Reversible dilatation of hypertrophied left ventricle in pheochromocytoma: serial two-dimensional echocardiographic observations.
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Adrenal Gland Neoplasms↗
Biomedical subjects
C Shub
Publications and source records attributed to C Shub.
Selection of optimal drug therapy for the patient with angina pectoris.
The development of new drugs, especially beta-blocking and calcium entry-blocking agents, has greatly facilitated the medical treatment of angina pectoris. The specific needs of each patient should dictate the appropriate treatment of angina pectoris. Angina may occur in patients who have various concomitant disorders such as hypertension, diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, or arrhythmias, and the physician must take these factors into account when a drug regimen is prescribed. Individual drugs should be chosen on the basis of specifically desired pharmacologic effects, and the dosages should be gradually adjusted according to the patient's response. Although a therapeutic regimen should be selected primarily on the basis of efficacy, the physician must also attempt to recommend a simple and cost-effective program.
Adrenergic beta-Antagonists↗
Surgical repair of uncomplicated atrial septal defect without "routine" preoperative cardiac catheterization.
Whether all patients with atrial septal defect should undergo cardiac catheterization before surgical correction is controversial. Of 152 patients of all ages with surgically documented isolated atrial septal defect (ostium secundum, ostium primum and sinus venosus types) who underwent preoperative two-dimensional echocardiography between January 1978 and December 1983, there were 55 (36%) (group 1) who did not have preoperative cardiac catheterization. These 55 patients are compared with the 97 patients (64%) who did have preoperative catheterization studies (group 2). Group 1 patients were younger (mean age 22 versus 36 years) and did not have clinical evidence of other associated cardiac disorders. Forty-four (80%) of the group 1 patients had typical findings for atrial septal defect on cardiac examination, chest radiograph and electrocardiogram compared with 16 (16%) of group 2 patients (p less than 0.001). The most frequent reasons for cardiac catheterization in group 2 patients were documentation of diagnosis, usually because of atypical clinical findings, and exclusion of associated cardiac abnormalities. Contrast echocardiography, radionuclide shunt studies and Doppler echocardiography were used as additional confirmatory tests in 36 patients (65%). In 19 patients (35%), two-dimensional echocardiography was the only confirmatory test. There were no false positive two-dimensional echocardiographic studies. There were no operative deaths or significant perioperative complications in any of the patients. At a mean follow-up of 28 months (range 6 to 64), there was one late death (3 1/2 years postoperatively) in a 61 year old man with chronic congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Detection of intrapericardial hematoma after open heart surgery: the roles of echocardiography and computed tomography.
Two patients who had right atrial compression caused by intrapericardial hematomas after coronary artery bypass grafting and aortic valve replacement are described. During the course of postoperative evaluation, each patient underwent an echocardiographic examination followed by computed tomography of the chest. Two-dimensional echocardiography visualized the hematomas in both cases. Computed tomography played a useful adjunctive role by further clarifying their nature, location and extent.
Aged↗
Two-dimensional echocardiographic detection of mediastinal pheochromocytoma.
A patient had a functioning pheochromocytoma in the aorticopulmonary region of the middle mediastinum. Two-dimensional echocardiography, utilizing the suprasternal approach, was useful in detecting the tumor and in defining its anatomic relationships to other vascular structures within the mediastinum.
Adult↗
Angina pectoris. Clinical strategies in diagnosis.
Angina pectoris is a clinical diagnosis with various forms and manifestations. In many cases, the diagnosis can be made without expensive supplementary cardiovascular tests. In a given patient, the likelihood of significant coronary artery disease can be assessed clinically from such variables as age, sex, type of symptoms, and risk factors. Because of cost considerations and limited resources, additional cardiovascular testing (treadmill exercise testing, radionuclide procedures, echocardiography, and coronary angiography) cannot be done in every case, and the physician must carefully decide if and when to order each of these tests as well as judge their cost-effectiveness. Cardiovascular tests should be ordered on a "need-to-know" basis and with a specific, answerable question in mind. The physician needs to consider not only the expected probability of disease in the patient to be studied but also the reliability and performance characteristics of each test.
Adult↗
Prognostic value of predischarge 2-dimensional echocardiogram after acute myocardial infarction.
