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Biomedical subjects

A H Roche

Publications and source records attributed to A H Roche.

At least 19 recordsLinked to original sources
PubMed1997

Late regression of the dilated site after coronary angioplasty: a 5-year quantitative angiographic study.

BACKGROUND: Limited data are available on the changes that occur at the dilated site late after coronary angioplasty. The aim of this study was to evaluate with quantitative angiography the natural history of changes that occur in the dilated segment between "early" (approximately 6 months) and "late" (approximately 5 years) follow-up after angioplasty. METHODS AND RESULTS: Of 127 consecutive patients (174 lesions) with successful angioplasty, 125 underwent early angiography. Three patients subsequently died, and 24 underwent revascularization surgery or repeated angioplasty, giving a study-eligible population of 98 patients. Quantitative angiographic analysis was performed before and immediately after angioplasty and at early and late follow-up in the study population of 84 patients (115 lesions), which was 86% of study-eligible patients. Mean lesion diameter stenosis decreased from 36.3+/-14.2% at early to 29.6+/-13.5% at late follow-up (P<.0001). No lesion developed late restenosis by the 50% diameter loss criterion. Late regression was related to stenosis severity at early angiography (r=-.58, P<.001). Subgroups at early angiography of 40% to 49% stenosis and > or = 50% stenosis showed significant regression at late angiography. CONCLUSIONS: Lesion regression at the dilated site is common late after angioplasty. The more severe a stenosis is at early angiography, the more likely the chance that there will be late regression. A strategy of watchful waiting may be appropriate for patients with restenotic lesions of borderline severity.

Adult↗
PubMed1994

End-systolic volume and long-term survival after coronary artery bypass graft surgery in patients with impaired left ventricular function.

BACKGROUND: Left ventricular function is the main predictor of long-term survival in patients with coronary artery disease. In patients with impaired left ventricular function after myocardial infarction, end-systolic volume is a better predictor than the global ejection fraction. We analyzed long-term follow-up of patients with impaired left ventricular function undergoing coronary artery bypass graft surgery to evaluate preoperative predictors of survival. METHODS AND RESULTS: Consecutive patients with ejection fractions < or = 40% (n = 193) who had undergone surgical revascularization were followed to assess the predictive value of preoperative baseline characteristics and catheterization findings for long-term survival. Patients were followed for 133 +/- 30.7 months. At the time of surgery, patient age was 56 +/- 7.9 years and 169 patients (87.6%) had a history of previous myocardial infarction. Thirty-one patients (16%) were female. The ejection fraction was 32 +/- 7%, and the end-systolic volume was 147.4 +/- 52.6 mL. One hundred sixty-four patients (84.9%) had three-vessel disease, and 44 (22.8%) had a left main stenosis with > 50% diameter loss. Follow-up was complete in 99%. Fourteen patients died (7.3%) within the first 30 days after surgery. Twelve-month actuarial survival was 86%, 4-year survival was 80%, and 10-year survival was 40%. Predictors of poor long-term survival on multivariate analysis were end-systolic volume index (chi 2 = 14.02, P = .002), number of previous myocardial infarctions (chi 2 = 6.47, P = .001), preoperative stenosis score (chi 2 = 4.97, P = .02), and age at the time of surgery (chi 2 = 4.45, P = .03). CONCLUSIONS: End-systolic volume index is the major predictor of survival after coronary artery bypass graft surgery in patients with impaired left ventricular function. Strategies to prevent ventricular dilatation, such as angiotensin-converting enzyme inhibitors, may improve the long-term outcome in these patients.

Adult↗
PubMed1992

Directional coronary atherectomy in lesions unfavourable for balloon angioplasty: initial Green Lane and Mercy Hospitals experience.

AIMS: directional coronary atherectomy is a new percutaneous interventional technique in which coronary arterial stenotic material is shaved off to alleviate stenosis. This study presents the initial outcome of coronary atherectomy at Green Lane and Mercy hospitals where the major indications for atherectomy are lesions with angiographic appearances unfavourable for balloon angioplasty or where balloon angioplasty had been unsuccessful. METHODS: data on patients undergoing coronary atherectomy between February 1990 and December 1991 were analysed. No patient or procedure was excluded. RESULTS: for the first 28 lesions in 25 patients, procedural success, improvement in lumen diameter to less than 50% diameter loss stenosis, but freedom from myocardial infarction, death or emergency bypass surgery, was achieved in 27 of 28 lesions. In one patient there was acute thrombotic coronary arterial closure treated successfully by balloon angioplasty. Another patient developed an asymptomatic fistulous connection with an adjacent coronary vein which resolved spontaneously. CONCLUSIONS: although technically more difficult than balloon angioplasty, directional coronary atherectomy can be carried out in selected patients with a high initial success rate and low complication rate. The technique has allowed percutaneous treatment of a number of selected patients unsuitable for balloon angioplasty, and has turned an unsuccessful angioplasty into an initial procedural success in others.

