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Biomedical subjects

A Greengart

Publications and source records attributed to A Greengart.

At least 19 recordsLinked to original sources
PubMed1994

Lipomatous hypertrophy of the interatrial septum.

Lipomatous hypertrophy of the interatrial septum, a finding associated with obesity and advancing age, consists of accumulation of adipose tissue including fetal adipose tissue in the interatrial septum. It is a rare lesion of the heart and can reach notable size. A case is reported in which the diagnosis of lipomatous hypertrophy of the interatrial septum was established intraoperatively; the large bulk of the lipoma was such that it required major reconstruction of the interatrial septum and right and left atrial walls.

Aged↗
PubMed1993

Coronary atherectomy versus angioplasty: the CAVA Study.

Directional coronary atherectomy was developed with the hope that it would lower the risk of acute closure and restenosis by leaving a larger smoother lumen and fewer dissections than angioplasty. To evaluate this hypothesis, we compared the clinical and angiographic results of directional coronary atherectomy with those of percutaneous transluminal coronary angioplasty in well-matched groups. We studied 126 consecutive atherectomies and 127 angioplasties performed on similar lesions. Procedural results were evaluated with regard to dissections, complications, acute closure, and residual stenosis. Each patient's clinical course was followed, and each patient was contacted at 6 months for evaluation of recurrent angina, need for repeat catheterization, and angiographic rate of restenosis. Baseline clinical and angiographic characteristics of the two groups were well matched and met the criteria established as being appropriate for atherectomy. The angiographic success rate was 98% after angioplasty and 99% after atherectomy. There were fewer dissections after atherectomy (13%) compared with the number after angioplasty (22%; p = 0.03). Residual stenosis was 8.3 +/- 9% after atherectomy compared with 15 +/- 12% after angioplasty (p = 0.0001). However, there were more complications after atherectomy (p = 0.03). There was no significant difference between the two groups in the recurrence rate of angina or in the angiographic restenosis rate at 6 months. It was concluded that when lesion characteristics and vessel size are appropriate for atherectomy, the procedural success rate of either atherectomy or angioplasty is extremely high. Although atherectomy leads to a larger residual lumen and fewer dissections, the complication rate after atherectomy is higher than that after angioplasty. There is a trend toward more occlusions after atherectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Aortoventriculoplasty in the management of an infected Cabrol graft.

This report describes use of a modified aortoventriculoplasty (Konno procedure) for reoperation on a patient with prosthetic aortic valve conduit endocarditis. The modified Konno procedure was necessary to expose the mid-left ventricular outflow tract to reconstruct an aortic annulus.

Aortic Valve↗
PubMed1992

Giant T-wave inversion in patients with acute coronary insufficiency.

We have observed an electrocardiographic (ECG) pattern of deep T-wave or "giant T wave" inversion in patients with acute coronary insufficiency. We reviewed the ECGs of 936 patients admitted to our coronary care unit during a one-year period. We found the pattern of giant T-wave inversion was present in nine patients (1 percent). We examined the echocardiograms of all of these patients and we analyzed the coronary angiograms on the seven patients in whom it was performed. We found that giant T-wave inversion was usually found in patients with stenosis in the left coronary system. In addition, the majority of these patients also had echocardiographic evidence of left ventricular hypertrophy. We conclude that the high frequency of a partially patent vessel in the left coronary system suggests that this ECG pattern may be useful in identifying patients who might benefit from coronary revascularization.

Acute Disease↗
PubMed1991

Exercise-induced ventricular tachycardia in association with a myocardial bridge.

Sustained ventricular tachycardia induced by exercise is uncommon. This is a report of a patient who has a positive exercise test at a high level of exercise. The electrocardiogram has classic ischemic ST depressions. Following the appearance of these ST depressions, the patient developed ventricular tachycardia at a rapid rate. Workup that included an echocardiogram and cardiac catheterization revealed myocardial bridging of the left anterior descending artery as the only structural abnormality. Electrophysiologic studies revealed the patient to have ventricular tachycardia only with isoproterenol (Isuprel) infusion.

