Biomedical subjects
Publications and source records attributed to A K Yates.
Cerebral embolism may complicate lesions of the subclavian arteries or aortic isthmus distal to the origins of the vertebral or carotid arteries. This may be due to retrograde propagation of occlusive thrombus. In other cases the vessels are patent but there are periods of reverse blood flow, creating a potential for reflux of embolic material to the ostia of the neck vessels.
Two cases of pulmonary arteriovenous fistula were treated by local anatomical dissection and excision. This technique is preferable to pulmonary resection when the fistula is localised and superficially situated. The feeding vessels must be included in the resection to avoid possible recurrence. The history of the surgical removal of arteriovenous fistulae is discussed, and the reasons for preferring local excision are given.
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A method is described whereby mitral valve function can be tested during cardiopulmonary bypass under physiological conditions. This method avoids the risk of systemic air embolism during testing and can be used even in the presence of aortic regurgitation. Monitoring left ventricular pressure simultaneously with aortic root pressure prevents any overdistention of the left ventricle. This method has been in use at Guy's Hospital since 1970 and has been satisfactory and safe.
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Two prophylactic antibiotic regimes were compared in 129 patients who had open heart surgery for mitral and/or aortic valve replacements at Guy's Hospital. The first group were prescribed cephalothin for five days beginning with premedication. The second group were prescribed the combination of cloxacillin and gentamicin for the same time. The incidence of minor infection was low. There was no statistical difference between the two antibiotic regimes. The major infections were due predominantly to Gram negative organisms and difficult to prevent by any prophylactic regime.
Two patients with intractable life-threatening ventricular tachycardias have been studied using intracardiac electrograms and programmed electrical stimulation of the heart. Both patients have shown to have an underlying re-entry mechanism in the ventricles as the basis for the tachycardias. Both patients underwent epicardial mapping studies at cardiac surgery, and the site of re-entry was established. In one patient the re-entry front was found to start in the posterobasal region of the left ventricle and in the other patient the re-entry front was found in the anterobasal region of the right ventricle. In both patients surgical interruption of the re-entry front was carried out. Both patients are alive and free from tachycardias at the time of writing.