Search PubMed⌕ Search

Biomedical subjects

W L Henry

Publications and source records attributed to W L Henry.

At least 127 records · Page 7Linked to original sources
PubMed1978

Intraoperative, intracardiac echocardiography during left ventriculomyotomy and myectomy for hypertrophic subaortic stenosis.

In 15 patients undergoing left ventriculomyotomy and myectomy for idiopathic hypertrophic subaortic stenosis (IHSS), the thickness of the interventricular septum was measured before and after muscle resection by means of a modified sternal-notch pediatric ultrasound transducer. Preoperative and intraoperative measurements by echogram were highly correlated (r = 0.92, P = 0.6), and accurately predicted the dimensions of the excised bar of muscle (r = 0.98, P = 0.6). The mean depth of the trough created at operation was 9.7 +/- 0.8 mm, and the mean thickness of the septum remaining was 14.3 +/- 0.9 mm. When studied 6 months postoperatively, all surviving patients were functionally improved, and none had a pressure gradient when studied in the resting state. However, two-thirds of the patients had residual provocable gradients (decreased by 70% from those preoperatively). Intraoperative echogram measurements failed to correlate with the presence or extent of the postoperative provocable gradients. Intraoperative echocardiography provides imaging of dimensions otherwise unavailable, and may help define the characteristics of the myectomy that result in uniform symptomatic and hemodynamic benefit.

Cardiac Surgical Procedures↗
PubMed1978

Delayed cardiac tamponade associated with prophylactic anticoagulation in patients undergoing coronary bypass grafting. Early diagnosis with two-dimensional echocardiography.

Pericardial tamponade occurring late in the hospitalization of a patient who has undergone a heart operation can be life threatening. Recognition of this insidious, but treatable, complication is difficult. Three patients experienced delayed tamponade while receiving warfarin prophylactically following coronary arter bypass. Two-dimensional echocardiography was useful in recognizing the effusion (and thus aided the diagnosis of tamponade) in each patients. The question of whether prophylactic antiocagulatin should be employed for patients undergoing coronary artery bypass procedures is also considered in light of both the present experience and collected reports from the literature.

Adult↗
PubMed1978

Clinical applications of real-time two-dimensional scanning in congenital heart disease.

Real-time two-dimensional visualization of cardiac anatomy has been a major advance in the noninvasive evaluation of congenital heart disease. Performed from precordial or suprasternal notch sites, the techniques allow noninvasive evaluation of the cardiac chambers, atrioventricular valves, and great arteries for the diagnosis of common and complex forms of congenital heart disease. Two-dimensional real-time echocardiography, therefore, can be expected to become an integral part of the noninvasive diagnosis and serial followup of children and infants with congenital heart disease.

Aortic Valve Stenosis↗
PubMed1978

Continuous epicardial echocardiographic assessment of postoperative left ventricular function.

An ultrasound transducer which is sutured to the heart at operation and removal percutaneously has been developed and tested in 20 animals. The potential of this device to monitor cardiac function was measured by simultaneously recording 67 left ventricular angiograms and echograms over a wide range of hemodynamic function. In addition, the reproducibility of the data obtained from the transducer and the safety of application and withdrawal were examined. We found highly significant (p less than 0.005) linear correlation between echocardiographic and angiographic measurements of left ventricular end-diastolic volume, end-systolic volume, and ejection fraction. This transducer may provide the means to assess left ventricular size and ejection fraction continuously after cardiac operations in man.

Animals↗
PubMed1977

Echocardiographic evaluation of patients with mitral stenosis.

Since the introduction of ultrasound technics to study the heart, echocardiographic evaluation of the mitral valve has become the most sensitive and specific noninvasive method for diagnosing mitral stenosis. Identification of the anterior mitral leaflet and the reduction of its velocity of motion was the first clinical application of M-mode echocardiography. Although simultaneous visualization of both mitral leaflets aids in the diagnosis of mitral stenosis, quantitation was not achieved until real-time imaging systems were developed to produce cross-sectional images of the mitral orifice. Currently, M-mode echocardiography remains the technic of choice for routinely diagnosing mitral stenosis. It is also useful in confirming mitral stenosis when associated abnormalities, such as aortic regurgitation, are present. Mitral orifice area is best determined with cross-sectional (two-dimensional) imaging systems. This method correlates well with hemodynamic parameters. Both methods offer the clinician serial evaluation before and after operative intervention.

Aortic Valve Insufficiency↗
PubMed1977

Echocardiographic observations in patients with systemic infiltrative disease involving the heart.

Echocardiography was used to evaluate the heart in 19 patients with one of various systemic diseases known to be associated with infiltrative cardiomyopathy. Four patients had systemic amyloidosis, 10 had idiopathic hypereosinophilia and 5 had iron overload caused by multiple blood transfusions. Although 10 patients (53 percent) had no clinical evidence of cardiac disease, all 19 had echocardiographic abnormalities; the left ventricle was symmetrically thickened (more than 11 mm) and left ventricular mass was increased (more than 275 g) in all; the left ventricular transverse dimension was modestly increased (more than 52 mm) in 5 patients (26 percent) and the velocity of mitral valve closure in early diastole was reduced (less that 60 mm/sec) in 5 patients. Systolic function, as evidenced by ejection fraction, was well maintained (greater than 60 percent) in 18 of 19 patients. Thus, it appears that echocardiographic abnormalities can be detected in many patients with a systemic disease associated with infiltrative cardiomyopathy even before clinically evident heart disease develops.

