patients were largely composed of fibrous tissue; the media were frequently replaced by fibrous tissue, and the adventitia were often densely thickened by fibrous tissue. In five patients, there was focal thickening (with or without luminal narrowing) of the intramural coronary arteries. Thus, radiation to the heart may produce a wide spectrum of functional and anatomic changes but particularly damage to the pericardia and the underlying epicardial coronary arteries.

Adolescent↗
PubMed1981

Survival for 20 years or longer after transmural acute myocardial infarction: analysis of eight well-documented necropsy patients.

Clinical and necropsy findings are described in eight patients who lived 20 to 31 years (mean 24 years) after healing of a transmural acute myocardial infarct. Two had left ventricular aneurysms and one had both right and left ventricular infarcts. Survival for 2 decades or more after healing of a transmural acute myocardial infarct has rarely been documented and descriptions of hearts at necropsy in patients with well-documented infarcts 20 years or more earlier are virtually nonexistent.

Adult↗
PubMed1981

Non-fatal healed transmural myocardial infarction and fatal non-cardiac disease. Qualification and quantification of coronary arterial narrowing and of left ventricular scarring in 18 necropsy patients.

A qualitative and quantitative analysis of the amount of myocardial scarring and the degree and extent of coronary arterial narrowing by atherosclerotic plaque in the entire lengths of each of the four major epicardial coronary arteries is described in 18 necropsy patients with healed transmural myocardial infarcts and death from a non-cardiac condition. An average of 30 per cent of the basal half and 38 per cent of the apical half of the left ventricular wall was scarred. The nine patients with clinical evidence of previous acute myocardial infarction tended to have larger left ventricular scars than the nine patients without such evidence but the difference was not significant. An average of 26 cm (51 5 mm segments) of coronary artery were examined from each patient ad 25 cm (49 5 mm segments) from each of 19 control subjects. Of 924 segments examined in the 18 patients, 292 (32%) were 76 to 100 per cent narrowed in cross-sectional area (controls = 5); 321 (35%) were 51 to 75 per cent narrowed (controls = 34%); 210 (23%) were 26 to 50 per cent narrowed (controls = 44%), and 101 (11%) were 0 to 25 per cent narrowed (controls = 17%). The extent of severe narrowing of 75 per cent or more was similar (25%) in the left anterior descending and left circumflex coronary arteries; the right was the most severely narrowed artery and the left main was not severely narrowed in any patient. Excluding, then, the left main artery, the amount of severe narrowing in the proximal and distal halves of the other three vessels was similar. The amount of severe narrowing was not related to the age at death or to heart weight, but was greater in patients with hypertension or with a history of acute myocardial infarction.

Aged↗
PubMed1981

Calcific deposits developing in a bovine pericardial bioprosthetic valve 3 days after implantation.

Calcific deposits, localized in a thin layer of thrombus covering the cuspal surfaces, were present 3 days after implantation in a valved pulmonic conduit that contained an Ionescu-Shiley bovine pericardial valve and was placed in a 29-year-old man with double outlet right ventricle, valvular and infundibular pulmonic stenosis, and ventricular septal defect. Factors that may have contributed to such a rapid calcification were the relatively young age of the patient, the development of acute renal insufficiency postoperatively, and the administration of large amounts of calcium chloride intravenously during blood transfusions and during episodes of cardiac arrest.

Adult↗
PubMed1981

Significance of coronary arterial thrombus in transmural acute myocardial infarction. A study of 54 necropsy patients.

In 54 necropsy patients with transmural acute myocardial infarction (AMI) and coronary arterial thrombi, histologic sections of coronary arteries that contained the thrombi were examined by video-planimetry to determine if the amount of luminal narrowing caused by thrombi was comparable to that produced by underlying atherosclerotic plaques, and to determine the amount of luminal narrowing by plaques immediately proximal and distal to the thrombi. The 54 coronary arteries in the 54 patients were narrowed 33-98% (mean 81%) by atherosclerotic plaque alone in cross-sectional area at the site of the thrombus (occlusive in 47 and nonocclusive in seven), from 26-98% (mean 75%) within the 2-cm segment proximal to the thrombus, and from 43-98% (mean 79%) within the 2-cm segment distal to the thrombus. Of the 54 arteries, 52 (96%) were narrowed 76-98% in cross-sectional area by atherosclerotic plaque alone at or immediately proximal or distal to the thrombus and 26 (48%) were narrowed 91-98% by plaque alone. The thrombi were 0.1--6.0 mm2 (mean 1.4 mm2) in cross-sectional area and the underlying atherosclerotic plaques were 3.0-21.0 mm2 (mean 8.7 mm2). Thus, among necropsy patients with transmural AMI, coronary thrombi occur at sites already severely narrowed by atherosclerotic plaques.

Acute Disease↗
PubMed1981

Accuracy of angiographic determination of left main coronary arterial narrowing. Angiographic--histologic correlative analysis in 28 patients.

To evaluate the accuracy of coronary angiography in identifying severe narrowing of the left main coronary artery (LMCA), the degree of narrowing observed by angiography was compared to that observed at necropsy in 28 patients with symptomatic coronary heart disease in whom angiography had been performed within 40 days of death. The angiograms were evaluated independently by three experienced angiographers. In 20 of the 28 patients (71%), the degree of narrowing of the LMCA was either underestimated (13 patients) or overestimated (10 patients) by two or three of three angiographers; of 84 angiographic judgments made by the three angiographers in the 28 patients, 54 (64%) were underestimates (33 judgments, 39%) or overestimates (21 judgments, 25%) of the degree of LMCA narrowing. Of 12 LMCAs narrowed 76-100% in cross-sectional area at necropsy, six were underestimated at preoperative angiography by two or three of three angiographers; of 12 LMCAs narrowed 51-75% in cross-sectional area at necropsy, all 12 were either under- or overestimated angiographically by two or three of three angiographers; of four LMCAs narrowed 26-50% in cross-section at necropsy, two were overestimated by two of three angiographers. Thus, angiographic determination of degrees of narrowing of the LMCA during life is subject to considerable error. The angiographic errors appear to have resulted primarily from the presence of atherosclerotic plaque in the LMCA and an insufficient number of angiographic projections.

Adult↗
PubMed1981

Right ventricular outflow obstruction from thrombus with small peripheral pulmonary emboli.

A patient is described with clinical features of massive pulmonary embolism and a normal pulmonary angiogram. At necropsy, a large thrombus obstructed right ventricular outflow. A right atrial or right ventricular angiogram is suggested in patients suspected of having pulmonary embolism when a pulmonary angiogram shows the pulmonary trunk and main right and left pulmonary arteries to be normal.

Adult↗
PubMed1981

Running to death.

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Arteriosclerosis↗
PubMed1981

Transmural myocardial infarction in hypertrophic cardiomyopathy: a cause of conversion from left ventricular asymmetry to symmetry and from normal-sized to dilated left ventricular cavity.

Transmural myocardial infarction in the absence of epicardial coronary arterial narrowing is fairly common at necropsy in patients with hypertrophic cardiomyopathy. Although difficult to diagnose clinically in patients with hypertrophic cardiomyopathy, acute myocardial infarction occasionally has a typical presentation, as in the patient presented in this report. More often, however, transmural acute myocardial infarction in patients with hypertrophic cardiomyopathy is not associated with classic signs and symptoms, but leads to production of, or worsening of, congestive cardiac failure which thereafter usually rapidly progresses. Thus, transmural myocardial infarction is a major complication of hypertrophic cardiomyopathy.

Adult↗