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Biomedical subjects

W D Edwards

Publications and source records attributed to W D Edwards.

At least 181 records · Page 10Linked to original sources
PubMed1988

Surgical pathology of the common atrioventricular valve: a study of 11 cases.

Eleven patients (six females and five males) underwent partial or complete excision of common atrioventricular valves. Their ages ranged from 11 months to 23 years (mean, 8 years). Six patients had complex congenital heart disease: three with asplenia, two with polysplenia, and one with a hypoplastic left ventricle and severe pulmonary stenosis. Pure regurgitation characterized all 11 valves and was severe in eight. Neither active nor healed endocarditis was observed in any valve. Of the 11 valves, nine were thickened, and eight had features of floppy valves, including hooding deformity, inadequate chordal insertions, and disruption of the fibrosa by the spongiosa. In ten valves fibrous pads also involved the leaflet surfaces. These observations support the concept that floppy valves may result from congenital abnormalities in valvular development.

Adolescent↗
PubMed1988

Quantitation of leukocytes in endomyocardial tissue from 100 normal human hearts at autopsy. Implications for diagnosis of myocarditis from biopsy specimens of living patients.

From 100 normal human hearts, evenly distributed by age and sex, 5 endomyocardial samples were obtained from the septal surface of each ventricle with a cardiac bioptome. In each case, from both ventricles, the number of lymphocytes, eosinophils, plasma cells, and neutrophils was counted in 10 high-power (x400) microscopic fields, and the mean number of each type of leukocyte was calculated. In 95% of the 2,000 high-power fields, the number of interstitial lymphocytes was less than 5.0. Moreover, in all but one heart, the mean number of lymphocytes was less than 4.0. The mean number of eosinophils was 0.0-0.1 and of plasma cells was 0.0-0.3. The median number of neutrophils was 0.6. Recognition of the normal number of leukocytes in the heart may help to minimize false positive interpretations of myocarditis in biopsy specimens of endomyocardial tissue from living patients.

Autopsy↗
PubMed1988

Quantitation of mast cells in 100 normal and 92 diseased human hearts. Implications for interpretation of endomyocardial biopsy specimens.

In endomyocardial specimens from 100 normal hearts from autopsy, the mean number of mast cells per high-power field was calculated. A peak occurred in the third decade and was more marked in women than men. In the fourth through seventh decades, mean values were greater in men than women. For both sexes, the number of mast cells in the left ventricle tended to exceed that in the right ventricle. The number of mast cells was similarly determined in 92 diseased hearts. The range of mean values overlapped considerably with that of normal hearts. The highest mean values occurred in subjects with mast cell neoplasia, giant cell myocarditis, and lymphocytic myocarditis; and the lowest occurred in the group with amyloidosis. The values in patients with eosinophilic myocarditis did not differ appreciably from normal. Increased numbers of mast cells tended to be associated with areas of fibrosis more than with inflammatory infiltrates.

Adult↗
PubMed1988

Idiopathic arterial calcification of infancy with unusual clinical presentations in sisters.

Two cases of idiopathic arterial calcification of infancy that occurred in sisters are reported. One patient died at age 14 months after a protracted course characterized by the nephrotic syndrome, blood chemistry abnormalities, hypertension, seizures, and a microangiopathic hemolytic anemia. Her sister died at age 3 weeks after a precipitous illness that initially was misinterpreted at autopsy as Reye's syndrome.

Calcinosis↗
PubMed1988

Histologic comparison of experimental coronary artery bypass grafts. Similarity of in situ and free internal mammary artery grafts.

This study compares patency and histologic structure of in situ internal mammary artery grafts, free internal mammary artery grafts, stripped, free internal mammary artery grafts, and stripped, free superficial femoral artery grafts (a muscular artery model) in a canine model of coronary artery bypass. Twenty-four adult mongrel dogs underwent bypass of the circumflex coronary artery with one of the above grafts. Three months postoperatively, graft patency was assessed by angiogram, and postmortem specimens were studied by intraluminal injection of a dilute barium solution proximal to the graft. Proximal, mid, and distal segments of each graft were examined microscopically. In situ internal mammary artery grafts and free internal mammary artery grafts were not significantly different in regard to patency, vascular wall cellular structure, or perfusion of the vasa vasorum. The stripped, free internal mammary artery group had a higher incidence of thrombosis, intimal thickening, and medial injury than the pedicled (in situ and free internal mammary artery) grafts. This difference may be due to early vascular wall ischemia as a result of poor early perfusion of the vasa vasorum. The stripped, free superficial femoral artery grafts were all patent, but all had adventitial injury.