Adult↗
PubMed1977

Effects of operation on left atrial size and the occurence of atrial fibrillation in patients with hypertrophic subaortic stenosis.

The relation between left atrial size and atrial fibrillation was examined in 37 patients who had left ventriculomyotomy and myectomy at the National Heart and Lung Institute. Atrial fibrillation was present in 11 of 27 (41%) patients with an echocardiographically measured left atrial dimension greater than 45 mm. No patient with a left atrial dimension less than 45 mm had atrial fibrillation pre or postoperatively. Eleven of 13 patients less than 40 years of age with an abnormal preoperative left atrial dimension had a 10% or greater reduction in left atrial dimension postoperatively. A group of 21 patients 40 years of age or older had an abnormal left atrial dimension preoperatively, and no significant change postoperatively. These results indicate that left ventriculomyotomy and myectomy can produce a significant decrease in left atrial size in younger patients with idiopathic hypertrophic subaortic stenosis. It is hoped that the decrease in atrial size may reduce the risk of atrial fibrillation in these patients.

Adult↗
PubMed1977

Comparison of echocardiographic and necropsy measurements of ventricular wall thicknesses in patients with and without disproportionate septal thickening.

In several patients with asymmetric septal hypertrophy (ASH) diagnosed by echocardiography (septal-free wall thickness ratios greater than or equal to 1.3), we have discovered marked discrepancies between the echocardiographic and necropsy measurements of wall thicknesses that led to uncertainty regarding the actual cardiac diagnosis. To resolve these apparent incongruities, the echocardiograms and hearts of 17 patients with cardiac disease were studied. Six of nine patients with abnormal septal-free wall ratios greater than or equal to 1.3 during life had septal-free wall ratios that were not diagnostic of disproportionate septal thickening at necropsy. Such discrepancies may be explained as follows: 1) echocardiographic measurements during life were made in diastole (as per convention), but measurements at necropsy were made in hearts that appeared to have been in the systolic phase of the cardiac cycle; 2) the left ventricular free wall thickens considerably more than the ventricular septum in systole, as determined by echocardiography. This latter phenomenon resulted in septal-free wall ratios in systole that were consistently smaller than those in diastole. Furthermore, septal-free wall ratios obtained at necropsy corresponded most closely to those obtained by echocardiography in systole.

Adult↗
PubMed1977

Prevalence and characteristics of disproportionate ventricular septal thickening in patients with acquired or congenital heart diseases: echocardiographic and morphologic findings.

Echocardiographic and necropsy studies were performed in 304 patients with various cardiac diseases. The overall prevalence of disproportionate ventricular septal thickening (septal to free wall ratio greater than or equal to 1.3) was 10%. However, it was related to the type of cardiac lesion. Prevalence was high (greater than 20%) in pulmonary stenosis or primary pulmonary hypertension, lower (less than 15%) in Eisenmenger syndrome or aortic or mitral valvular disease and was not present in atrial or ventricular septal defect. In right ventricular overload, prevalence of disproportionate septal thickening correlated with increasing ventricular systolic pressure. None of 16 patients with disproportionate septal thickening studied at necropsy showed marked disorientation of cardiac muscle cells in the ventricular septum, characteristic of genetically transmitted asymmetric septal hypertrophy (ASH). Furthermore, disproportionate septal thickening was demonstrated by echocardiography in only one of 59 first degree relatives of patients with disproportionate septal thickening and associated cardiac diseases. Thus, disproportionate ventricular septal thickening associated with other cardiac diseases usually is due to secondary hypertrophy and is not a manifestation of genetically transmitted ASH.

Adolescent↗
PubMed1977

Cross-sectional echocardiography in the diagnosis of congenital heart disease. Identification of the relation of the ventricles and great arteries.

Using a mechanical sector-scanner, two-dimensional echocardiograms were obtained from 28 normal subjects, 15 patients with tetralogy of Fallot, 11 patients with complete transposition of the great arteries and six patients with double outlet right ventricle. The image obtained perpendicular to the long axis of the left ventricle at the base of the venticular septum was superimposed on the image obtained perpendicular to the long axis at the origin of the great arteries. In normal subjects, these superimposed images demonstrated that the aorta originated posterior and to the left of the ventricular septum. In patients with tetralogy of Fallot, the aorta was displaced anterior and to the right resulting in the aorta over-riding the ventricular septum. In patients with double outlet right ventricle both great arteries originated anterior to the ventricular septum (i.e., from the right ventricle). In patients with complete transposition, the aorta originated anterior and the pulmonary artery posterior to the ventricular septum. Thus, cross-sectional echocardiography permits noninvasive identification of the relation of the ventricles and great arteries and, therefore, provides important information for the diagnosis of patients with congenital heart disease.

