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Biomedical subjects

C E Kinley

Publications and source records attributed to C E Kinley.

At least 19 recordsLinked to original sources
PubMed1996

Opening the pleura during internal mammary artery harvesting: advantages and disadvantages.

OBJECTIVE: To evaluate the findings of previous studies that opening of the pleura during internal mammary artery (IMA) dissection might be an important factor in increasing the operative morbidity. DESIGN: A randomized control trial. SETTING: A university hospital. PATIENTS: Two hundred and eighty consecutive patients with no significant pulmonary disease. INTERVENTION: Harvesting of the IMA with (130 patients) or without (150 patients) opening the pleura. MAIN OUTCOME MEASURES: Comparison of the incidence of pleural effusion, cardiac tamponade, postoperative respiratory complications and the hospital stay. RESULTS: Pleural effusion occurred more often in the patients who had opening of the pleura (20% versus 5%); however, none of the patients required tapping. Postoperative bleeding with cardiac tamponade occurred in five patients in the closed pleura group. Six patients in the open pleura group had postoperative bleeding but without tamponade. The average postoperative stay was 7 days for both groups. No significant differences were recorded in postoperative respiratory complications. CONCLUSIONS: Opening of the pleura during IMA harvesting does not increase the operative morbidity. It may have other advantages and is recommended in most cases of IMA harvesting.

Female↗
PubMed1995

Evidence of type 2 herpes simplex infection in human coronary arteries at the time of coronary artery bypass surgery.

OBJECTIVE: To examine histologically biopsies from the coronary arteries of patients undergoing coronary artery bypass grafting (CABG) for evidence of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) antigen and to correlate the incidence with pathological and clinical data. DESIGN: Sequential patients undergoing CABG in whom adequate tissue could be obtained for histology. SETTING: University teaching hospital. PATIENTS: Forty-six patients were enrolled. Thirty-one provided sufficient tissue and clinical information for the analysis. METHODS: Biopsy material was collected in the operating room and prepared immediately for histology and electron microscopy. Slides were prepared by staining with hematoxylin and eosin, Masson trichrome, avidin biotin complex immunoperoxidase for HSV-1 and HSV-2 protein and specific DNA probes for HSV-1 and HSV-2 by hybridization. Clinical data were obtained in structured interviews. RESULTS: Sixty-one per cent of biopsies demonstrated evidence of inflammation, 45% were positive for antigen to HSV-2 and only one to HSV-1. Significant positive correlations were detected between inflammatory cells in the biopsy and a recent history of cold sores and between the presence of the infiltrate and positivity to HSV-2 antigen. CONCLUSION: A correlation exists between HSV-2 infection and the inflammatory response associated with atherosclerosis.

Adult↗
PubMed1994

The safety of intermittent warm blood cardioplegia.

Continuous warm blood cardioplegia is considered to be an effective method for myocardial protection. However, frequently the flow of the cardioplegia needs to be interrupted for better visualization. Intermittent warm blood cardioplegia was reported to be safe by some investigators. To assess the degree of this safety, 76 patients who underwent operations for coronary or valvular disease, or both, were divided into two groups of 38 patients each. The two groups were well matched for age, ejection fraction, number of coronary bypasses and type of valvular procedures. Cold blood cardioplegia (CBC) was used intermittently every 15 min in the first group while the second group received warm blood cardioplegia (WBC) intermittently every 15 min. The clamp time range was 50-140 min. There were no deaths in either group, four myocardial infarctions occurred, two in each group. Low cardiac output occurred in 13 patients of the WBC group and in 7 patients of the CBC group, electrocardiogram (ECG) global ischemic changes were recorded in 14 patients of the WBC group compared to 6 patients of the CBC group. Statistically the results indicate that the techniques are comparable if the clamp time is less than 90 min. However, after 90 min the development of ECG changes and low cardiac output are significantly higher when WBC is used P < 0.001. Therefore, it is concluded that using the WBC intermittently is as safe as CBC when the clamp time is less than 90 min, however extra precautions are needed with longer clamp times.

Aged↗
PubMed1994

Optimal imaging techniques for locating leaflets after escape from prosthetic heart valves.