Adult↗
PubMed1989

Effects of occlusion of the left anterior descending coronary artery during angioplasty on right-sided cardiac pressures and electrocardiographic changes.

Controversy persists regarding the presence and extent of right ventricular involvement with acute anterior injury. Also unclear are the incidence and significance of ST elevations in the right-sided leads in acute left anterior descending artery occlusion. Baseline and coronary occlusion hemodynamics and 15-lead electrocardiograms (addition of RV3 through RV5) were recorded in 42 patients during 32 left anterior descending and 13 right coronary artery angioplasties. The right coronary and left anterior descending artery angioplasties had similar baseline right and left ventricular hemodynamics, as well as identical right atrial to pulmonary wedge pressure ratios (0.51 right coronary vs 0.51 left anterior descending). Whereas the right coronary and left anterior descending occlusions produced similar elevations in right ventricular filling pressures, the left anterior descending occlusions produced greater elevations in left ventricular filling pressures. The right atrial to pulmonary wedge ratio increased with right coronary occlusions, but was unchanged with left anterior descending occlusions (0.79 right vs 0.46 left, p less than or equal to 0.0001). Presence of right-lead ST elevations in 10 left anterior descending occlusions did not con-note increased right ventricular filling pressures, but did suggest increased left ventricular ischemia and dysfunction. In conclusion, right ventricular dysfunction, as manifested by increased filling pressures, is seen with both right coronary and left anterior descending occlusions. Although it is the predominant abnormality in right coronary occlusions, in left anterior descending occlusions it is proportional to left ventricular dysfunction. ST elevations in a right lead with left anterior descending occlusions do not constitute a marker for increased right ventricular dysfunction.

Angioplasty, Balloon↗
PubMed1989

Pericardial effusion early in acute myocardial infarction.

The incidence and significance of pericardial effusions early in acute myocardial infarction remain unclear. Using two-dimensional echocardiography, 172 patients with an acute myocardial infarction were evaluated within 72 h of presentation. Thirty patients (17%) had a pericardial effusion (29 small, 1 moderate) while 142 (83%) did not. No patient developed cardiac tamponade or required pericardiocentesis. Patients with pericardial effusions had higher peak creatine kinase as compared to patients without effusions (2036 +/- 1466 vs. 1483 +/- 1241, p less than 0.05) and a greater number of aneurysms (20% vs. 6%, p less than 0.05). In-hospital mortality was higher in the patients with pericardial effusions (10% vs. 2%, p less than 0.05). In conclusion, pericardial effusions are common in the early AMI period but are generally small and hemodynamically insignificant. They are associated with larger infarcts and greater mortality.

Aged↗
PubMed1989

Anticipation of bypass surgery: can it induce silent myocardial ischemia?

Psychological stress has been demonstrated to induce myocardial ischemia. To determine whether stressful events before a coronary artery bypass grafting procedure precipitate myocardial ischemia, silent or symptomatic, and whether this can have an effect on the prognosis, 26 patients were evaluated before a bypass operation with continuous Holter monitor recording. Specific events monitored were signing surgical consent, receiving preoperative medications, shaving and preparing, and transfer to the operating room. A positive Holter result was defined as an ST segment depression of 1 mm or more lasting one minute or longer. Six patients (23%) were found to have one or more episodes of substantial ST segment depression, with a total of ten episodes lasting 208 minutes recorded. All episodes were silent and not associated with an increase in mean heart rate. The majority of episodes occurred randomly, although three episodes did occur between 5 and 6 AM at the time of transport to the operating room. This appeared to be related more to the circadian rhythm than to the stress of transport. No perioperative or postoperative myocardial infarctions occurred, and all patients were alive at 30 days. In conclusion, silent myocardial ischemia present in the immediate preoperative period does not appear to be related to specific preoperative events. Frequency of early morning ischemia may warrant changes in the medication schedule to provide additional protection during these hours.