Adult↗
PubMed1990

Rest and exercise hemodynamics of 20 to 23 mm allograft, Medtronic Intact (porcine), and St. Jude Medical valves in the aortic position.

Doppler echocardiography was used to measure gradients and valve areas at rest and after supine bicycle exercise in 35 patients with valve replacements 20 to 23 mm in size. Thirteen patients with a St. Jude Medical valve (St. Jude Medical, Inc., St. Paul, Minn.) were matched to 13 patients with an allograft valve, and seven patients with a Medtronic Intact (porcine) valve (Medtronic, Inc., Minneapolis, Minn.) to seven patients with an allograft valve. Patients were matched for age, sex, valve size, body surface area, and left ventricular systolic function. There was no statistically significant difference between the matched groups for body surface areas, resting cardiac output, exercise heart rate, or workload achieved. Mean pressure gradient was higher for St. Jude Medical than for allograft groups, both at rest (11.8 +/- 6.67 mm Hg for St. Jude Medical versus 6.67 +/- 2.98 mm Hg for allografts) and after exercise (16.4 +/- 8.47 mm Hg versus 9.7 +/- 3.94 mm Hg), but the differences were of borderline significance (p = 0.016 and 0.027, respectively). Valve area at rest was similar for both devices (1.4 +/- 0.45 cm2 for St. Jude Medical versus 1.8 +/- 0.56 cm2 for allograft; p greater than 0.1). There were highly significant differences between patients with Intact and those with allograft valves for resting mean pressure gradient (19.3 +/- 4.23 mm Hg for Intact versus 5.9 +/- 3.68 mm Hg for allograft; p less than 0.001) and for exercise mean pressure gradient (27.8 +/- 8.63 mm Hg versus 8.1 +/- 8.43 mm Hg; p less than 0.001). The differences between the valve areas at rest also were significant (1.1 +/- 0.12 cm2 versus 2.2 +/- 0.62 cm2; p less than 0.01). It is concluded that when a tissue valve is indicated in patients with a small aortic root, the freehand allograft aortic valve is an ideal device from the hemodynamic perspective and is superior to the Intact valve. It is also probably superior in this respect to the St. Jude Medical valve, although the analysis may be biased slightly in favor of the allograft valve.

Aged↗
PubMed1989

Doppler echocardiography in the assessment of the homograft aortic valve.

To determine the utility of Doppler echocardiography in the evaluation of the homograft valve in the aortic position, 27 patients with normally functioning valves (group 1) and 30 patients with suspected malfunctioning valves (group 2) were examined. Simultaneous cardiac catheterization and Doppler echocardiography were performed in 23 group 2 patients. Doppler and surgical findings were compared in 7 patients too ill for invasive studies. In group 1 patients, the maximal velocity (+/- standard deviation) was 1.8 +/- 0.37 m/s, the mean pressure gradient was 7.1 +/- 3.07 mm Hg and the mean aortic valve area was 2.2 +/- 0.79 cm2. The maximal velocity in group 2 patients with aortic regurgitation (AR) classified as moderate or greater was 2.5 +/- 0.55 m/s, compared with 1.8 +/- 0.44 m/s in patients with mild AR or less (p less than 0.01). In the quantitation of AR, pulsed-wave mapping and angiographic grades were identical in 18 patients and differed by 1 grade in 5. Seven patients too ill for catheterization had severe destruction of valve leaflets at cardiac surgery. In 6 patients, both Doppler grading methods suggested severe AR. In a seventh patient, who had an obstructed Starr-Edwards valve in the mitral position, AR was graded as mild by pulsed-wave mapping. Only 1 patient had homograft valve stenosis, with a withdrawal gradient at catheterization of 34 mm Hg and a Doppler maximal gradient of 36 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Clinical evaluation versus Doppler echocardiography in the quantitative assessment of valvular heart disease.