The authors report two cases of leaflets escaping from an Edwards-Duromedics bileaflet prosthetic heart valve (Baxter-Edwards Division, Baxter Healthcare Corp., Irvine, Calif.). Several imaging techniques were used in attempts to locate the leaflets. Only computed tomography (CT) led to conclusive results. Because progressive extrusion through the arterial wall was documented surgically in these cases, the authors recommend that CT be performed as early as possible after a leaflet escapes, even in asymptomatic patients. Extrusion through the arterial wall precludes percutaneous intravascular movement or retrieval of escaped leaflets.

Adult↗
PubMed1989

The measurement of afterload, vascular input impedance, and power distribution in aorto-femoral bypass.

The effects of aorto-femoral bypass grafts on the vascular input impedance, and the ratio of pulsatile to total power were studied in eight dogs. Unilateral ileo-femoral stenosis was simulated and comparisons were made between the input impedance and power distribution in healthy and simulated disease situations. Input impedance magnitude spectra and phase were displayed graphically and it was shown that the presence of the simulated disease increases the ratio of pulsatile to total power as measured in the abdominal aorta from 7.5 to 14.8% (p less than 0.05). This suggests that the presence of the stenosis creates an impedance mismatch thus causing reflected waves to propagate proximally towards the heart. It was concluded that the way in which the heart transfers fluid power into the arterial bed was compromised by the presence of the ileo-femoral partial stenoses. It is further suggested that the system described in the paper makes it possible to quantitatively assess afterload, vascular input impedance and cardiovascular power distribution as a quasi-real time diagnostic procedure.

Anastomosis, Surgical↗
PubMed1986

Simulation of coronary artery revascularization.

Simulation of the commonly constructed geometries of aorto-coronary bypass anastomoses was carried out using especially fabricated distensible tubes and a pulsatile pump. The system pressure was maintained between 80 and 120 mmHg. The total mean flow was set at 250 ml min-1 (Reynolds number of 200) and the pulsatile frequency was varied from 0 to 2 Hz. A water-glycerine mixture having a density and viscosity similar to that of blood was used throughout. A 16 mm film of the front of black dye injected proximal to the anastomosis was made as the dye approached and passed through the anastomosis. Anastomotic geometries consisted of: end to side, parallel, 45 degree angle, and 90 degree angle. Stenoses, located in the tube representing the coronary artery, were simulated using a bevelled insert which represented an 80-85% area reduction. Flow visualization revealed that distensible tubes gave more realistic flow patterns than rigid tubes, a result particularly evident when a stenosis was present. Pulsatile flow demonstrated considerably more mixing than steady flow. The use of pulsatile flow in distensible tubing with a partial stenosis showed retrograde flow through the stenosis which was not evident for either steady flow or for flow in rigid tubing. The flow at the anastomatic site of the graft having an angle of 0 degrees showed a jetting action with a zone of recirculating fluid being present whereas for a 90 degree graft a distinct helical flow was formed distal to the anastomosis.

Aorta↗
PubMed1986

Prevention of neurological injury during myocardial revascularization in patients with calcific degenerative aortic disease.

Neurological injury following myocardial revascularization may result from embolization of atheromatous debris from the diseased ascending thoracic aorta. Eight patients with calcified aortas who underwent elective myocardial revascularization suffered major strokes as a result of manipulation and clamping of the diseased ascending aorta during a 30-month period before July, 1981. computerized axial tomography scans demonstrated multiple cerebral infarctions in each patient. Six patients never regained consciousness and died as a result of neurological injury; 2 patients regained consciousness but were left with major neurological deficits. Later, 21 patients with calcific aortic degenerative disease underwent a specific operative protocol, designed to prevent neurological injury during elective myocardial revascularization. All 21 patients recovered without neurological complications. Specific attention to operative technique allowed this difficult group of patients with incapacitating angina and calcific degenerative aortic disease to have the benefit of coronary bypass.

Aorta, Thoracic↗
PubMed1986

Myocardial metabolism and hemodynamic responses with fentanyl-enflurane anesthesia for coronary arterial surgery.

