摘要:

A consecutive series of 100 patients receiving left internal mammary artery grafts and a consecutive series of 100 patients receiving saphenous vein grafts as treatment of isolated left anterior descending coronary artery stenosis were reviewed to determine survival, graft patency, disease progression and New York Heart Association functional class. The mean follow-up was 67 months, and the mean catheterization interval was 20 months.Recommendations for revascularization can be made selectively to patients with critical isolated left anterior descending stenoses who have limiting symptoms and large areas of viable myocardium at risk.

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Aortocoronary bypass surgery, widely accepted in the treatment of patients with coronary artery disease, is controversial in the management of variant angina. Persistence of attacks, occlusion of the graft or postoperative infarction have been described and could be explained by a persistent spasm frequently observed in variant angina that might occlude the distal part of the grafted vessel.It has been suggested that plexectomy might be added to the aortocoronary graft procedure in order to prevent the spasm. Our study includes 35 patients with variant angina who had surgery. They were divided into two groups. Group 1 (n= 13) had aortocoronary bypass alone; the patients in group 2 had plexectomy in addition to the myocardial revascularization. The average follow-up period was 37 months in group 1 and 20 months in group 2. The results were assessed by clinical study, stress testing, control of patency of the grafts and provocative test with an ergot alkaloid (methergine).Despite the difficulties of evaluating the effects of the various treatments in these patients with a wide spontaneous variability of symptoms, these data suggest that a complete plexectomy associated with aortocoronary bypass gives better results (86%) than bypass alone (61%) in variant angina. The recurrence rate of attacks was lower (5%) when plexectomy was associated with bypass than with bypass alone (18%).

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Stress and resting myocardial perfusion were assessed in 38 patients who received 96 grafts. Stress perfusion was evaluated with thallium-201 and resting myocardial blood flow distribution with radiolabeled particles. When both stress and rest perfusion were normal, graft patency was 82% (51 of 62 rafts). Graft patency was also high (81%, 13 of 16) in areas where stress perfusion abnormalities resolved or become less apparent at rest. However, when stress perfusion defects remained unchanged at rest, the graft was likely to be occluded (73%, 11 of 15). Maintenance of normal rest perfusion or improvement of rest perfusion postoperatively was also associated with a high graft patency rate (80%, 35 of 44), whereas the development of new rest perfusion defects postoperatively implied graft occlusion (86%, six of seven).

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To ascertain the effects of surgical closure of atrial septal defect on left ventricular geometry and degree of mitral prolapse, 14 patients with atrial septal defect were studied by cross-sectional and M-mode echocardiography preoperatively and 7 days postoperatively. Seven of the 14 patients (50%) had mitral valve prolapse preoperatively by cross-sectional echocardiography. To quantitate the degree of prolapse, we measured the net algebraic area subtended by the apposed mitral valve leaflets in systole (MVAS) with respect to the mitral ring. The mitral valve prolapse group had an MVAS of 0.3 ± 3.1 units (mean ± SEM) preoperatively, while the group without mitral valve prolapse had an MVAS of 12.5 ± 3.1 units (p< 0.02). Postoperatively, prolapse either decreased in degree or was abolished in six of seven patients (86%), associated with an increase in MVAS to 14.7 ± 4.4 units (p< 0.02). In all patients, septal curvature in diastole on short-axis view normalized either partially or completely postoperatively, resulting in decreased left ventricular eccentricity (1.34 ± 0.06 preop vs 1.06 ± 0.07 postop, p < 0.001). Atrial septal defect closure, therefore, leads to normalization of left ventricular geometry and in patients with evidence of mitral valve prolapse, is associated with a decrease in the degree of prolapse.

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Patients with cardiac denervation resulting from allograft transplantation have been observed to increase their diastolic and systolic blood pressure during isometric exercise without concomitant cardioacceleration. To determine the mechanism for the blood pressure increase, heart rate, blood pressure, and ventricular volumes (measured using fluoroscopy of tantalum midwall myocardial markers) were recorded before and after a 50% maximal voluntary contraction. Seven cardiac transplant recipients (denervated heart) and seven nontransplant patients (innervated heart) were studied. Innervated and denervated heart patients increased systolic blood pressure by 16% and 21% and total peripheral resistance by 20% and 12%, respectively. The percentage responses were not significantly different between groups, except for heart rate, which increased 17% in innervated heart patients and 2% in denervated heart patients (p< 0.05). Neither group had enhanced contractility or increases in cardiac output, suggesting that the blood pressure increases resulted in both groups from increased peripheral resistance.

