摘要:

AbstractThe natural history of dilated cardiomyopathy is variable, and the prognosis difficult to predict. Several clinical and hemodynamic parameters have been proposed as prognostic indicators. Reports on the relationship between ventricular arrhythmias, degree of hemodynamic impairment, and sudden death are controversial. To define accurately the prognosis in dilated cardiomyopathy, 55 patients with this clinical syndrome underwent clinical evaluation, radionuclide ventriculography, echocardiography, 12‐lead electrocardiography, and 24 hr ambulatory monitoring, and the data thus obtained were evaluated based on predictive value. Over a follow‐up period of 14.1 ± 7.9 months, 11 patients (20%) died, all suddenly. Univariate analysis revealed that patients with more severe functional impairment (P = 0.0449), lower cardiac index (P = 0.0226), lower ejection fraction (P = 0.0426), and higher pulmonary artery wedge pressure (P = 0.0314) had greater mortality risk. Age, duration of symptoms, 12‐lead electrocardiographic abnormalities, and atrial arrhythmias were not predictive of higher mortality. The number of PVCs per hr, the occurrence of couplets, the degree of PVCs prematurity, and the presence, frequency, rate, and duration of ventricular tachycardia did not have prognostic significance. A stepwise discriminant analysis identified functional class, cardiac index, and presence or absence of multiform PVCs as the group of variables that together could more accurately predict outcome in our dilated cardiomyopathy patients. Using a formula derived from the results of this analysis, the outcomes of 36 of 49 patients (74%) was correctly predicted, with a specificity of 100% and a sensitivity

ISSN:0098-6569    

DOI:10.1002/ccd.1810110502

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractWe studied the site, severity, and coronary angiographic morphology of coronary lesions and their ability to predict progression of coronary narrowing and obstruction of coronary arteries. Twenty‐six patients who had 94 lesions at the time of first angiography were followed for a mean of 29 ± 17 (SD) months. Progression of disease jor obstructions of vessel occurred in 11 lesions (12%): eight new total obstructions (8.5%) and three subtotal (3%). Narrowings of>75% of the luminal diameter were more likely to become totally obstructed than less severe narrowings (P = 0.01), but three total occlusions occurred at sites where mild disease had been present previously. Lesions in patients with double or triple vessel disease showed a marginally greater tendency to become totally occluded than in patients with single vessel disease (P<0.1). We found no relationship between new total obstructions and the angiographic morphology of the lesion (smooth or irregular) nor with its length or position in the artery or the extent of atheroma in the vess

ISSN:0098-6569    

DOI:10.1002/ccd.1810110503

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractThe advantages and disadvantages of an arterial sheath to introduce catheters percutaneously through the femoral artery were prospectively studied in 184 consecutive patients without peripheral vascular disease undergoing routine diagnostic left heart catheterization and coronary arteriography. The arterial sheath was used randomly in 91 patients (sheath group) and the standard Seldinger technique in 93 (control group). There were no differences in age or sex between the two groups. All patients were studied with no premedication and had the same dose of lidocaine local anesthesia and heparin. No major complication occurred in any of the patients in the sheath or control groups. There were no significant differences in groin hematomas between the two groups. The patients in the control group more commonly had severe or moderately severe discomfort requiring additional local anesthesia. We conclude that the use of an arterial sheath percutaneously for introduction of catheters for left heart catheterization and coronary arteriography is advisable, particularly for anxious patients who have a low pain threshold.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110504

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractOf the various techniques that are available to assess the presence and magnitude of intracardiac shunting, oximetry and indicator dilution are used most frequently. This study was performed to compare these methods in adult patients with pure left to‐right intracardiac shunting. In 27 patients [12 men, 15 women, aged 32 ± 12 (mean ±SD) years], shunt magnitude was assessed in close temporal proximity by both techniques. The oximetric percentage left‐to‐right shunt averaged 55 ± 16%, whereas the indocyanine green dye percentage shunt was significantly less (36 ± 14%, p20% in 23 patients. Thus, there is a substantial difference in shunt magnitude between the oximetric and the indicator dilution techniques. In infants, indicator dilution yields results that are larger than those obtained with the oximetric method. Conversely, in adults, the indicator dilution technique gives results that are consistently smaller than those obtained with oximetry. As a result, the decision regarding therapy of an intracardiac shunt should be made with thi

