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Biomedical subjects

C F Wooley

Publications and source records attributed to C F Wooley.

At least 91 records · Page 5Linked to original sources
PubMed1980

Metabolic studies in mitral valve prolapse syndrome. A neuroendocrine--cardiovascular process.

Symptomatic patients with mitral valve prolapse (MVP) frequently mimic thyrotoxicosis, hyperadrenergic states or hypoglycemia. Twenty symptomatic patients with auscultatory and echocardiographic MVP were studied in the clinical research unit. T3, T4 and plasma cortisol were normal. Patients with MVP had normal responses to oral glucose administration but higher glucose levels than the controls (p less than 0.05). Twenty-four-hour urinary epinephrine (E) and norepinephrine (NE) were greater than normal (E + NE excretion, 44 +/- 2 vs 29.5 microgram/g creatinine, p less than 0.001). The short electromechanical systole corrected for heart rate (529 +/- 3.9 vs normal 548 +/- 2 msec, p less than 0.01) also reflected high adrenergic tone. Frequent premature ventricular complexes (PVCs) with couplets and triplets were found in 14 patients. Catecholamine excretion and frequency of PVCs were parallel and both decreased significantly at night (p less than 0.001). Plasma catecholamine increase with exercise was greater in patients in whom the number of PVCs increased more than 10 per minute compared with patients in whom the number of PVCs remained relatively unchanged (620 +/- 80 vs 98 +/- 20 msec, p less than 0.01). We conclude that symptomatic patients with MVP have high adrenergic tone that may be responsible for or contribute to the multiple symptoms.

Adolescent↗
PubMed1980

The spectrum of cardiac defects in the Ehlers-Danlos syndrome, types I and III.

Nineteen patients with types I and III Ehlers-Danlos syndrome were hospitalized at our institution between 1973 and 1978. Chest roentgenogram, electrocardiogram, and echocardiogram were done; 11 patients underwent cardiac catheterization. Thirty-five cardiac or great vessel abnormalities were detected. Fifteen patients had nitral valve prolapse; six also had tricuspid valve prolapse. Dilatation of the aortic root or extasia of the sinuses of Valsalva, or both, occurred in six patients. Dilatation of the pulmonary artery and annulus caused pulmonary regurgitation in one patient. Congenital heart defects included bicuspid aortic valve (two), pulmonary valvular stenosis (one), ventricular septal defect (two), and an atrial septal defect (one). The apparent high prevalence of cardiovascular abnormalities in hospitalized patients with types I and III Ehlers-Danlos syndrome necessitates a careful cardiovascular evaluation. Conversely, Ehlers-Danlos syndrome types I and III should be excluded in patients with mitral or tricuspid valve prolapse, great vessel dilatation, and congenital heart defects.

Adolescent↗
PubMed1979

The differential diagnosis of paracardiac lesions: pericardial cysts.

The differential diagnosis of paracardiac lesions includes pericardial cysts (PC), which are benign, developmental lesions. Patients with PC are usually asymptomatic, although chest pain or dyspnea may occur. The diagnosis may be established by chest roentgenogram (radiographic contour and location), fluoroscopy (changes in shape with respiration or positioning the patient), and echography (smooth, cystic contour and characteristic location). We present the diagnostic approach to patients with PC, and a review of the case histories of 12 patients with PC. Two symptomatic patients with PC were treated with surgical excision. Cyst aspiration in two patients yielded clear fluid and was initially considered therapeutic, but was followed by gradual reaccumulation of fluid. Six of ten asymptomatic patients followed for three to ten years did not develop symptoms, nor was there radiographic evidence of progressive PC enlargement. Three of ten died from unrelated causes during the follow-up period. Although symptomatic patients with PC may require surgical excision, asymptomatic patients with PC should be managed conservatively.

Adolescent↗
PubMed1979

Altered collagen composition in a prolapsing mitral valve with ruptured chordae tendineae.

A patient presented with mitral valve prolapse, ruptured chordae tendineae, severe mitral regurgitation and congestive heart failure. Pathologic studies demonstrated myxomatous changes of both mitral leaflets. Collagen analysis of the valve and of the chordae tendineae revealed the presence of type I collagen in normal quantities and a striking absence of type III and AB collagens. The altered collagen in this patient's mitral valve probably contributed to the development of his mitral valve disorder.

Chordae Tendineae↗
PubMed1978

Intraoperative localization of intestinal arteriovenous malformation.

Intestinal arteriovenous malformation (AVM) is an uncommon cause of gastrointestinal hemorrhage and is difficult to diagnose. Selective visceral angiography is essential to make the diagnosis and to localize the lesion. We treated two patients in whom AVMs of the small intestine were located by means of arteriography and intraoperative selective mesenteric venous pressure and PO2 measurements. The local venous return from an intestinal AVM is characterized by elevated venous pressure and PO2 levels compared with the venous drainage of adjacent normal intestine.

Aged↗
PubMed1978

The murmur of pulmonic regurgitation in tetralogy of Fallot with absent pulmonic valve.

Absent pulmonic valve (APV) in tetralogy of Fallot produces a pulmonic regurgitation murmur (PRM) which is usually late in onset after A2, low pitched, and of crescendo-decrescendo character. We have seen three adult patients with tetralogy of Fallot with APV and have done intracardiac sound and pressure studies in two. The PRM was loudest in the RV outflow tract (RVOT), where the onset was earlier than the murmur recorded on the chest wall. The crescendo portion of the PRM occurred during an abnormally slow decline in the RVOT pressure pulse after the crossover of PA and RVOT pressures. The RVOT pressure reached its minimum 30 msec after the RV body pressure, resulting in a pressure gradient between the two. The PRM peaked 30 msec later in the RV body than in the RVOT. The delayed precordial onset of the PRM after A2 is likely due to failure of transmission of early vibrations through the chest wall. The morphology of the PRM in tetralogy of Fallot with APV may be related to delayed relaxation with altered diastolic compliance of the RVOT which is subjected to a large regurgitant volume from the massively dilated pulmonary arteries.