Ten patients for coronary vein grafting had induction of anesthesia with fentanyl (30 micrograms/kg), followed by enflurane-oxygen sufficient to decrease systolic blood pressure by 27% before intubation. Enflurane was continued in concentrations to maintain blood pressure below that with patients awake. All patients had preserved ventricular function and effective beta-blockade. Studies of hemodynamic functions and myocardial blood flow and oxygenation were done before induction, six times during anesthesia, and twice postoperatively. The blood pressure decrease on induction and before bypass was due to reduced cardiac index without decreased heart rate or systemic resistance. Stroke work index decreased 47% on induction and remained below awake level throughout. Coronary sinus blood flow decreased 26% after intubation and remained so before bypass. Without change in coronary resistance, coronary sinus oxygen content increased 30% on induction and stayed elevated before bypass. Normal lactate extraction continued after induction and increased before bypass; mean extraction decreased after bypass, with one or two hearts producing lactate in the first 24 postoperative hr. Fentanyl-enflurane-oxygen maintained a steady mild hemodynamic depression during the operation and soon afterward, which preserved myocardial oxygenation.

Anesthesia↗
PubMed1986

Myocardial metabolism and hemodynamic responses with isoflurane anesthesia for coronary arterial surgery.

Isoflurane-oxygen was given for induction and maintenance of anesthesia to ten patients having coronary artery bypass grafts. All had preserved ventricular function without hypertension or other cardiac lesions; treatment with beta-blocking drugs was maintained until the operation in all patients. Cardiac output, arterial and central pressures, coronary sinus (CS) blood flow, arterial and CS oxygen, Hb, and lactate contents were measured before, six times during, and twice after anesthesia. On induction, systolic arterial pressure was purposely reduced 33% along with systemic resistance by increasing the concentration of isoflurane; cardiac index, heart rate, and coronary flow did not change. Coronary resistance decreased 23% and CS oxygen content increased 56%; but in three of ten patients myocardial lactate production took place, evidence of global ischemia. Induction of anesthesia was not smooth in three patients. Controlled hemodynamic depression could be maintained with isoflurane-oxygen, but the frequency of myocardial lactate production before and after perfusion was greater than with other general anesthetics. Isoflurane dilated portions of the coronary bed but, because anaerobic metabolism occurred concomitantly, the theory that redistribution of flow can take place resulting in ischemic areas of ventricle is supported.

Adult↗
PubMed1985

Intimal hyperplasia in autogenous vein grafts used for arterial bypass: a canine model.

Late vein graft occlusion following myocardial revascularisation is usually the result of progressive intimal hyperplasia which ultimately leads to vein graft thrombosis. Considerable attention has recently been directed towards the development of optimal platelet-inhibiting drug regimens designed to prevent intimal hyperplasia in autogenous vein grafts. This report describes an animal model that reliably reproduces short-term intimal hyperplasia in autogenous vein grafts, thus facilitating the study of platelet-inhibiting drug regimens for the prevention of intimal hyperplasia. 28 segments of undistended jugular vein were implanted end-to-end between bilaterally divided femoral arteries in 14 mongrel dogs. Seven control animals (CON) received a non-lipid diet one week before and for 6 weeks following vein implantation. A further seven animals received a 2% cholesterol diet throughout the study. Serum cholesterol was measured at 4.06 +/- 0.6 mmol X litre-1 in the CON and did not change significantly throughout the study. Serum cholesterol rose from 3.9 +/- 0.4 to 8.5 +/- 0.8 mmol X litre-1 in the lipid-supplemented animals (p less than 0.001). Vein grafts were harvested at 6 weeks and fixed in formaldehyde. Precise measurements of intimal thickness in microns were measured from multiple vein graft cross-sections with a Zeiss computerised interactive image analysing system. A mean of 102 +/- 15 measurements were made from each vein graft cross-section. Intimal thickness of autogenous vein grafts prior to implantation were similar in both groups and measured 4.15 +/- 0.4 micron. Intimal thickness increased in CON animals to 23.3 +/- 3 microns.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Encircling endocardial resection with complete removal of endocardial scar without intraoperative mapping for the ablation of drug-resistant ventricular tachycardia.

