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Biomedical subjects

A Smolinsky

Publications and source records attributed to A Smolinsky.

At least 55 records · Page 3Linked to original sources
PubMed1983

Calculated preoperative mean left atrial pressure as a guide to volume load at the termination of aortocoronary bypass operation.

The routine use of an arbitrary fixed left atrial (LA) pressure during volume load after aortocoronary bypass operation was compared with use of an individualized postoperative target LA pressure according to a calculated preoperative LA pressure in two groups of consecutive patients. The preoperative LA pressure of each patient was calculated from the preoperative left ventricular end-diastolic pressure (LVEDP) by the formula: mean LA pressure = 1.16 x LVEDP - 8.53. Left atrial pressure, mean arterial pressure, mean right atrial pressure, and cardiac output were measured simultaneously on arrival at the intensive care unit and 60 minutes later. Cardiac index (CI) and systemic vascular resistance (SVR) were calculated from the variables already mentioned. Results indicated a significantly higher CI and significantly lower SVR in patients in whom volume load was aimed at the calculated preoperative LA pressure. It was concluded that the optimal postoperative LA pressure is specific for each patient and depends on the preoperative LVEDP.

Adult↗
PubMed1982

Treatment of nocturnal angina with 10 degrees reverse Trendelenburg bed position.

The effect of 10 degrees reverse Trendelenburg tilt of the bed was studied in ten patients with refractory nocturnal angina on 2 consecutive nights before aortocoronary bypass surgery. For the control night the bed was placed in the semi-orthopnoeic position, and for the test night it was put in the reverse Trendelenburg position. This position significantly reduced central venous pressure, diastolic pulmonary artery pressure, the number of isosorbide dinitrate tablets taken sublingually, and the number of angina episodes per night. Reverse Trendelenburg tilt of the bed therefore seems effective for relief of nocturnal anginal pain.

Aged↗
PubMed1981

Correction of tetrad of Fallot with reduced incidence of right bundle branch block.

In 20 patients who underwent a modified surgical repair of tetrad of Fallot complete right bundle branch block developed in only 8 (40 percent). Standard and intraoperative conduction studies indicated that in these patients the right bundle branch block was due to injury of the right bundle branch near the ventricular septal defect (proximal right bundle branch block). The modified operative technique is aimed at minimizing the injury to the right ventricle and it includes a significantly shorter than usual ventriculotomy incision and avoidance of the septal (moderator) band during infundibulectomy. Intra- and postoperative hemodynamic studies of these patients revealed that relief of the right ventricular outflow obstruction was optimal.

Adolescent↗
PubMed1981

Prevention of supraventricular tachyarrhythmia with low-dose propranolol after coronary bypass.

Eighty-five patients receiving long-term propranolol therapy were randomized after aorta-coronary bypass grafting either to receive minidose propranolol (Group I) or to serve as controls (Group II). They were compared with 18 patients (Group III) who did not receive beta blocking agents prior to operation but were given propranolol postoperatively. Poor-risk patients (those having left ventricular aneurysms, low ejection fraction, or congestive heart failure) as well as patients who required catecholamines postoperatively were included in the study. All three groups were comparable with respect to all risk factors. Propranolol (5 to 10 mg/6 hr) was started through a nasogastric tube 6 hours after operation and continued orally in all patients in Groups I and III. Supraventricular tachyarrhythmia appeared in two of 37 patients in Group I (5%), 19 of 48 patients in Group II (40%), and five of 18 patients in Group III (27%). The incidence of supraventricular tachyarrhythmia was significantly lower in Group I than in Groups II and III (p less than 0.001, Group I versus Group II; p less than 0.01, Group I versus Group III). In conclusion, low-dose propranolol is very effective in preventing supraventricular tachyarrhythmia following aorta-coronary bypass in patients receiving beta blockers preoperatively. The increased tendency for postoperative supraventricular tachyarrhythmia to develop in these patients is attributed to hypersensitivity to adrenergic stimulation after propranolol withdrawal. The tachyarrhythmia can be prevented by early reinstitution of propranolol in low doses after the operation.

Administration, Oral↗
PubMed1981

Fractional gradients along the outflow tract of the right ventricle in tetralogy of Fallot: anatomic and hemodynamic correlative study.