Angiography↗
PubMed1988

Endomyocardial biopsy in 30 patients with primary amyloidosis and suspected cardiac involvement.

Thirty patients with primary amyloidosis in whom cardiac involvement was suspected underwent endomyocardial biopsies. Medical records and biopsies were reviewed and echocardiograms were interpreted by observers who were unaware of the recorded findings. Cardiac amyloidosis was documented by endomyocardial biopsy in 30 (100%) of the patients. In two patients, amyloid was present in only one of four specimens, suggesting that a minimum of four biopsy samples is necessary to eliminate the possibility of sampling error. Only 36 (55%) of 65 biopsy specimens of extracardiac tissues contained amyloid. Findings were positive for amyloidosis in 11 (58%) of 19 rectal biopsies and in 16 (52%) of 31 bone marrow biopsies. Of interest, only the endomyocardial biopsy tissues were positive for amyloid in eight (27%) of the 30 patients, among whom 12 extracardiac biopsies had been performed. Two-dimensional echocardiography was consistent with the diagnosis of amyloidosis in 19 (68%) of 28 patients and was abnormal but nonspecific in the remainder. Endomyocardial biopsy frequently provides information about cardiac involvement with amyloid when biopsy of other organs is negative or echocardiography is nonspecific.

Adult↗
PubMed1987

Senile cardiac amyloidosis with myocardial dysfunction. Diagnosis by endomyocardial biopsy and immunohistochemistry.

Senile cardiac amyloid discovered at autopsy is usually regarded as an incidental finding. However, in immunohistochemical studies of autopsy material, three distinct forms of senile cardiovascular amyloid have been characterized, including a systemic form that diffusely infiltrates the cardiac ventricles. The systemic form can be identified immunohistochemically with use of antiserum to human prealbumin. We diagnosed senile systemic amyloidosis causing cardiac dysfunction in five men (57 to 72 years old) by using antiserum to prealbumin in myocardial biopsy tissue. Clinically, the five patients were indistinguishable from patients with nonsecretory immunoglobulin-derived primary amyloidosis with cardiac involvement; only immunohistochemical staining of myocardial tissue distinguished between the two entities. This distinction is important, because the treatment and prognosis of the two disorders are different. We recommend immunohistochemical staining of myocardial tissue for prealbumin in patients with biopsy-proved cardiac amyloid in whom no monoclonal immunoglobulin light chain is detectable in the serum or urine.

Aged↗
PubMed1987

Aortic valve stenosis: etiology, pathophysiology, evaluation, and management.

More patients with valvular aortic stenosis are being recognized, especially elderly patients with degenerative disease of the aortic valve. For nearly all patients with aortic valvular stenosis, 2-D and Doppler echocardiography have been found to be reliable for both the diagnosis and the establishment of severity (by gradient and valve area) of stenosis as well as for assessment of left ventricular function. Therefore, we project a lesser role for cardiac catheterization in the future, limited to definition of the coronary anatomy. Aortic valve replacement remains the proven therapy for patients with symptomatic aortic stenosis, although the decalcification/lithotripsy and balloon valvuloplasty techniques appear to be promising options in selected patients.

Aortic Valve↗
PubMed1987

Surgical pathology of the mitral valve: a study of 712 cases spanning 21 years.

The gross surgical pathologic features of the mitral valve were reviewed in 712 patients who had undergone mitral valve replacement at our institution during 1965, 1970, 1975, 1980, and 1985. Among the 452 cases of mitral stenosis, either with or without mitral insufficiency, 99% were attributable to postinflammatory disease and 1% were related to congenital mitral stenosis. Among the 260 cases of pure mitral regurgitation, the two most common causes were a floppy valve (38%) and postinflammatory disease (31%). Moreover, a floppy valve was observed in 73% of the 59 examples of chordal rupture and in 38% of the 16 cases of infective endocarditis. Women accounted for 73% of the 452 cases of mitral stenosis and for 72% of the 530 cases of postinflammatory disease. In contrast, men accounted for 58% of the 260 cases of pure mitral regurgitation, including 76% of the floppy valves and 69% of the infected valves. During the 21 years spanned by the study, the relative frequency of postinflammatory mitral insufficiency progressively decreased, whereas that of floppy mitral valves increased. It is unclear whether aging, heredity, environmental factors, changes in the frequency of acute rheumatic fever, or changes in patient referral practices may account for this observation.