Blood Pressure↗
PubMed1978

An electrophysiologic study of swallowing-induced tachycardia.

Electrophysiologic studies were performed on a 73-year-old man with swallowing-induced supraventricular tachycardia, in order to define the characteristics of this unique dysrhythmia in this patient. Swallowing reliably provoked an automatic atrial focus type of atrial tachycardia, which usually changed into an atrioventricular nodal reentrant tachycardia when a critical delay in atrioventricular nodal conduction (atrio-His interval greater than or equal to 340 msec) was achieved. The atrioventricular nodal reentrant form of tachycardia did not occur spontaneously. The ease of induction and the duration of the episodes of supraventricular tachycardia were facilitated with the intravenous administration of atropine and ouabain and were decreased with administration of procainamide hydrochloride.

Aged↗
PubMed1977

Occult constrictive pericardial disease. Diagnosis by rapid volume expansion and correction by pericardiectomy.

Significant pericardial disease can exist without overt manifestations. Occult constrictive pericardial disease (OCPD) is identified by normal baseline hemodynamics and normal left ventricular systolic function with a characteristic response to rapid volume infusion. Following the intravenous administration of 1000 ml of normal saline over six to eight minutes, striking elevations of filling pressures are seen; however, diagnosis depends specifically upon a) the development of typical pressure pulse morphology of constriction, b) loss or reversal or respiratory variation of right atrial pressure, and c) precise diastolic equilibration of intracardiac pressures. Nineteen patients with OCPD have been identified in a five year period. Unexplained fatigue, dyspnea and chest pain was the uniform pattern of presentation. Eleven have undergone pericardiectomy resulting in a dramatic symptomatic improvement in all. Each demonstrated gross and/or microscopic evidence of pericardial disease. Recatheterization with volume infusion in five patients following pericardiectomy has revealed return to normal or near normal hemodynamics. This study describes the method for diagnosis of OCPD and recommends pericardiectomy for the management of disabling symptoms.

Adolescent↗
PubMed1975

Routine use of the hydrogen platinum electrode system in shunt detection.

Routine use of the hydrogen platinum electrode system (HPES) in 1,375 consecutive cardiac catheterizations facilitated shunt detection in 171 patients, led to the diagnosis of unsuspected shunts in 18 patients, and was of particular value in accurately localizing unusual left-to-right shunts. Left-to-right shunts were detected in 171 patients (12% of the total catheterizations). Eighteen unsuspected shunts (10% of the total shunts, or 1% of the total catheterizations) were found. Atrial septal defect (ASD), partial anomalous pulmonary drainage (PAPVD), ventricular septal defect (VSD), and ruptured Valsalva aneurysm were demonstrated, usually associated with other congenital or acquired lesions. HPES was of particular value in accurately localizing the venous drainage of 38 unusual or complex lesions with left-to-right shunting. Five patients with rheumatic mitral valve disease had PAPVD, a higher incidence (1.2% of rheumatic mitral valve disease) than had previously been reported. The rationale for use of a sensitive shunt detection method as a routine part of the catheterization procedure is discussed.

Adolescent↗
PubMed1975

Postural changes in left ventricular and mitral valvular dynamics in the systolic click - late systolic murmur syndrome.

Marked changes in the auscultatory pattern with posture have been noted in patients with mid-systolic clicks and/or late systolic murmurs (MSC-LSM). MSC tend to move earlier in systole and LSM become longer and often louder when patients assume upright posture. Systolic prolapse of the mitral leaflets with mild regurgitation account for MSC-LSM; earlier and greater prolapse with more and prolonged regurgitation associated with a reduced left ventricular volume (LVV) in the upright position would explain the auscultatory changes. Twenty-two patients with MSC-LSM were studied supine and at 45 degrees head-up tilt, recording intracardiac pressures, cardiac outputs, systolic time intervals, and performing LV cineangiography. Systolic prolapse of one or both mitral leaflets was demonstrated in all patients. Left ventricular end-diastolic and end-systolic volumes both decreased significantly at 45 degrees in all sixteen technically satisfactory studies. Greater mitral prolapse was noted upright in 12 of 14 studies with enough sinus beats to judge. The amount of mitral regurgitation was mild in all, and changes in amount from supine to upright posture could not be discerned angiographically. THE FINDINGS, SUGGEST THAT THE AUSCULTATORY CHANGES OCCURRING WITH UPRIGHT POSTURE IN PATIENTS WITH MSC-LSM are related to greater prolapse of the mitral leaflets which is associated with a small LVV in the upright position.

Angiocardiography↗
PubMed1975

Intracardiac sound and pressure: right heart events. Toward an ultimate classification of auscultatory events.

These observations are presented as a tentative step towards an ultimate classification of auscultatory events based on ICSP studies, chest wall phonocardiography, and auscultatory areas, with continuing clarification or modification by angiography, Doppler techniques, echocardiography, computer usage, and any available, useful technique. The ultimate diagnostic value of ICSP information resides in the feed-back loop wherein this information is used daily at the bedside as part of the understanding and explanation of daily auscultatory phenomena.

Aortic Valve Stenosis↗