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Biomedical subjects

A P Kruse

Publications and source records attributed to A P Kruse.

10 recordsLinked to original sources
PubMed1997

Donor left ventricular hypertrophy increases risk for early graft failure.

A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25% of deaths were due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction compared with donors with normal echocardiographic profiles (33% vs 3%, P = 0.007).

Adult↗
PubMed1985

Oral verapamil for prophylaxis of supraventricular tachycardia after myocardial revascularization. A randomized trial.

To determine if the prophylactic administration of oral verapamil is effective in reducing the incidence of supraventricular tachycardia after myocardial revascularization, 141 patients were entered into a double-blind randomized trial. Seventy patients received verapamil 80 mg every 8 hours beginning immediately after operation and continuing for 5 days, and 71 patients received placebo. Patients were monitored during the study period and observed for the occurrence of supraventricular tachycardia. The verapamil and placebo groups were similar with regard to sex, age, preoperative antianginal drugs, number of bypass grafts, average bypass time, and average occlusion time. A total of 39 patients had supraventricular tachycardia, 20 were receiving verapamil, and 19 were receiving placebo. The average ventricular rate was 127 +/- 13 beats/min for the verapamil group with supraventricular tachycardia compared with 140 +/- 12 beats/min for the placebo group with the mean differences not significant (p = 0.10). On the basis of these data, it is concluded that verapamil 80 mg every 8 hours beginning early after myocardial revascularization is not effective in reducing the incidence of supraventricular tachycardia.

Administration, Oral↗
PubMed1984

Management of patients with carotid bruit undergoing cardiopulmonary bypass.

During a 31 month period, 1,433 consecutive patients undergoing cardiac procedures were screened for carotid bruit. A total of 94 patients with carotid bruit were identified who had ultrasonic carotid duplex scans. Nine patients had a history of transient ischemic attack, carotid bruit, and reduction in internal carotid artery diameter by greater than or equal to 50% according to ultrasonic carotid duplex scanning. All nine patients underwent carotid angiography followed by thromboendarterectomy prior to or simultaneous with cardiopulmonary bypass. There was one neurological complication leading to death in this subset. Sixteen patients with asymptomatic carotid bruit had ultrasonic carotid duplex scanning revealing an internal carotid artery lesion of greater than or equal to 50% but did not undergo arteriography or thromboendarterectomy prior to the cardiac procedure. Perfusion pressure was maintained at greater than or equal to 70 mm Hg during bypass. There were no focal neurological events in this subset. Sixty-six patients with internal carotid artery stenosis of less than 50% diameter reduction and asymptomatic bruits had no further work-up or modification in perfusion technique, and there were no focal neurological events in this group. Thus there were no focal neurological events in any of the 82 patients with asymptomatic carotid bruit. An additional group of three patients with a previous stroke and internal carotid artery occlusion by ultrasonic carotid duplex scanning had transient exacerbation of neurological symptoms after cardiopulmonary bypass. The remaining 1,339 patients without carotid bruit had nine (0.7%) focal neurological events postoperatively. We believe that asymptomatic patients with or without hemodynamically significant stenosis can safely undergo cardiopulmonary bypass procedures without carotid thromboendarterectomy. Patients with asymptomatic bruits can be safely screened with ultrasonic carotid duplex scanning and do not require arteriography prior to cardiopulmonary bypass.

Auscultation↗
PubMedDate not supplied

Limited cytomegalovirus-specific immunoglobulin M and immunoglobulin G profiles in heart transplant recipients.

Twenty heart transplant recipients were assayed serially with cytomegalovirus cultures and with Western blot techniques for development of anticytomegalovirus immunoglobulin M (IgM) and immunoglobulin G (IgG). Patients were followed up 3 to 29 months (mean, 15 months) after transplantation. All but three patients received a 5-week perioperative course of passive immunization with immune globulin. Of nine seronegative patients with seropositive grafts, positive cytomegalovirous cultures developed in all, secondary organ involvement (gastrointestinal or pneumonia) developed in four of nine. Four of nine patients produced limited IgM profiles, consisting of only one to three bands; six of the nine patients had atypical, restricted IgG profiles. Three of four patients in whom secondary organ invasion developed had limited IgM profiles, and all four had atypical IgG profiles. Four of five patients with primary infection without symptoms produced full IgM profiles. Delay of IgM production until a time coincident with or after evidence of viral shedding was documented in all patients with primary infection and secondary organ involvement. Among 11 seropositive patients, five received seropositive grafts and six seronegative grafts. Of the five patients with seropositive grafts, positive cultures (reinfection) developed in three; all three responded with full IgM profiles. However, secondary organ involvement developed in two of these three in spite of full IgM profiles. Symptomatic illness did not develop in any patient with a seronegative donor, even in the presence of positive cultures (reactivation). Persistence of IgM for up to 26 months was found in all patients with primary infection or reinfection. In heart transplant recipients, limited IgM and IgG profiles in primary infection may confer increased risk of secondary organ invasion whereas the early development of full IgM profiles may correlate with disease without symptoms. In seropositive patients, production of full IgM profiles may not protect from reinfection with secondary organ involvement if the organ donor is seropositive, a potential source of a new viral strain.

Antibodies, Viral↗