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Biomedical subjects

W H Bain

Publications and source records attributed to W H Bain.

77 records · Page 5Linked to original sources
PubMedDate not supplied

Early systemic hypertension after surgical closure of atrial septal defect.

The systemic haemodynamic changes occurring in the immediate post-operative period were examined in a series of patients undergoing closure of atrial septal defect (A.S.D.) and in a consecutive series of all patients undergoing open-heart surgery in this Unit. Significant systemic hypertension was observed in 47.5% of patients in the A.S.D. series. In an attempt to explain this finding, several other haemodynamic variables were examined in relation to the systemic blood pressure. There was no correlation between central venous pressure or blood loss and systemic blood pressure. However, there was an inverse correlation between blood balance and systolic and diastolic blood pressure at 4 hours after operation. The explantation of this finding is unclear but it may be due to the effects on atrial receptors of lower right atrial and pulmonary artery pressures following closure of the A.S.D. Although the post-operative systemic hypertension was transient in most cases, it may produce adverse effects in the early post-operative period and therefore treatment with hypotensive agents should be considered in severe cases.

Blood Volume↗
PubMedDate not supplied

Recent clinical experience with percutaneous intra-aortic balloon pumping.

From January 1984 to August 1985, 51 out of 2138 patients undergoing cardiac surgery (2.38 per cent) had an intra-aortic balloon pump (IABP) inserted or an attempted insertion. The patients ranged in age from 24 to 68 years (mean 54.2 years). An IABP was inserted preoperatively in four patients, all of whom were in cardiogenic shock; peroperatively in 27 patients who could not be weaned from cardiopulmonary bypass; and postoperatively in 16 patients who had haemodynamic deterioration. Failed insertion occurred in a further four patients. Twenty-eight patients (59.6 per cent) had percutaneous insertion of the balloon, in 17 (36.2 per cent) the common femoral artery was exposed prior to insertion and in two (4.2 per cent) the balloon was inserted into the thoracic aorta. The overall survival rate was 38.3 per cent for patients with successful insertion. Major complications that threatened life or limb occurred in 10.25 per cent of patients. These complications were confined to females and in these patients the percutaneous technique for inserting intra-aortic balloons should be used with caution.

Adult↗
PubMedDate not supplied

Sinoatrial disorders, the "sick sinus" syndrome. Experience with implanted cardiac pacemakers.

The long term results of permanent pacemaker implantation in patients with disorders of the sinoatrial node and atrial conduction pathways were studied. In a consecutive series of 300 patients treated by pacemaker implantation, 68 ((22.3%) had sinoatrial disorders. Mean age of the group was 54 years (33-82 years); 37 were male, 31 female. Diagnosis was confirmed by serial electrocardiography with overdrive suppression of sinoatrial node function as indicated. Twenty-two patients presented with sinus bradycardia alone (Type I disorder) and 46 with bradycardia-tachycardia syndrome (Type II disorder) were completely controlled. of the 46 Type II patients, in 30 (65.2%) tachyarrhythmias were controlled by pacing alone and in 14 (30.4%) by pacing and antiarrhythmic drug therapy. Congestive cardiac failure was relieved in 80% and anginal pain in 70% of patients with rate control alone. Systemic embolisation did not recur after pacemaker implantation. The average duration of pacemaker therapy was 52 months (12-96 months). In this series, long term ventricular demand pacing proved beneficial in both types of sinoatrial disorders.

Adult↗
PubMedDate not supplied

Hypernatraemic dehydration following tricuspid valve replacement.

The development of abnormally high plasma sodium and plasma osmolality levels is described in 5 patients following open-heart surgery involving prosthetic replacement of the tricuspid valve. These biochemical abnormalities developed in the early post-operative period and were associated with an excessive diuresis during the first 3 to 4 days after operation. Biochemical correction required a prolonged, high volume intravenous water load, and was paralleled by progressive clinical improvement, notably in peripheral circulation, tissue turgor and cerebral function. Plasma sodium and osmolality levels and observed fluid balance in 20 patients undergoing similar surgical procedures for tricuspid valve lesions fail to show this hypernatraemic, hyperosmolar state, and indicate that the majority of such patients have a markedly positive observed fluid balance in the early post-operative period. These differences are statistically highly significant (p less than 0.001). Consideration of urine/plasma osmolality levels reveals a transient but highly significant impairment of renal concentration in the hypernatraemic patients (p less than 0.001).

Blood↗