Adolescent↗
PubMed1987

Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases.

Among 646 patients with pure aortic stenosis who underwent valve replacement at our institution between 1981 and 1985, the three most frequent causes were calcification of congenitally bicuspid aortic valves (38%), degenerative (senile) calcification of tricuspid aortic valves (33%), and postinflammatory (presumably rheumatic) calcification and fibrosis (24%). Among the 324 patients younger than 70 years of age, calcified bicuspid valves were observed in 50%. In contrast, among 322 patients 70 years of age or older, degenerative calcification accounted for 48% of the stenotic aortic valves. During the 5 years of the study, the relative frequency of postinflammatory disease decreased from 30% to 18%, and that of bicuspid valves decreased from 37% to 33%. In contrast, the relative frequency of degenerative calcification increased from 30% to 46%. Consequently, degenerative (senile) calcification is currently the most common cause of aortic stenosis among patients undergoing valve replacement at our institution. This finding may be related to changes in life expectancy in the general population, alterations in patient referral practices, and an increased willingness of surgeons to operate on older patients. Regardless of cause, the observed temporal changes in etiologic factors for aortic stenosis may indicate a potential source of increasing health-care costs among the elderly population.

Aged↗
PubMed1987

Correlation between magnetic resonance imaging of the heart and cardiac anatomy.

An understanding of anatomy forms the cornerstone for accurate interpretations of pathologic alterations. In this article, we present cardiac magnetic resonance images and the corresponding sections of normal hearts obtained at autopsy and cut in planes parallel and perpendicular to the ventricular septum in addition to the standard anatomic orthogonal planes (coronal, sagittal, and transverse). This correlation demonstrates the ability of magnetic resonance imaging to display cardiac anatomy accurately and noninvasively. Because magnetic resonance imaging provides excellent contrast between flowing blood and cardiac walls and has the capacity to provide direct images in multiple planes without inherent difficulties, this procedure has advantages over other currently available imaging techniques.

Adult↗
PubMed1987

Malignant neoplastic emboli to the coronary arteries: report of two cases and review of the literature.

Two patients were seen with malignant neoplastic emboli to the coronary arteries. One, a 61-year-old woman with a malignant fibrous histiocytoma of the thigh and a solitary pulmonary metastatic lesion, died of an acute myocardial infarction due to a neoplastic coronary embolus after lobectomy. The other, a 51-year-old woman with bronchogenic adenocarcinoma, died of extensive cerebral metastases. At autopsy, she also was found to have had an acute myocardial infarction associated with a neoplastic coronary embolus.

Adenocarcinoma↗
PubMed1987

Cardiomyopathies.

Explore the source record for details and available documents.

Arrhythmias, Cardiac↗
PubMed1987

Coexistent pulmonary and portal hypertension: morphologic and clinical features.

Patients with portal hypertension of varying etiology may develop pulmonary artery hypertension. In the present autopsy study, pulmonary and hepatic tissue was studied in 12 patients in whom pulmonary and portal hypertension coexisted. Plexogenic pulmonary arteriopathy was present in 10 patients, 7 of whom had coexistent thromboembolic lesions. One patient had isolated medial hypertrophy, which may be an early stage in the plexogenic category, whereas isolated thromboembolic pulmonary vascular disease was observed in one subject. Hepatic disease was consistent with alcoholic cirrhosis in seven patients, cryptogenic cirrhosis in four and extrahepatic portal hypertension without cirrhosis in one. Thrombocytopenia was present in all 10 patients whose platelet count was determined. This study suggests that pulmonary hypertension associated with portal hypertension commonly has a plexogenic appearance on histologic examination. However, thrombosis (whether embolic or in situ) may also contribute to vascular obstruction.

Collateral Circulation↗