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Biomedical subjects

A C Braverman

Publications and source records attributed to A C Braverman.

16 recordsLinked to original sources
PubMed1998

Exercise and the Marfan syndrome.

The Marfan syndrome is a heritable disorder of connective tissue affecting approximately one in 5000 to one in 10,000 individuals. The manifestations of the Marfan syndrome primarily involve the cardiovascular, musculoskeletal, and ocular systems. Aortic dilatation and dissection are the major causes of morbidity and mortality in the Marfan syndrome. The person with Marfan syndrome is often tall and agile and may unknowingly participate in certain physical activities and sports, putting himself or herself at risk for aortic dissection and sudden death. With appropriate diagnosis and treatment, the person with the Marfan syndrome can expect to live a long life. This article will review the diagnosis, genetics, clinical manifestations, and medical and surgical management of the Marfan syndrome. Guidelines for physical activity and exercise for the person with Marfan syndrome will be presented.

Aortic Diseases↗
PubMed1998

Detection of coronary stenoses on source and projection images using three-dimensional MR angiography with retrospective respiratory gating: preliminary experience.

OBJECTIVE: Our objective was to study the ability of three-dimensional MR angiography with retrospective respiratory gating to reveal stenoses in proximal coronary arteries on source and projection images. CONCLUSION: Proximal coronary artery stenoses can be identified using three-dimensional MR angiography with retrospective respiratory gating, both with projection images and on source images alone. Reasons for missed lesions included collateral vessels and retrograde flow distal to complete occlusion and volume averaging of vessels with adjacent structures. Causes of false-positive interpretations included small foci of decreased signal intensity distal to complete occlusion, partial volume effects on individual partitions, and regions of distal vessels leaving the imaging plane.

Aged↗
PubMed1997

Transesophageal echocardiographic and clinical features of aortic intramural hematoma.

OBJECTIVE: This study sought to determine the transesophageal echocardiographic features and natural history of patients with aortic intramural hematoma. METHODS: The transesophageal echocardiograms of all patients who had symptoms indicative of aortic dissection over 6 years were reviewed. Measurements were made of the involved aortic segment in the study patients, and follow-up was obtained. RESULTS: In patients with aortic intramural hematoma, the wall thickness of the involved segment was significantly greater for descending segments than ascending segments (ascending aorta 7 +/- 2 mm, descending aorta 15 +/- 6 mm, p = 0.0016). In each case, the crescent-shaped intramural hematoma involved one wall predominantly, leading to compression of the aortic lumen. The findings of echolucent areas and displaced intimal calcium were found in the majority of patients. Four of eight patients with intramural hematoma of the ascending aorta were treated medically and four were treated surgically. The 30-day mortality was 50% in the medically treated patients and 0% in the surgically treated group. Four of 11 patients with isolated intramural hematoma of the descending aorta were treated medically and seven were treated surgically. All medically treated and 86% of surgically treated patients were alive at 30 days. CONCLUSIONS: Aortic intramural hematoma has distinct and identifiable transesophageal echocardiographic features. These data support those of previous studies documenting high morbidity and mortality in patients with aortic intramural hematoma.

Aged↗
PubMed1997

Physical and cognitive functioning among chronically ill African-American and white elderly in home care following hospital discharge.

OBJECTIVES: Although race is recognized as an important variable in health status and medical care, the conditions of African-American and white elders have not been studied sufficiently as they enter home care after hospital discharge. This study tests hypotheses that African-American elders enter home care sicker, more dependent, and cognitively impaired. METHODS: Hypotheses were tested in two independent studies, both conducted in a Midwestern city. Study 1 compares the physical and cognitive conditions of 208 African-Americans and white elders discharged home after hospitalization for congestive heart failure. Data were obtained from medical records and from patient interviews. Study 2 compares the physical and cognitive conditions of 212 African-Americans and white elders discharged home after hospitalization for hip fracture, cerebral vascular accident, and congestive heart failure. Data were obtained from medical records and interviews with patients' discharge planners. RESULTS: African-Americans were found to go home more sick, more dependent, and more cognitively impaired, although no race difference was found in instability at discharge. CONCLUSIONS: These findings raise concerns about African-American elders' access to care in community settings, given their greater needs at discharge.

Activities of Daily Living↗
PubMed1997

Aortic dissection.

Explore the source record for details and available documents.

Acute Disease↗
PubMed1995

High-output congestive heart failure following transjugular intrahepatic portal-systemic shunting.

A hyperdynamic circulatory state with elevated cardiac output, decreased peripheral vascular resistance, and sodium retention occurs in patients with portal cirrhosis. Surgical portal-systemic shunts and transjugular intrahepatic portal-systemic shunts (TIPS) have been shown to worsen the high-output state in these patients. However, clinical evidence of high-output congestive heart failure has been reported only rarely to complicate cirrhosis. We describe a patient who developed high-output congestive heart failure with markedly elevated filling pressures after TIPS and had complete resolution of heart failure after liver transplantation.

Cardiac Output, High↗
PubMed1994

Penetrating atherosclerotic ulcers of the aorta.

The term penetrating atherosclerotic aortic ulcer describes a condition in which an atherosclerotic plaque ulcerates and burrows through the internal elastic lamina into the media, leading to a variable amount of intramural hematoma formation. The typical patient is elderly with multiple cardiac risk factors and presents with acute chest or back pain. Diagnosis of penetrating aortic ulcer may be confirmed by computed tomography, magnetic resonance imaging or aortography. Penetrating aortic ulcers usually occur in the mid- and distal descending thoracic aorta and may be complicated by transmural aortic rupture, embolization, pseudoaneurysm formation, or progressive aneurysmal dilatation. The patient with a penetrating ulcer requires close follow-up to detect the development of complications, and may require surgical therapy.

