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Biomedical subjects

W C Sheldon

Publications and source records attributed to W C Sheldon.

At least 55 records · Page 3Linked to original sources
PubMed1977

Internal mammary artery graft for ischemic heart disease. Effect of revascularization on clinical status and survival.

Four hundred consecutive patients, 80 percent of whom had multiple vessel obstruction, received a single internal mammary artery graft (121 patients) alone or combined with vein grafts (279 patients) in 1971 and 1972. Four patients died during or within 30 days of the operation. Sixteen patients had intraoperative infarction; three died. Arteriography was performed postoperatively (mean 12 months) in 254 patients, and 248 of 261 internal mammary artery grafts (95 percent) and 195 of 237 vein grafts (82 percent) were patent. Follow-up was complete (mean interval 38 months); all 80 patients with single vessel disease are alive, and the 3 year survival rate for patients with double and triple vessel disease was 98.7 and 94.4 percent, respectively. Comparison of longevity of 741 patients who had received vein grafts in 1967 to 1970 with that of 400 patients with internal mammary artery grafts (1971 to 1972) indicates greater survival for the recent series (P less than 0.004). Factors responsible for improved survival include (1) reduced operative mortality, (2) fewer intraoperative infarctions, (3) more complete revascularization, and (4) higher patency rate of the internal mammary artery graft.

Adult↗
PubMed1977

Ventricular tachyarrhythmias following surgery for myocardial revascularization. A follow-up study.

Of 1,599 patients who underwent surgery for direct myocardial revascularization in 1973 at Cleveland Clinic Hospital, 19 patients (1.2 percent) developed primary ventricular fibrillation or ventricular tachycardia during the immediate postoperative period. Occurrence of postoperative ventricular tachyarrhythmias could not be predicted by assessment of preoperative symptoms or by evaluation of the extent of coronary artery disease and left ventricular function. There was no increase in early or late mortality or morbidity (including postoperative myocardial infarction) among patients who developed postoperative primary ventricular tachyarrhythmias.

Angina Pectoris↗
PubMed1976

Ectopic origin of the left anterior descending coronary artery from the right coronary sinus. Report of a case simulating anterior descending obstruction.

A patient with anomalous aortic origin of the left anterior descending coronary artery was studied. The clinical picture and the preliminary angiographic findings simulated obstruction of the left anterior descending coronary artery near its origin. Careful catheter exploration of the right coronary sinus led to the correct diagnosis, emphasizing the importance of complete visualization of all branches of the coronary tree, including distal radicles of a supposedly occluded vessel.

Adult↗
PubMed1975

Coronary arteriographic findings in 1,000 women under age 50.

In a consecutive series of 1,000 women under age 50 examined by coronary cinearteriography principally for evaluation of chest pain, 236 had at least 50 percent narrowing of one or more coronary arteries. The youngest, and the only patient who died, was 26 years old. The anterior descending coronary artery was the vessel most frequently involved; the right coronary artery was most often totally occluded. The amount of arterial involvement seemed to be related to the duration of symptoms. Only 10 percent of women with serum cholesterol levels under 200 mg/100 ml had significant coronary artery disease, whereas 44 percent of those with levels over 275 mg/100 ml had significant disease. Electrocardiographic evidence of myocardial infarction was uncommon in women with single vessel disease, but left ventriculograms disclosed that additional patients had areas of decreased contractility. Eleven of 46 women with electrocardiographically diagnosed myocardial infarction had no significant coronary artery disease. The cause of the electrocardiographic finding remained obscure in some. Although there was an excellent correlation of clinical diagnoses with arteriographic findings in women thought not to have angina pectoris, only half of those thought to have angina pectoris had significant coronary artery disease. This finding may be a major reason for recommending coronary arteriography for the evaluation of angina-like pain in women under age 50.

Adult↗
PubMed1975

The structural study of the saphenous vein.

From November, 1971, to September, 1974, 1,179 patients received aortocoronary saphenous vein bypass grafts at the Cleveland Clinic Hospital. Segments of saphenous vein from each patient were sent for microscopical analysis. These vein segments were classified as normal or abnormal (phlebosclerotic). Four hundred ninety-six normal vein grafts in 295 patients were restudied and had a patency of 87.9%. One hundred forty-four abnormal vein grafts in 86 patients were restudied and showed 89.5% patency. This study suggests that histopathological identification of an abnormal (phlebosclerotic) vein segment does not constitute a determining factor as far as late patency is concerned in a vein segment that is not grossly sclerotic.

Adult↗
PubMed1975

Results of graft surgery for coronary artery disease: a progress report.

Coronary artery surgery is here to stay, but it will continue to be influenced by accumulating experience and evolving techniques. Direct internal mammary-to-coronary artery anastomoses offer the hope for improved results in certain patients. Tissue-compatible prosthetic grafts could be developed and offer an alternative in selected patients. Improved microsurgical techniques may permit broader applications with multiple grafts to smaller branches in patients with more diffuse disease. We are continually reminded, however, that surgical treatment is palliative, and that most of these patients will ultimately die of their disease. Thus the search for a better understanding of the arteriosclerotic process and improved methods for altering the course of the disease becomes more important than ever.

Coronary Angiography↗
PubMed1975

The spectrum of exercise test and angiographic correlations in myocardial revascularization surgery.

Maximal exercise tests and angiographic evaluations were obtained in a group of patients before and after myocardial revascularization. Patients were classified on the basis of angiography and operative records. Two primary groups of 33 patients with complete revascularization and 95 patients with postoperative residual ischemia were studied. The residual ischemia subgroups included patients with partial revascularization, progressive coronary atherosclerosis, or graft failure. Patients with complete revascularization had statistically significant improvements in work capacity, maximal heart rate, maximal rate-pressure products, abnormal exercise electrocardiograms, exercise-induced angina pectoris, and atrial gallop sounds. A spectrum of lesser improvements in these measurements was observed in the subgroups with residual ischemia. Total graft failure resulted in no significant improvements in exercise-test parameters. Maximal stress tests provide a useful adjunct to routine clinical follow-up of myocardial revascularization patients. Myocardial revascularization is associated with significant patient palliation as determined by serial stress testing.

Angina Pectoris↗