Encircling endocardial resection, with complete removal of endocardial scar unguided by intraoperative mapping, was employed in 10 patients with drug-resistant sustained ventricular tachycardia. Reproducible sustained ventricular tachycardia was induced in all patients preoperatively with programmed electrical stimulation. A trial of conventional antiarrhythmics had failed in all 10 patients; seven patients required frequent cardioversion, and three patients required overdrive suppression with temporary transvenous pacing. Encircling endocardial resection was performed in all patients, with complete removal of endocardial scar; partial reimplantation of the mitral apparatus was required in nine patients. Eight patients underwent aneurysmectomy, and the nine patients who required concomitant aorta-coronary bypass received a total of 13 grafts (mean 1.3 grafts per patient). There were no spontaneous postoperative arrhythmias. One patient without postoperative clinical arrhythmias, who had required daily preoperative cardioversion, had inducible ventricular tachycardia with postoperative programmed electrical stimulation, but not after loading with procainamide. Mean follow-up was 17.3 months. Eight patients are alive and well. There were two late deaths. One patient died with recurrent ventricular septal defects 2.5 months following extensive septal encircling endocardial resection, and one patient was readmitted after 4 months with massive pulmonary embolus and right-sided heart failure. This early experience suggests that this procedure, with complete removal of endocardial scar, successfully ablates reentrant ventricular tachycardia. We believe that the procedure will prove to be more effective than localized endocardial resection because the encircling procedure removes all ventricular sites that have the potential to generate reentrant ventricular tachycardia.

Aged↗
PubMed1985

Cod-liver oil in the prevention of intimal hyperplasia in autogenous vein grafts used for arterial bypass.

Cod-liver oil, rich in eicosapentaenoic acid, an unsaturated fatty acid, was administered to 14 mongrel dogs to determine if this acid would prevent platelet-mediated intimal hyperplasia. Twenty-eight 1 cm segments of undistended jugular vein were interposed between bilaterally divided femoral arteries. Seven control animals were fed a 2% cholesterol diet 1 week before and for 6 weeks after the operation. A further seven animals received cod-liver oil capsules containing 1.8 gm of eicosapentaenoic acid daily 1 week before and for 6 weeks after autogenous vein implantation, in addition to the lipid-supplemented diet. Baseline serum cholesterol was 4.6 +/- 0.4 mmol/L. The rise in serum cholesterol was similar in the two groups and increased to 7.4 +/- 0.6 mmol/L (control group) and to 6.8 +/- 0.2 mmol/L (eicosapentaenoic acid group) (p less than 0.001). Prothrombin time, partial thromboplastin time, bleeding time, and platelet counts were unchanged in the two groups. Vein grafts, harvested at 6 weeks, were fixed in formaldehyde. Mean intimal thickness was measured from multiple vein graft cross sections with a Zeiss computerized interactive image analyzing system. A mean of 140 +/- 11 measurements were computed from each graft. Marked intimal hyperplasia occurred in the control group and increased from 4.3 +/- 0.3 to 86.4 +/- 14 micron. In contrast, a high eicosapentaenoic acid diet inhibited intimal hyperplasia, with intimal thickness only increasing from 4.0 +/- 0.4 to 24.8 +/- 2.7 micron (p less than 0.001). These data indicate that eicosapentaenoic acid inhibits platelet-mediated intimal hyperplasia and suggest that cod-liver oil could be used to prevent intimal hyperplasia in vein grafts used for myocardial revascularization.

Animals↗
PubMed1984

Myocardial metabolism and haemodynamic responses with enflurane anaesthesia for coronary artery surgery.

Ten patients were studied before, during and after enflurane anaesthesia for coronary vein grafting. All had good ventricular function and nine were receiving effective beta blockade. Cardiac output and vascular pressures were measured, plus coronary sinus blood flow (CBF), myocardial oxygen consumption (MVO2) and lactate extraction (MLE). Enflurane induction (10 minutes, mean 1.72 per cent end tidal) reduced blood pressure (MAP), due to decreased cardiac index (CI), with no change in heart rate or systemic resistance. Intubation returned MAP and CI to control level but the heart rate increased. Subsequently, enflurane kept MAP, CI and stroke work below the awake level. CBF decreased on induction, rose again on intubation and remained normal before bypass. MVO2 fell on induction from an increase in CS oxygen content, which remained elevated. Normal MLE continued in every patient. There was no evidence of myocardial ischaemia in patients on beta blockade, when haemodynamics were maintained at or below those of the sedated, awake state.

Adult↗
PubMed1984

Myocardial metabolism and haemodynamic responses during high-dose fentanyl anaesthesia for coronary patients.