Aorta↗
PubMed1991

Doppler echocardiographic estimation of mitral valve area during changing hemodynamic conditions.

Patients with mitral stenosis often present during periods of hemodynamic stress such as pregnancy or infections. The Doppler pressure half-time method of mitral valve area (MVA) determination is dependent on the net atrioventricular compliance as well as the peak transmitral gradient. The continuity equation method of MVA determination is based on conservation of mass and may be less sensitive to changes in the hemodynamic state. To test this hypothesis, 17 patients admitted for catheterization with symptomatic mitral stenosis and no more than mild regurgitation underwent Doppler echocardiography at rest and during supine bicycle exercise targeted to an increase in heart rate by 20 to 30 beats/minute. Net atrioventricular compliance was also estimated noninvasively. Cardiac output and transmitral gradient increased significantly during exercise (p less than 0.001), while net atrioventricular compliance decreased (p less than 0.001). MVA by the pressure half-time method increased significantly during exercise from 1.0 +/- 0.2 to 1.4 +/- 0.4 cm2 (p less than 0.001). There was no significant difference in MVA estimation using the continuity equation comparing rest to exercise, with the mean area remaining constant at 0.8 +/- 0.3 cm2 (p = 0.83). Thus, during conditions of changing hemodynamics, the continuity equation method for estimating MVA may be preferable to the pressure half-time method.

Adult↗
PubMed1991

New onset ventricular tachycardia during pregnancy.

A previously healthy young woman who developed the new onset of symptomatic sustained ventricular tachycardia during pregnancy is described. Evaluation revealed mitral valve prolapse with minimal mitral regurgitation, and normal left ventricular size and function. The arrhythmia resolved after delivery, but recurred nine months later in a nonsustained form. Electrophysiologic study revealed only nonsustained ventricular tachycardia, and she was treated with propafenone. It is suggested that the pregnant state may have been important in the pathogenesis of her arrhythmia.

Adult↗
PubMed1991

Cyclophosphamide cardiotoxicity in bone marrow transplantation: a prospective evaluation of new dosing regimens.

Cyclophosphamide (CY) cardiotoxicity may be a lethal complication of bone marrow transplantation. Previous echocardiographic studies have reported that left ventricular dysfunction due to CY occurs in over 50% of patients undergoing transplantation. To evaluate the cardiotoxicity of new dosing protocols that included twice-daily rather than once-daily CY, 44 bone marrow transplantation patients were prospectively evaluated with serial ECGs and echocardiograms. Twenty-six patients received a once-daily lower-dose protocol (mean total 87 +/- 11 mg/kg), and 18 patients received a twice-daily higher-dose (mean total 174 +/- 34 mg/kg) CY regimen. In the higher-dose CY group, significant reductions in summed ECG voltage (-20%) (P less than .01) and increases in left ventricular mass index (LVMI) (+10%) (P less than .05) were detected in the first week following therapy. These changes resolved by the third week following CY and were significantly greater than the changes noted in the lower-dose group. However, left ventricular ejection fraction (EF) did not change significantly in either group. Five patients developed clinical cardiotoxicity (four, pericarditis; one, congestive heart failure); four of the five patients were in the higher-dose group (P = .14). Only a prior history of congestive heart failure or a baseline EF less than 50% was an independent correlate of clinical cardiotoxicity (P less than .05). Thus, dose-dependent cardiotoxicity following the use of CY for bone marrow transplantation is evident as reversible decreases in ECG voltage and increases in left ventricular mass, possibly reflecting myocardial edema or hemorrhage. However, systolic dysfunction is much less common with these new twice-daily dosing regimens when compared with earlier studies of high-dose once-daily CY.

Adult↗
PubMedDate not supplied

The role of transthoracic echocardiography in the management of patients seen in an outpatient cardiology clinic.

Transthoracic two-dimensional (2D) Doppler echocardiography may provide new or additional information in patients, but it is often not known whether the results alter the treatment plan. We investigated whether results of clinically indicated 2D echocardiography were different from the physician's clinical examination or led to changes in management in 200 consecutive outpatients seen in a university-based clinic. A questionnaire was completed by the physician regarding physical findings and treatment plan before 2D echocardiography was performed. After results were known, the physician was asked to report any differences compared with clinical examination or changes in patient management. Most patients (83%) were studied to evaluate left ventricular (LV) or valvular function. 2D echocardiography confirmed clinical assessment in 182 patients (one inadequate 2D echocardiogram) and disclosed a new diagnosis in 17. 2D echocardiography provided additional information, not expected from clinical assessment or history, in 94 patients. Clinical assessment, compared with 2D echocardiography, was concordant in 154 (77%) of 199 patients with regard to LV systolic function but in only 22 (50%) of 44 with valve disease. Alterations in management based on results of 2D echocardiography were instituted in 73 patients (36%), most often manifested by changes in pharmacologic therapy (n = 45; 62%). Results of 2D echocardiography obviated the need for further cardiac evaluation, surgery, or procedures in 30 patients, avoiding additional patient charges of $125,754.00. In contrast, results of 2D echocardiography led to the need for further evaluation, surgery, or procedures in 32 patients, resulting in additional patient charges of $70,860.00. In conclusion, 2D echocardiography provides new or additional information that results in changes in management strategy in one third of patients, and 2D echocardiography offers relative cost savings by avoiding additional procedures.

Adolescent↗