The prognostic value of a 2-dimensional echocardiogram (2-D echo) was determined in 46 patients (32 men and 14 women) who survived an acute myocardial infarction (MI) from November 1979 to December 1980. The mean age of the patients was 61 years (range 36 to 92). The MI was anterior in 21, inferior in 22 and indeterminate in 3; it was transmural in 31 and nontransmural in 15. A 2-D echo was obtained 10 to 15 days after the MI--that is, 1 to 3 days before hospital discharge. A wall motion score index (WMSI) was derived with the use of a 14-segment model of the left ventricle. Each segment was assigned a number corresponding to its wall motion (0 = hyperkinetic, 1 = normal, 2 = hypokinetic, 3 = akinetic, 4 = dyskinetic and 5 = aneurysm) and the WMSI was calculated by dividing the sum of these numbers by the number of segments visualized (1.0 = normal wall motion). During a mean follow-up of 21 months (range 15 to 28), 17 patients had a complication: death, recurrence of MI, congestive heart failure of New York Heart Association class III or IV, or angina graded New York Heart Association class III or IV. Patients with compared to those without complications had a significantly higher WMSI (2.2 +/- 0.4 and 1.7 +/- 0.5, p less than 0.005). The difference in WMSI between those who died and those who survived was not significant because of the small number of deaths.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Constrictive pericarditis associated with combined idiopathic retroperitoneal and mediastinal fibrosis.
Idiopathic retroperitoneal fibrosis and mediastinal fibrosis are localized expressions of a systemic sclerosing disease of unknown cause which, on rare occasions, may coexist in the same patient. Although pericardial involvement may occur, recurrent constrictive pericarditis that is unrelieved by pericardiectomy has not previously been reported in association with either idiopathic retroperitoneal or mediastinal fibrosis. Reported herein is a case of recurrent constrictive pericarditis that was unrelieved by two pericardiectomies , and autopsy revealed unsuspected combined idiopathic retroperitoneal and mediastinal fibrosis. The clinical, echocardiographic, and pathologic findings are described.
Echocardiography↗
Serial echocardiographic observations in patients with primary systemic amyloidosis: an introduction to the concept of early (asymptomatic) amyloid infiltration of the heart.
Echocardiography was used for the serial assessment of 27 patients with primary systemic amyloidosis. Thirteen patients had no clinical cardiac deterioration between the two echocardiographic studies (group 1), whereas in 14 patients (group 2), congestive heart failure or arrhythmias (or both) appeared or worsened during a mean observation period of 19 months. The only echocardiographic changes in group 1 were a mild increase in left ventricular mass and a mild decrease in left ventricular wall systolic thickening. Patients in group 2 had significant changes in left ventricular wall thickness (mean increase, 34%), in left ventricular mass (mean increase, 42%), in right ventricular wall thickness (mean increase, 78%), in left atrial size (mean increase, 19%), in left ventricular mass/voltage ratio (mean increase, 68%), in left ventricular radius/thickness ratio (mean decrease, 29%), and in left ventricular fractional shortening (mean decrease, 13%). Significant correlations were found in group 2 between changes in systolic and diastolic blood pressure and changes in ventricular wall thickness and mass. Changes in left ventricular systolic function did not correlate significantly with changes in other clinical, electrocardiographic, or echocardiographic measurements. In six cases (two in group 1), in which amyloid infiltration of the heart was proved by myocardial biopsy or autopsy, the only echocardiographic abnormality when the patients were asymptomatic was a moderate increase in left or right ventricular wall thickness. We found that M-mode and two-dimensional echocardiographic examinations can substantiate progressive amyloid infiltration of the heart and are useful tools for the noninvasive serial assessment of patients with primary systemic amyloidosis.
Adult↗
Role of two-dimensional echocardiography in the prediction of in-hospital complications after acute myocardial infarction.