In 16 patients undergoing surgical correction of tetralogy of Fallot, attempts were made to determine where, in the outflow tract, the most critical preoperative obstruction was located. In the open chest, pressures were taken in the right ventricle, proximal conus, distal conus, and pulmonary artery. Pressure gradients between these levels were indicative of stenosis at the infundibular ostium (Ost.), conus (C), and pulmonary valve (PV), respectively. Total delta P = delta P Ost. + delta P C + delta P PV, where delta P is the pressure gradient between the right ventricle and the pulmonary artery. In order to evaluate the contribution of each obstructive segment to the overall obstruction, we introduced a new term, the fractional gradient (FG). The FG is defined by the following formula: FG = (delta P segmental/delta P total). The average total pressure gradient in this series was 7 mm Hg. The average segmental gradients were 15.5, 39.0, and 17.0 mm Hg for the infundibular ostium, conus, and pulmonary valve, respectively. The FGs across segments were 0.20, 0.54, and 0.26, indicating that only 20% of the average obstruction was located in the infundibular ostium. The remaining obstruction is distal and unrelated to the infundibular ostium. Analysis of the FGs in the various types of conus indicated, from an anatomic viewpoint, that in 80% of patients with tetralogy the infundibulectomy does not have to be radical.

Adolescent↗
PubMed1981

Pericardial tamponade and its effect on cardiac performance in absence of the pulmonic valve.

A controlled study was undertaken to quantitate and compare the amount of accumulated pericardial fluid causing acute pericardial tamponade in animals with or without an intact pulmonary valve. In 13 mongrel dogs, acute pericardial tamponade was induced by gradual loading of the pericardial cavity with fluid (mean 21.3 cc/m2). In 10 dogs (Group A) the pulmonic valve was completely excised under caval occlusion and the pericardium resealed. In Group B, the control group (n = 3), caval occlusion was performed for the same period of time but the pulmonary valve was left intact. Reloading of the pericardium with fluid in both groups revealed that whereas in the Control Group B a similar volume of fluid was required (mean 213 cc/m2) to cause critical tamponade, in Group A a much smaller volume (mean 132 cc/m2) (40% decrease) now produced tamponade (p less than 0.001). The results of the study may have important practical implications in patients having cardiac operations in which the pulmonary valve is left incompetent, such as after complete repair of tetralogy of Fallot.

Animals↗
PubMed1980

Closed pulmonary valvotomy in infants under 6 months of age: report of 14 consecutive cases without mortality.

Fourteen infants, all under 6 months of age, underwent surgery for the relief of severe valvar pulmonary stenosis. A modified Brock (transinfundibular valvotomy) procedure was performed in all cases. Dilatation of the pulmonary valve with a mosquito clamp and biliary dilator is the basis of the modified operation. All infants survived the operation. In two patients there is residual, significant pulmonary stenosis, and in two additional cases pulmonary regurgitation is present.

Female↗
PubMed1976

The operative problem of small left atrium in total anomalous pulmonary venous connection: report of 5 patients.

A moderately small left atrium is a common finding in total anomalous pulmonary venous connection (TAPVC). In most patients in whom the common pulmonary vein is anastomosed to the left atrium, the small size of this chamber does not interfere with good operative results. Recently a patient was encountered in whom the left atrium measured less than 2 cm in its greatest dimension. This atrium was too small to take an anatomosis with the common pulmonary vein. Therefore the common pulmonary vein was anastomosed primarily to the right atrium, the floor of the fossa ovalis was excised, and a pericardial conduit was constructed. Subsequently, 4 additional patients have been similarly treated. The problem of small left atrium in TAPVC is discussed.

Adult↗
PubMedDate not supplied

Qualitative evaluation of antegrade percutaneous transluminal angioplasty by pressure waveform parameters.

When percutaneous transluminal angioplasty (PTA) is performed in an antegrade ("downstream") direction, intraluminal gradient measurements across the stenotic segment are not possible. Pressures recorded proximal to the lesion were evaluated for possible hemodynamic clues of changes in flow in ten consecutive patients before and after PTA. In all patients in whom the procedure was successful, the systolic pressure decreased by an average of 35 mm Hg. This decrease was not evident in the failed procedures. It is concluded that proximally recorded pressure changes can be used as an objective criterion to assess the success of PTA performed in arteries.

Aged↗