Fentanyl (mean dose 109 micrograms X kg-1) and oxygen were given to ten patients having coronary vein grafts. Serial studies were done before, during and after operation, of central and mean arterial pressures (MAP), cardiac index (CI) and coronary sinus flow (CBF) by thermodilution, myocardial oxygen consumption (MVO2) and lactate extraction (MLE). On induction CI and stroke work index decreased, but heart rate and MAP were unchanged as systemic resistance increased. Mean MAP and heart rate remained at the awake levels. Mean CBF remained unchanged along with stable MAP and coronary resistance. Oxygen content of CS blood increased on induction and remained elevated until the incision; it was above the awake level early postoperatively. MVO2 was low normal when the patients were awake and remained so. Normal MLE continued with a few exceptions. High-dose fentanyl did not uniformly abolish autonomic reflexes. Heavy premedication, complete beta adrenergic blockade and a high initial doses of fentanyl plus its continued infusion, aided in retaining a hypodynamic circulation and myocardial oxygenation.

Anesthesia, Inhalation↗
PubMed1984

The effects of nitrous oxide on myocardial metabolism and hemodynamics during fentanyl or enflurane anesthesia in patients with coronary disease.

Twenty patients about to have coronary artery bypass grafts were studied before and after 15 min of 50% nitrous oxide added to either fentanyl (75 micrograms/kg) or enflurane (0.5%) anesthesia. Arterial and central pressures and cardiac output were measured, plus coronary sinus blood flow and arterio-coronary sinus differences in oxygen, hemoglobin, and lactate contents. Fentanyl-N2O and enflurane-N2O both decreased systemic resistance, heart rate, cardiac output, and hence arterial pressure. Stroke work decreased significantly with little or no change in wedge pressure: ventricular function was impaired. Coronary flow and myocardial O2 consumption decreased with fentanyl-N2O. Oxygen extraction increased with enflurane-N2O, as did lactate contents of coronary sinus blood. Hemodynamic depression occurred from the combined effects of nitrous oxide and fentanyl or enflurane. The beta-blocked myocardia of nonstimulated coronary patients were becoming ischemic globally on 50% oxygen, after significant hypotension. From this and other evidence, we conclude that nitrous oxide may not be benign in patients with coronary arterial disease.

Adult↗
PubMed1984

Encircling endocardial resection for sustained drug-resistant ventricular tachycardia.

Localized endocardial resection guided by intraoperative mapping has been used recently to manage patients with drug-resistant ventricular tachycardia. Although not uniformly successful, this procedure is superior to simple aneurysmectomy. This report describes the authors' early experience with encircling endocardial resection with complete removal of endocardial scar in seven patients with drug-resistant, sustained, ventricular tachycardia, as identified by electrophysiologic studies. Intraoperative mapping was not used. Although no spontaneous clinical arrhythmia occurred after operation, ventricular tachycardia could be induced in one patient, but not after loading with procainamide. This was the only patient who required long-term antiarrhythmic therapy. There were no operative deaths, but one patient died 21/2 months after endocardial resection with recurrent ventricular septal defects and another died after 4 months. Our early experience indicates that encircling endocardial resection effectively eliminates re-entrant ventricular tachycardia and identifies ventricular septal defect as a potential postoperative complication following extensive septal endocardial resection.

Aged↗
PubMed1984

Effects of crystalloid and blood cardioplegic solutions on myocardial cooling during myocardial revascularization.

Cardioplegic protection during ischemic arrest is impaired in patients with serious coronary artery disease, resulting in large regional temperature gradients and impaired myocardial cooling. Recent data have suggested that the viscosity of cardioplegic solutions may affect their distribution beyond coronary artery stenosis. This study compared the effects of asanguineous and blood cardioplegic solutions on myocardial cooling in 26 such patients who underwent elective myocardial revascularization; 15 were subjected to blood cardioplegia and 11 to crystalloid cardioplegia. One litre of blood or asanguineous cardioplegic solution was infused into the aortic root at a constant infusion pressure. Samples for viscosity determination were taken from both cardioplegic solutions during their infusion. Regional myocardial temperature was measured distal to coronary artery obstructions following administration of the cardioplegic agent. Although the viscosity of the blood solution was 250% greater than the asanguineous solution, regional myocardial temperatures were not significantly different beyond the coronary artery stenosis. Regional temperature was reduced to less than 15 degrees C after infusion of the cardioplegic agent in regional myocardium with a normal coronary circulation. Marked temperature gradients were observed distal to a critical stenosis, with temperatures ranging between 18 degrees C and 20 degrees C for stenosis, and about 23 degrees C for obstruction. The authors conclude that the marked difference in viscosity between crystalloid and blood cardioplegic solutions does not significantly affect their distribution beyond a coronary artery stenosis.

Blood↗