To evaluate prospectively the prognostic value of two-dimensional echocardiography after acute myocardial infarction, two-dimensional echocardiography was performed on 61 consecutive patients who were admitted to the hospital with this condition. A left ventricular wall motion score index was derived from analysis of regional wall motion; an index of 2.0 or more within 12 hours of admission identified patients at high risk for pump failure, malignant ventricular arrhythmia or death. These complications occurred in 24 of 27 patients with an initial wall motion score index of 2.0 or more, but in only 6 of 34 with an initial index of less than 2.0 (p less than 0.0005). Of the 47 patients who were in Killip class I on admission, complications developed in 11 (79%) of the 14 with an initial index of 2.0 or more, but in only 6 (18%) of the 33 with an initial index of less than 2.0. After acute myocardial infarction, early determination of the wall motion score index by two-dimensional echocardiography is useful for identifying patients at high risk for complications and is especially valuable in the subset of patients who initially seem to be in stable condition as judged from clinical variables.
Aged↗
Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: echocardiographic-anatomic correlation in 115 patients.
The preoperative 2-dimensional (2-D) echocardiograms of all patients less than 50 years of age in whom the aortic valve had been directly inspected by the surgeon or the pathologist or both were reviewed. From June 1977 to June 1981, 283 patients aged less than or equal to 50 years had aortic valve surgery at the Mayo Clinic: 115 (aged 1 to 50 years [mean 32]) had 2-D examinations preoperatively. The echocardiograms were reviewed blindly, and the aortic valve structure was categorized as bicuspid, tricuspid, or indeterminate. On the basis of combined surgical and pathologic inspection, 50 aortic valves were congenitally bicuspid, 60 were tricuspid, 4 were unicommissural, and 1 was quadricuspid. By 2-D echocardiography, the number of cusps was indeterminate in 29 patients (25%). When these patients were excluded, the sensitivity, specificity, and diagnostic accuracy of 2-D echocardiography for bicuspid aortic valve were 78,96, and 93%, respectively. Thus, with adequate 2-D images, echocardiography is a sensitive and highly specific technique for the diagnosis of bicuspid aortic valve.
Adolescent↗
Papillary muscle rupture complicating acute myocardial infarction: analysis of 17 patients.
The records of 17 patients (10 men and 7 women) with the diagnosis of acute papillary muscle rupture secondary to acute myocardial infarction (AMI) were reviewed to determine the clinical course and pathologic features of this entity. Eight patients underwent operation after papillary muscle rupture had been diagnosed, and 9 had the diagnosis confirmed at autopsy without a prior surgical procedure. The ages were 44 to 80 years (mean 64). The site of AMI was inferolateral in 15 and anterior in 2. The recorded onset of mitral regurgitation ranged from less than 24 hours to 28 days after AMI (mean 6 days). Of the 11 patients presenting with pulmonary congestion alone, 6 remained stable and had subsequent mitral valve replacement and coronary artery bypass graft operation; however, 5 patients' condition initially stabilized with medical therapy and then suddenly deteriorated after a variable period (1 to 60 days), followed by death. Of the 6 patients who presented with systemic hypotension and pulmonary congestion, 4 were treated medically and died; 1 of the 2 who had surgical treatment survived. The extent of the AMI at autopsy was small and was limited to the subendocardium in half of the patients. Significant coronary artery disease was limited to a single vessel in 7 of 14 patients. The unpredictable and rapid clinical deterioration and the limited extent of coronary atherosclerotic disease and infarct size suggest that early surgical repair should be undertaken in patients with papillary muscle rupture after AMI.
Adult↗
Sensitivity of two-dimensional echocardiography in the direct visualization of atrial septal defect utilizing the subcostal approach: experience with 154 patients.
In the standard precordial echocardiographic imaging planes, there is frequent dropout of atrial septal echoes in the region of the fossa ovalis that can be minimized by use of the subcostal imaging approach. The diagnostic sensitivity of this approach was reviewed in 154 patients (mean age 31 years, range 2 months to 74 years) with documented atrial septal defect in whom a satisfactory image of the atrial septum could be obtained. Subcostal two-dimensional echocardiography successfully visualized 93 (89%) of the 105 ostium secundum atrial septal defects, all 32 (100%) ostium primum defects and 7 (44%) of the 16 sinus venosus defects. A defect was not visualized (false negative response) in 12 patients (11%) with an ostium secundum defect and in 9 patients (56%) with a sinus venosus defect. In three of the former and five of the latter, a two-dimensional echocardiographic contrast examination established the presence of the interatrial shunt. Twenty-four patients (16%) with clinical findings of uncomplicated atrial septal defect confirmed by two-dimensional echocardiography underwent surgical repair of the defect without preoperative cardiac catheterization. There were no perioperative complications. Two-dimensional echocardiographic examination of the atrial septum utilizing the subcostal approach is the preferred method for the confident, noninvasive diagnosis and categorization of atrial septal defects. Two-dimensional echocardiographic contrast and Doppler examinations complement the technique and enhance diagnostic accuracy.