ISSN:0098-6569    

DOI:10.1002/ccd.1810110505

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractTwenty‐eight brachial arteriovenous fistulae (AVF) flows were assessed by the Stewart and Hamilton method by bolus dye injection. These measurements were divided in two groups: a first group with dye injection into the AVF artery and a second group with dye injection into the efferent vessel of the AVF in close proximity. The increase and the decrease of dye concentration were regular and the circulation occurred very late in both groups. Reproducibility was assessed by the usual index: the mean of the differences between two successive measurements of each series related to the first of these two and expressed as a percentage, m(Qn‐ Qn‐1)/Qn%. In the two groups, the reproducibility index was at 10.1%, similar to the index applied to Grimby's results, measuring successive cardiac output by dye bolus injection at 9.8%. Theoretical criteria of validity of the Stewart and Hamilton method were checked for all measurements. Even when the duration of the measurement was very short, arteriovenous flow fulfilled the criteria of validity in the same way as cardiac output. Two AVF flows were measured successively at both injection sites with no difference between the obtained values. The same reproducibility of the efferent vessel injection site group suggests that an arterial puncture is not necessary for a correct assessment of AFV

ISSN:0098-6569    

DOI:10.1002/ccd.1810110506

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractTwo patients with biopsy‐proven amyloid restrictive cardiomyopathy were presented. Both cases showed ventricularization of an elevated right atrial pressure wave form in absence of tricuspid regurgitation. Possible explanations for this finding as well as its clinical implications are discussed.This observation indicates that ventricularization of right atrial pressure wave form could be a useful hemodynamic sign in amyloid restrictive cardiomyopathy in absence of tricuspid regurgitation. Furthermore, such a finding does not seem to be specific for tricuspid regurgitatio

ISSN:0098-6569    

DOI:10.1002/ccd.1810110507

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractThis article describes our in vitro experience of balloon angioplasty of the ductus arteriosus (DA) in three post mortem human specimens, as well as an in vivo dilatation of a stenotic DA. The in vitro histologic observations revealed disruption of the intima and areas of pathologically fragmented and disorganized fibers at the media, with integrity of the ductal wall in all three DA. These findings led us to attempt percutaneous transluminal angioplasty (PTA) of a stenotic DA in a 2.3‐kg newborn infant with hypoplastic left heart syndrome in a very deteriorated clinical condition. A Rashkind septostomy was associated with PTA of the stenotic DA. Following this, the gradients across the DA and across the atrial septum disappeared and the ductal angiographic diameter increased. Although an improved clinical condition was observed during the following hours, he died 1 day after. At necropsy, we found integrity of the ductal wall with histological changes similar to that observed in vitro. We conclude that PTA of stenotic DA could represent an alternative for palliative treatment of DA‐dependent congenital heart dise

ISSN:0098-6569    

DOI:10.1002/ccd.1810110508

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractA patient with significant obstructive coronary artery disease in an anomalous left main coronary artery arising from the right coronary artery is reported. The combination of this coronary anomaly with main left atherosclerotic disease is noteworthy and presented no surgical technical problem.

ISSN:0098-6569    

DOI:10.1002/ccd.1810110509

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractA 44‐year‐old man was diagnosed as having coronary artery disease (CAD) by arteriography in 1964. In the subsequent 20 years, he has undergone seven angiographic studies and four coronary bypass operations. Close scrutiny of the clinical events and the angiographic studies in this patient offers important clues to the behavior of CAD and the bypass grafts, both internal mammary artery (IMA) and saphenous vein grafts (SV

ISSN:0098-6569    

DOI:10.1002/ccd.1810110510

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY

摘要:

AbstractBecause arterial cannulation assists in management of critically ill patients (pts), we assessed the utility of extending intra‐arterial monitoring to hospitalized patients suffering in‐hospital cardiopulmonary arrest outside of intensive care wards. A totally self‐contained, readily portable system for rapid insertion of emergency intra‐arterial lines was evaluated in 16 pts from 53 to 89 years old (mean = 66.5 years) undergoing cardiopulmonary resuscitation. Cannulation was successful in 14 pts (88% success rate). In 8 of 14 pts, cannulation was achieved rapidly and efficiently, whereas in six it was slightly delayed, once due to technical problems and five times due to difficulty cannulating the vessel. In addition to providing continuous pressure monitoring and ready access to arterial blood samples, direct feedback from the intra‐arterial pressure waveform frequently led to improved compression technique by the resuscitator performing external cardiac massage. We conclude that under selected circumstances emergency intra‐arterial monitoring has a potentially important adjuvant role during cardiopulmonary re

ISSN:0098-6569    

DOI:10.1002/ccd.1810110511

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1985

数据来源: WILEY