Adolescent↗
PubMed1976

Asymetric septal hypertrophy in childhood.

Although considerable information is available concerning the clinical features and natural history of asymmetric septal hypertrophy (ASH) in adults, little is known of this disease in children. The clinical characteristics and course of 46 children with ASH, who were evaluated at the National Heart and Lung Institute, have been analyzed. Twenty-four children had obstruction to ventricular outflow; 22 children had no obstruction to ventricular outflow, including 11 patients without overt manifestations of cardiac disease other than echocardiographic evidence of ASH. Thirty-five of the 46 children have been followed for one to 16 years (average 7.4 years). These latter children represent that subgroup of patients with ASH referred to the National Heart and Lung Institute and diagnosed prior to the general availability of echocardiography. The clinical course of these patients was variable. Fourteen (40%) of the 35 patients improved or remained stable, including four patients who received propranolol. Ten (29%) of the 35 patients deteriorated clinically and 11 (31%) of the 35 patients died suddenly (4% mortality per year). Two of the patients who died suddenly had previously undergone operation (six and 13 years previously) with resultant abolition of the outflow gradient; four others were taking propranolol. Neither symptomatology, electrocardiographic abnormalities, heart size, left ventricular ejection or upstroke time, magnitude of outflow gradient, or left ventricular end-diastolic pressure proved predictive of sudden death. Excluding patients who had previous operation, eight (40%) of 20 patients with obstruction who were followed long term and one (9%) of 11 patients without outflow obstruction died suddenly. Thus, the clinical and hemodynamic spectrum of ASH in childhood is broad. However, deterioration in clinical condition or sudden death has been relatively common in children with overt signs of cardiac disease.

Adolescent↗
PubMed1976

Relation between echocardiographically determined left atrial size and atrial fibrillation.

In an attempt to define quantitatively the relation between left atrial size and atrial fibrillation, echocardiography was used to study 85 patients with isolated mitral valve disease, 50 patients with isolated aortic valve disease, and 130 patients with asymmetric septal hypertrophy. In all three groups of patients, atrial fibrillation was rare when left atrial dimension was below 44 mm (3 of 117 or 3%) but common when this dimension exceeded 40 mm (80 of 148 or 54%). In addition, when left atrial dimension exceeds 45 mm, cardioversion, while initially successful, is unlikely to produce sinus rhythm that can be maintained at least six months. These data suggest that left atrial size is an important factor in the development of atrial fibrillation and in determining the long term result of cardioversion. The pathophysiologic mechansim most consistent with this is that a chronic hemodynamic burden initially produces left atrial enlargement which in turn predisposes to atrial fibrillation. Only prospective studies will determine definitively whether these observations will be useful in decisions concerning prophylactic anticoagulation and elective cardioversion.

Adolescent↗
PubMed1976

Determinants of ventricular septal motion. Influence of relative right and left ventricular size.

To test the hypothesis that the ventricular septum moves during systole toward the center of the ventricular mass (so that the end-diastolic position of the septum within the heart should determine both the direction and the magnitude of septal motion during systole), echocardiograms from patients with several different hemodynamic burdens were analyzed. A linear relation was noted between the end-diastolic intracardiac position of the ventricular septum and the direction and magnitude of systolic septal motion in 1) forty three patients with an atrial septal defect )regression coefficient r = 0.80), 2) fourteen patients with other causes of right ventricular volume overload (r = 0.82), 3) nineteen patients with left ventricular volume overload (r = 0.74), 4) ten patients with right ventricular pressure overload (r = 0.93), 5) ten patients with left ventricular pressure overload (r = 0.80), 6) twenty-eight normal subjects (r = 0.82). We conclude that, in the presence of normal ventricular activation and contraction, the direction and magnitude of sepatal motion during systole is determined by the intracardiac position of the septum at enddiastole.

Adolescent↗
PubMed1976

Tunnel subaortic stenosis: left ventricular outflow tract obstruction produced by fibromuscular tubular narrowing.

The clinical and morphologic features of tunnel subaortic stenosis, an unusual form of obstruction to left ventricular outflow, are described in 11 patients. Although patients with tunnel subaortic stenosis demonstrate a variety of cardiovascular malformations, the most characteristic anatomic feature is fibromuscular tubular narrowing of the outflow tract that remains relatively unchanged during the cardiac cycle. The aortic anulus was abnormally small in six of the 11 patients, including one who also had a hypoplastic ascending aorta. Evidence of a small mitral orifice was present in two patients, and two other patients had asymmetric septal hypertrophy. Although operation was successful in significantly reducing the outflow gradient in two of the seven operated patients, all seven patients had gradients of 50 mm Hg or more at the most recent postoperative evaluation. Three patients (two with previous operation) died suddenly; each of these patients had mild or no symptoms. Because of the apparent ineffectiveness of current operative methods in patients with tunnel subaortic stenosis, it is important to differentiate this condition from obstructions to left ventricular outflow.

Adolescent↗