Adolescent↗
Intracavitary cardiac melanoma diagnosed by endomyocardial left ventricular biopsy.
A patient was evaluated for a persistent pericardial effusion and on two-dimensional echocardiography was found to have an intracavitary left ventricular mass. Twenty-two years earlier, a melanoma of the ethmoid sinus had been excised. An electrocardiogram revealed impressive T-wave abnormalities and pathologic Q waves, initially suggestive of "myocardial infarction." However, the coronary arteries were normal at angiography. At catheterization, the left ventricular mass was biopsied, using a transvenous catheter-directed technique, and proved to be a metastatic melanoma. This procedure obviated the need for diagnostic thoracotomy. We believe that this is a unique application of the use of catheter-directed biopsy to make a histologic diagnosis of a left ventricular neoplasm.
Biopsy↗
Enlargement of the aortic root or anulus with autogenous pericardial patch during aortic valve replacement. Long-term follow-up.
Patch enlargement of the aortic root or anulus is a widely accepted technique when restrictive anatomy is encountered during aortic valve replacement. Patches made of prosthetic material have been used almost exclusively, and patches of autogenous pericardium have not received wide acceptance. Although pericardium is advantageous because of its low cost, ready availability, and ease of handling, its long-term durability has not been fully established. From 1965 to 1981, 96 patients had autogenous pericardial patches placed during aortic valve replacement at the Mayo Clinic. In 81 patients, the patches were placed solely in a supravalvular position to facilitate aortic closure, while in 15 patients, the patches were placed in both subvalvular and supravalvular positions, allowing for annular expansion and insertion of a larger prosthesis. In a mean follow-up of 5.4 years, none of the 92 operative survivors has had clinical evidence of sudden patch failure and none has had patch aneurysms detected by routine chest roentgenography. One patient required reoperation for a perivalvular leak at the point where the prosthesis had been sutured to the patch. Objective data concerning the late postoperative status of the patch were available on 48 patients: 24 underwent reoperation, 16 underwent two-dimensional echocardiography, two underwent aortic root angiography, and six underwent postmortem examination. Patch aneurysms were universally absent, and in every patient the patches were well incorporated into the adjacent tissues. This proven durability suggests that autogenous pericardium is a satisfactory patch material when required during aortic valve replacement.
Adolescent↗
Two dimensional echocardiographic diagnosis of partial papillary muscle rupture.
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Aged↗
Dynamic left ventricular outflow tract obstruction associated with pheochromocytoma.
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Adrenal Gland Neoplasms↗
The unpredictable progression of symptomatic coronary artery disease: a serial clinical-angiographic analysis.
To determine whether risk factors or angiographic features could be correlated with progression of coronary artery disease, we independently analyzed serial coronary angiograms in 65 symptomatic patients for progression without knowledge of their respective risk factors. An important design feature of this study was that observer variability of coronary lesion assessment was objectively evaluated and taken into account in defining progression of coronary artery disease. The reproducibility of lesion assessment varied with the severity of stenosis: moderate stenoses had the greatest intraobserver and interobserver variability. At initial study, 337 partial and 68 complete occlusions were identified. Of the 337 partial occlusions at risk of progression, 73 (22%) progressed; 13 (3.2%) of the initial lesions regressed. In the 65 patients with persistent or increasing angina, progression occurred in 51 (78%) over a mean period of 24 months. Apart from the tendency of high-grade stenosis( greater than or equal to 98%) to progress to complete occlusion, no measured clinical, laboratory, or angiographic variable showed any significant effect on progression to coronary artery disease, in this selected group of symptomatic patients these same risk factors did not predict its progression. We believe that (1) and definition of progression should incorporate the factor of observer variability and (2) therapeutic measures designed to influence progression of coronary artery disease should take into account this apparently unpredictable progression.
Aged↗