We tested the hypotheses that Doppler echocardiography has a higher accuracy than clinical evaluation in the detection of significant aortic and mitral valvular heart disease and that Doppler echocardiography is highly accurate as compared with cardiac catheterization for the assessment of valvular disease severity. Thus, cardiac catheterization for the assessment of valve lesion severity may be unnecessary in selected patients. We prospectively evaluated 75 consecutive patients, ages 20-74 years (mean, 52 years), with clinically suspected valvular heart disease. Specific clinical and Doppler echocardiographic criteria were used to categorize each valve lesion as absent, insignificant, or significant. Criteria for a significant lesion at cardiac catheterization was an aortic or mitral valve area less than 1.1 or 1.5 cm2, respectively, or equal to or greater than 3+ cm2 aortic or mitral regurgitation at angiography. In all valve lesions, Doppler echocardiography had a higher overall accuracy than clinical evaluation. Increases in accuracies of 28%, 19%, 15%, and 7% occurred for mitral stenosis, aortic stenosis, aortic regurgitation, and mitral regurgitation, respectively, resulting in overall accuracies of 97%, 100%, 95%, and 96%. Clinical evaluation alone made 28 errors (37% of patients and 19% of valve lesions assessed), and 17 of these errors (23% of patients and 12% of valve lesions) would have resulted in inappropriate management. In only four (24%) of these 17 patients, the attending cardiologist would not have proceeded to assess the valve at cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Inheritance of hypertrophic cardiomyopathy: a cross sectional and M mode echocardiographic study of 50 families.

To determine the mode of inheritance of hypertrophic cardiomyopathy 193 first degree relatives (parents, siblings, and offspring) of 50 patients with hypertrophic cardiomyopathy were assessed by clinical examination, electrocardiography, M mode and cross sectional echocardiography, and necropsy when available. Thirty nine (20%) first degree relatives had hypertrophic cardiomyopathy--37% of parents, 25% of siblings, and 8% of offspring. Eight (23%) of 35 affected relatives diagnosed by echocardiography had normal clinical and electrocardiographic findings. In the total study group 43% of the male population and 30% of the female population were affected. This difference is statistically significant. In 28/50 families there was familial occurrence of hypertrophic cardiomyopathy. Familial occurrence was demonstrated in 17 of 18 families in which five or more family members were assessed. In 15 families the pattern of inheritance was consistent with an autosomal dominant trait; in the other 13 the affected members were identified in a single generation and the pattern of inheritance could not be determined.

Adolescent↗
PubMed1987

Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position.

A series of 252 isolated aortic homograft valves in 248 patients have been followed for 9 to 16.5 years (mean 10.8). The valves were sterilized in antibiotic solution and stored in a nutrient medium at 4 degrees C and were nonvital. There were 15 in-hospital deaths (6%) and a mortality of 2.7% in patients undergoing an elective first operation. Actuarial survival with the study valve in situ was 57% at 10 years and 38% at 14 years. Only 8.4% of the patients died late from homograft valve failure, chiefly because of failure to refer patients with endocarditis for reoperation or because reoperation was refused in elderly, frail subjects. Incompetence was the sole cause of valve failure and was due either to valve wear or endocarditis. Significant incompetence required reoperation. On actuarial analysis, freedom from significant incompetence for the entire group was 95% at 5 years, 78% at 10 years, and 42% at 14 years. Factors increasing the risk of significant incompetence due to valve wear on multivariate analysis were increasing donor valve age (greater than or equal to 55 years), recipient age (less than 15 years), and an aortic root diameter over 30 mm. Analysis of the patient group that excluded each of these variables (low-risk group), which comprised 61% of the study population, indicated freedom from significant incompetence due to valve wear of 98% at 5 years, 94% at 9 years, and 56% at 13 years.

Actuarial Analysis↗
PubMed1986

Long-term tolerance of amiodarone treatment for cardiac arrhythmias.

For the 5-year period 1979 to 1983, 242 patients were followed up who had received amiodarone treatment, 156 for supraventricular tachycardia (SVT) and 86 for ventricular arrhythmias. Five patients were lost to follow-up overseas; the rest were followed to cessation of therapy, death or recent review for a mean of 24 +/- 15 months. Male/female incidence was 1.8:1 and mean age was 58 years (range 4 to 88). Half the group had impaired left ventricular function. Adverse effects were recorded in 59% of the patients and led to drug withdrawal in 26% of the total group. In contrast, unsuccessful treatment was the cause of drug withdrawal in only 5% of the patients, although an additional 25% stopped taking the drug for various reasons. Actuarial survival for the whole group, and subgroups with SVT and ventricular tachycardia/fibrillation were 66%, 74% and 52%, respectively, at 50 months. For the whole group, the actuarial probability of being alive and continuing with amiodarone therapy was only 19% at 50 months. Thus, although amiodarone was effective, few patients tolerated the drug on a long-term basis. Although amiodarone remains a valuable treatment for patients with ventricular tachycardia, its long-term effectiveness for patients with SVT is less certain.

Adolescent↗
PubMed1986

Idiopathic giant cell myocarditis: case report.

Idiopathic giant cell myocarditis has not been previously reported from Australasia; a typical case is presented, and the clinical and pathological findings discussed. Possible aetiologies are discussed in the light of positive serology to coxsackie B viruses.

Adult↗
PubMed1986

A familial syndrome of cardiac myxomas, myxoid neurofibromata, cutaneous pigmented lesions, and endocrine abnormalities.