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Exercise responses were obtained from 149 children and young adults (average age 14.5 years) and divided by sex and body surface area (BSA): children with BSA < 1 in; children with BSA 1-1.19 m2; males with BSA 2 1.2 ma; and females with BSA > 1.2 in. Total work, mean and maximal power outputs were more affected by body size (height) than age in children with BSA < 1 m and in males and females with BSA > 1.2 in. Mean systolic pressure increased up to 64% above the preexercise supine value at peak effort, with the level of mean maximal systolic pressure having a positive relationship with body size (height), power output and preexercise sitting systolic pressure in all subgroups except children with BSA 1-1.19 m2. Mean diastolic pressure increased up to 24% above the preexercise supine value at peak effort. ST-segment depression of 1-2 mm was recorded in 12.1% (18 of 149) of the population at peak exercise. These changes occurred in 8.9% of all males and in 16.9% of all females (p> 0.1). The data from this study reveal the importance of sex and body size in the clinical interpretation of exercise responses in growing subjects, provide a reference for objective evaluation of subjects with or without cardiac abnormalities and provide a guide for careful monitoring of subjects during an exercise study.

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Nifedipine induces a potent vasodilating and antihypertensive effect in man through a calciumantagonistic action. The drug was tested alone and in combination with methyidopa in 23 subjects with uncomplicated primary severe hypertension (diastolic pressure > 120 mm Hg) in a short- and long-term therapeutic trial. Hourly pressure readings during the short-term period showed that the antihypertensive response to nifedipine (10 mg orally) is maximal within 40 minutes and lasts for 8-12 hours. When nifedipine is administered every 6 hours the tendency of blood pressure to rise after each dose is repressed by the next dose, so that pressure remains significantly reduced throughout the 24 hours; when methyidopa is combined (250 mg four times daily) blood pressure is further reduced toward normal, without significant fluctuations during the day. After 10 days of drug combination, the antihypertensive response was mediated through reduction of peripheral vascular resistance associated with increase in cardiac output. Renal function was unchanged or improved and sodium retention and plasma volume expansion were not promoted. In six patients with very severe hypertension (diastolic pressure > 140 mm Hg) complicated by cardiac failure, a dosing regimen every 4 hours of the two compounds promptly relieved dyspnea and lung congestion and, within 2-3 days, stabilized blood pressure to an average of 150/98 mm Hg. Persistence of the antihypertensive efficacy of this drug combination in a dosing regimen every 6 hours and its beneficial effects on heart size, ECG and fundi were documented in 22 subjects (four of whom belonged to the decompensated group) who completed a 12-month follow-up. A tendency in seven cases to ankle pitting or edema was the major side effect of nifedipine; the cause of this effect remains obscure.

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To evalute the role of the renin-angiotensin system and sodium depletion in the hypotensive response to 1-sarcosine-8-alanine-angiotensin II (saralasin), 15 male patients with essential hypertension were studied on a diet containing 120 mEq of sodium and 100 mEq of potassium per day. After a 5-day control period, all subjects had a mild pressor response to the saralasin infusion (p< 0.01). After 5 days of the diuretic metolazone (5 mg/day), eight of the 15 patients had a vasodepressor response; these responders had a significantly greater increase in plasma renin activity and angiotensin II concentrations than did the nonresponders. Sodium deficit differed markedly (p< 0.001) between the two groups (361 4 121 mEq (SD) vs 52 ± 26 mEq sodium, respectively). The addition of spironolactone (400 mg/day) for 5 days resulted in saralasin responsiveness in all but two patients, both of whom had small sodium deficits. Thus, variability in the natriuretic response to diuretics may affect saralasin testing and limit its clinical utility.

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The central and peripheral hemodynamic responses to the angiotensin-converting enzyme inhibitor teprotide (SQ20881) were simultaneously determined in 10 patients with severe, refractory congestive heart failure using Swan-Ganz catheterization and venous-occlusion calf plethysmography. Significant declines in mean arterial pressure (82.5 ± 4.9 to 67.1 4 5.0 mm Hg [SEM],p< 0.001), systemic vascular resistance (1787 ± 130 to 1272 i 115 dyn-sec-cm-5,p< 0.001) and mean pulmonary capillary wedge pressure (26.8 ± 2.5 to 17.1 ± 2.5 mm Hg,p< 0.001) accompanied improvement in cardiac index (2.04 4 0.17 to 2.47 i 0.20 I/min/m2, p < 0.001). Reduction in mean right atrial pressure (9.8 4 2.0 to 5.2 : 1.8 mm Hg, p < 0.005) was not a result of limb venodilation, as calf venous capacitance did not change. The decrease in limb vascular resistance (76.6 ± 11.0 to 62.9 + 10.7 units, p < 0.05) did not parallel the fall in systemic vascular resistance in either magnitude or duration (p< 0.05). Pulmonary arteriolar resistance was not appreciably changed.Teprotide therefore reduces ventricular afterload and significantly improves cardiac function in patients with congestive heart failure. The greater change in systemic than in limb vascular resistance implies preferential redistribution of flow to other regions. These findings shed light upon the role of the renin-angiotensin system in the regulation of regional vasoconstriction in congestive heart failure and suggest that teprotide may act as a unique “vasoreleaser” of pathophysiologic arteriolar constriction.

ISSN:0009-7322    

出版商:OVID    

年代:1980

数据来源: OVID