Aged↗
PubMed1989

Full dose subcutaneous heparin therapy.

Anticoagulation is used extensively for the treatment and prevention of thromboembolic disease. Full dose anticoagulation with heparin is usually administered intravenously via continuous 24-hour infusion to avoid complications with intermittent intravenous administration. Continuous intravenous therapy is costly and cumbersome for nurses and patients. Subcutaneous administration of heparin in full dosage offers an attractive therapeutic alternative. This study examines the safety, efficacy, and cost considerations of this form of therapy. Fifteen patients admitted to the hospital for myocardial infarction were evaluated. After the patients were transferred from the cardiac intensive care unit, intravenous heparin was discontinued, while therapeutic anticoagulation was maintained via the subcutaneous route. Complications were limited to local hematoma formation. A cost comparison revealed substantial savings with subcutaneous administration.

Aged↗
PubMed1988

Septal rupture: effect of oxygen administration.

A patient with interventricular septal rupture as a complication of myocardial infarction was studied to determine whether varying the concentration of inspired oxygen would alter the magnitude of intracardiac shunt. A significant correlation was found showing that high concentration of inspired oxygen results in increased left to right shunting probably due to systemic vasoconstriction and pulmonary vasodilatation.

Combined Modality Therapy↗
PubMed1988

Relationship between location of chest pain and site of coronary artery occlusion.

Chest pain characteristics and site of coronary artery occlusion were evaluated in 148 patients having single-vessel coronary angioplasty and in 95 patients having double-vessel angioplasty. The locations of chest pain included substernal and left precordium, right precordium and epigastric. The possible sites of pain radiation were limited to neck/jaw, left arm, right arm, and interscapular. The patient described whether or not the pain was typical of previous angina, and the presence of ST segment deviation was noted to be certain that ischemia was present. The analysis showed that the occluded artery could not be reliably identified. However, it was possible to say which artery was most likely not diseased. Patients presenting with substernal or left chest pain with radiation to the left arm had a less than 10% chance of having right coronary artery disease. A patient presenting with epigastric pain radiating to the neck or jaw had a less than 13% chance of having left anterior descending disease. It is concluded that in patients with single- and double-vessel coronary disease, there is some relationship between chest pain pattern and disease location.

Angina Pectoris↗
PubMed1986

Etiology and clinical significance of new fascicular conduction defects following coronary bypass surgery.

Two hundred consecutive patients undergoing only coronary bypass surgery were studied. Forty-five patients (group A) developed new fascicular conduction blocks and 155 patients (group B) did not. The 45 patients in group A developed the following fascicular conduction blocks: right bundle branch block 47%, right bundle branch block and left anterior hemiblock 8%, right bundle branch block and first-degree atrioventricular block 2%, left anterior hemiblock 11%, left bundle branch block 18%, right bundle branch block-left anterior hemiblock and first-degree atrioventricular block 5%. There were no significant differences in sex, incidence of diabetes, number of grafts performed, ejection fraction (less than 55%), and perioperative infarction. Group A patients were older (p less than 0.01). Hypertension was found frequently in group A (27 vs 45 patients; p less than 0.01) and was present for a mean of 12.4 years in group A and 4.9 years in group B (p less than 0.01). Preoperative use of digitalis was found in 14 (31%) patients in group A and in 18 (12%) patients in group B (p less than 0.01). Twenty-one (47%) patients in group A had significant disease (greater than 70%) of the left main coronary artery as compared to 17 (10.9%) in group B (p less than 0.001). There was no difference in the recurrence of angina or the survival rate at 14 months. In conclusion, the incidence of new fascicular conduction block after bypass surgery is 22.5%. Long-standing hypertension, left main coronary disease, and the preoperative use of digitalis appear to be predisposing factors. New fascicular conduction block does not affect prognosis.

Age Factors↗