Biomedical subjects
Publications and source records attributed to B M Groves.
We report two cases of the inadvertent insertion of a saphenous vein bypass graft into the anterior cardiac vein creating an aortocoronary vein fistula. The clinical recognition, evaluation, and management are discussed. Suggestions on surgical technique to help minimize or eliminate this potential complication during saphenous vein bypass surgery are proposed.
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In order to assess the accuracy and reproducibility of the proposed American Society of Echocardiography (ASE) method for measuring left ventricular dimensions on M-mode echocardiograms, we measured the end-diastolic (Dd) and end-systolic (Ds) dimensions by the ASE method and our current technique in 50 normal subjects and 24 patients without coronary artery disease who had symmetrically contracting ventricles on cineangiography. Dd and Ds were significantly greater by the proposed ASE method than by our current technique (p less than 0.001), but the correlation between the two was good (r = 0.93 and 0.83, respectively). In 10 of the normal subjects, the interobserver variability of both methods was excellent. In the 24 patients, the proposed method consistently overestimated the angiographic left ventricular volumes compared with our current technique and occasionally the discrepancies were quite large. Therefore, the proposed ASE method for measuring left ventricular dimensions is not clearly superior to other currently available techniques.
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The effects of 1.25, 2.0, and 2.5 MAC isoflurane on atrioventricular conduction were studied by His-bindle electrocardiography during atrial pacing in ten dogs. No effect upon atrioventricular conduction as evidenced by changes in A--H interval (the time of conduction from low right atrium to His-bundle, representing primary AV nodal conduction) was found at these concentrations. Atrial pacing to 200 beats/min did not influence the A--H interval at the three anesthetic concentrations. The stability of cardiac rhythm observed clinically with isoflurane may be related to this lack of effect upon the AV node.
To analyze the relationship between the myocardial supply and demand for oxygen in patients with aortic regurgitation, the ratio of the diastolic pressure-time index (DPTI) over the systolic pressure-time index (SPTI) was derived from recordings of pressure during cardiac catheterization in 24 patients with aortic regurgitation, and this ratio was compared with that in 14 normal subjects and in ten patients with congestive cardiomyopathy (an ejection fraction less than 0.30). Patients with aortic regurgitation had a DPTI/SPTI of 0.75 +/- 0.06 (mean +/- SE), which was lower than in the normal subjects (1.24 +/- 0.06) and patients with cardiomyopathy (1.06 +/- 0.03) (P less than 0.001). Among the patients with aortic regurgitation, the 13 with a DPTI/SPTI below 0.70 had more severe aortic regurgitation than the 11 with a DPTI/SPTI above 0.70. Aortic regurgitation results in a reduced myocardial supply-demand ratio, as measured by the DPTI/SPTI, which is related to the severity of the valvular regurgitation and is not present in patients with left ventricular dysfunction secondary to congestive cardiomyopathy.
Systolic anterior motion of the anterior mitral valve leaflet and asymmetric septal hypertrophy are the principal components of the dynamic subaortic stenosis in hypertrophic obstructive cardiomyopathy. Mitral valve systolic anterior motion without septal hypertrophy or left ventricular outflow tract obstruction has been described, but asymmetric septal hypertrophy is supposedly a consistent feature of dynamic subaortic stenosis. We describe two patients with syncope, chest pain and the typical systolic murmur of hypertrophic subaortic stenosis whose echocardiograms showed mitral valve systolic anterior motion but not asymmetric septal hypertrophy. Normal septal thickness on echo was confirmed by intravenous indocyanine green to identify the right septal endocardium. At catheterization, left ventricular outflow tract gradients were provoked, and neither patient had interventricular septal hypertrophy on biventricular cineangiography. These findings in two cases suggest that mitral valve systolic anterior motion can be the only definable anatomic abnormality associated with symptomatic dynamic left ventricular outflow tract obstruction and that asymmetric septal hypertrophy is not a necessary component of this condition.
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Sources of scattered radiation exposure to personnel from a ceiling-mounted x-ray tube were examined at the side of cardiac catheterization patients. A fully adjustable mounting for a lead glass shield was designed to afford maximum radiation protection to the attending physician's head and neck area, while minimizing interference with the procedure.
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The effect of pancuronium bromide on atrioventricular conduction was studied by His-bundle electrocardiography during atrial pacing at different heart rates in halothane-anesthetized dogs. Pancuronium bromide, 0.1 mg/kg, uniformly enhanced atrioventricular conduction, as evidenced by decreased A-H interval (the time from the onset of the first high-frequency component of atrial depolarization to His deflection). Wenckebach second-degree atrioventricular block appeared in five of 14 animals during atrial pacing with halothane anesthesia. This block was uniformly abolished by pancuronium. The enhancement of atrioventricular conduction may contribute to the development of tachyarrhythmias following administration of pancuronium in certain patients, particularly those who have atrial fibrillation or atrial flutter.
Technetium-99m stannous pyrophosphate (Tc-PYP) cardiac scintiphotos were performed on 101 of 221 patients admitted to the Coronary Care Unit to rule out acute myocardial infarction (AMI). Criteria were defined for the diagnosis of AMI, variant angina and unstable angina. 42 patients were diagnosed as having had an AMI. 22 patients had transmural and 20 patients had nontransmural AMI. 40 of the 42 patients with AMI (95%) had positive scintophotos; 2 (5%) had negative scintiphotos. 59 patients did not have an AMI; (97%) had negative scintiphotos. Four of these 59 patients had variant angina; all had negative scintiphotos. Seven of these 59 patients had unstable angina; 2 had positive scintiphotos. Tc-PYP scintiphotos have high sensitivity and specificity and are accurate in correctly classifying patients as having or not having AMI.
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