A family syndrome of cardiac myxomas, myxoid neurofibromata, cutaneous pigmented lesions, and endocrine abnormalities is described. Three cases from a family of four are presented. All had cutaneous pigmented lesions. The mother had left and right atrial myxomata, her daughter a left ventricular myxoma, subcutaneous myxoid neurofibromata, and mammary fibroadenosis, and her son has no evidence of cardiac myxoma. Elevated circulating levels of insulin-like growth factors in the one family member tested raises the possibility of abnormal stimulation of somatic growth and may be linked to development of soft tissue neoplasms in these patients.

Adolescent↗
PubMed1986

Anatomical and echocardiographic correlations in the normal heart.

Knowledge of the normal intracardiac structures and their variations is essential for interpretation of two-dimensional echocardiography. The anatomical features seen in the standard echocardiographic views have been demonstrated in normal heart specimens. The cardiac chambers and their connections must be identified. Visualisation of the inferior vena caval drainage to the right atrium usually enables its identification. The right ventricle may be distinguished by the more distal attachment of the tricuspid valve compared to the mitral valve and the presence of the moderator band. The pulmonary artery is recognised by its bifurcation, whereas visualisation of the origin of the brachiocephalic arteries or of both coronary arteries from a great artery identifies the aorta. Anatomical variants such as a prominent Eustachian valve of the inferior vena cava in the right atrium and fibromuscular strands or 'heart strings' traversing the left ventricular cavity are frequently visualised on the two-dimensional echocardiograms.

Adolescent↗
PubMed1985

Progression of hypertrophic cardiomyopathy to congestive cardiomyopathy: case report.

A case of hypertrophic cardiomyopathy presenting with chest pain and dyspnoea was followed for 18 years. During this time the patient showed a progressive loss of cardiac murmurs and over the last 12 months of life developed a dilatated cardiomyopathy associated with congestive heart failure, supraventricular and ventricular tachyarrhythmias.

Adult↗
PubMed1985

Complete heart block and bowel infarction secondary to rheumatoid disease.

A case of complete heart block secondary to rheumatoid involvement of the conduction system is presented. The same patient died after infarction of the colon as a consequence of arterial spasm superimposed upon pre-existing rheumatoid changes in the mesenteric arteries. The coexistence of rheumatoid involvement of the heart and of the bowel vasculature has not previously been reported.

Arthritis, Rheumatoid↗
PubMed1983

Detection of deterioration or infection of homograft and porcine xenograft bioprosthetic valves in mitral and aortic positions by two-dimensional echocardiographic examination.

Results of two-dimensional echocardiographic examinations were compared with angiographic, hemodynamic and surgical results in 44 patients with bioprosthetic valves in mitral and aortic positions who were undergoing elective or urgent reinvestigation 24 to 87 months (mean 34) after implantation. In these patients, there were 18 homograft aortic valves in the aortic position, 9 stent-mounted homograft aortic valves in the mitral position, 13 porcine xenograft valves in the mitral position and 12 in the aortic position. Poor cusp support, gross fluttering and prolapse of cusps behind or below the anulus identified aortic insufficiency by two-dimensional echocardiography in six patients with an aortic homograft and four patients were identified with insufficiency of a stent-mounted aortic homograft in the mitral position. Two-dimensional echocardiographic examination revealed mitral stenosis in three patients with a porcine xenograft valve in the mitral position and suggested mitral insufficiency in two others. Bacterial endocarditis on homograft or porcine xenograft valves was associated with easily imaged vegetations by two-dimensional echocardiography in 10 patients. Despite difficulties in imaging valve cusps, and the skill required to obtain good echocardiographic images of bioprosthetic valves, significant valve deterioration or infected prostheses were quite effectively imaged by two-dimensional echocardiography in this study.

Adolescent↗
PubMed1981

Amiodarone in long term management of refractory cardiac tachyarrhythmias.

Amiodarone was used in 30 patients with tachyarrhythmias refractory to treatment with several antiarrhythmic agents. In 18 patients with supraventricular arrhythmias (recurrent atrial tachycardia in seven; atrial fibrillation, recurrent in four and persistent in five; Wolff-Parkinson-White syndrome in two), complete control was obtained in eight and marked improvement in eight patients. Conversion of persistent atrial fibrillation to sinus rhythm was documented in three patients. Congestive heart failure improved markedly in three patients who had persistent atrial fibrillation during amiodarone therapy. In 12 patients with tachycardia of ventricular origin effective control was obtained in nine. The incidence of side effects was low. Amiodarone is effective in maintaining sinus rhythm in many patients with both supraventricular and ventricular tachyarrhythmias when standard antiarrhythmic agents have failed.

Adult↗