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Biomedical subjects

D D Payne

Publications and source records attributed to D D Payne.

At least 37 records · Page 2Linked to original sources
PubMed1988

Use of self-adhesive external defibrillator pads for complex cardiac surgical procedures.

We describe a useful technique for the management of life-threatening arrhythmias that occur during complex or reoperative cardiac surgical procedures when internal defibrillation cannot be achieved. Two self-adhesive external pads are attached to the patient before draping to enable the delivery of current for defibrillation or cardioversion without the need for removal of adhesive surgical drapes and the cumbersome use of external defibrillator paddles.

Arrhythmias, Cardiac↗
PubMed1988

Efficacy of retrograde coronary sinus cardioplegia in patients undergoing myocardial revascularization: a prospective randomized trial.

The efficacy of retrograde coronary sinus cardioplegia (RCSC) administered through the right atrium compared with aortic root cardioplegia (ARC) has not been examined critically in patients undergoing coronary artery bypass grafting (CABG). Twenty patients having elective CABG were randomized prospectively to receive cold blood ARC (Group I, 10 patients) or cold blood RCSC (Group II, 10 patients). Patient demographics were similar in both groups. Ventricular function was assessed preoperatively by radionuclide ventriculography and postoperatively by simultaneous hemodynamic and radionuclide ventriculographic studies with volume loading. There was no change in ejection fraction (EF) (preoperative versus postoperative value) in Group I (50 +/- 6% versus 53 +/- 6%) but in group II, at similar peak systolic pressure and similar left ventricular end-diastolic volume index (LVEDVI), LVEF improved significantly (49 +/- 6% versus 60 +/- 12%, p less than 0.05). Postoperative ventricular function (stroke work index versus EDVI) for the left ventricle and right ventricle were similar in both groups. Evaluation of postoperative LV systolic function (end-systolic blood pressure versus end-systolic volume index) and diastolic function (pulmonary capillary wedge pressure versus EDVI) were also similar in both groups. Retrograde coronary sinus cardioplegia is as effective as ARC for intraoperative myocardial protection, and provides excellent postoperative function in patients undergoing elective CABG.

Blood↗
PubMed1988

Successful repair of postoperative ascending aortic mycotic false aneurysms using circulatory arrest.

Mediastinal wound infections following open-heart operations are successfully managed in most patients by aggressive debridement and placement of substernal drainage catheters or application of omental or muscle flaps. Nonetheless, the involvement of foreign bodies, such as felt pledgets adjacent to cardiac structures, can result in infections that persist despite flap coverage and can present as mycotic false aneurysms of the ascending aorta. We present the cases of 3 patients who underwent successful repair of such aneurysms late after surgical treatment of mediastinal wound infections. We describe our technique of repair using groin cannulation for bypass, moderate hypothermia, and circulatory arrest to improve exposure and minimize bleeding.

Aged↗
PubMed1987

Laser-assisted endocardiectomy for refractory ventricular tachyarrhythmias: preliminary intraoperative experience.

Previous in vitro investigations utilizing necropsy specimens have suggested a potential role for laser irradiation in the treatment of refractory ventricular tachyarrhythmias associated with pathologically thickened endocardium. In the patient described in the present report, findings of these previous in vitro studies were applied intraoperatively to a patient undergoing surgery for ischemic heart disease associated with ventricular tachyarrhythmias. Aneurysm resection and manual subendocardial resection were performed using standard techniques. Laser irradiation was used to ablate pathologically thickened endocardium involving the papillary muscle and thereby avoid mitral valve replacement. Postoperatively, there was no auscultatory evidence of mitral regurgitation, and ventricular tachycardia could not be induced by electrophysiologic provocative testing. This preliminary experience confirms that laser irradiation is both a feasible and potentially advantageous means of accomplishing endocardial debridement in patients undergoing arrhythmia-ablation procedures.

Cardiomegaly↗
PubMed1987

Intraoperative, two-dimensional echocardiography-guided removal of retained intracardiac air.

The removal of intracardiac air after cardiotomy may be simplified with the use of two-dimensional echocardiography. This technique can be used to readily identify retained pockets of air and can function as a guide to needle aspiration of the ventricular chambers. With a valve prosthesis in place, de-airing can be accomplished with minimal displacement of the heart. The technique is easy to use and the images are simple to interpret.

Air↗
PubMed1987

Methemoglobinemia from intravenous nitroglycerin: a word of caution.

The dose of intravenously administered nitroglycerin (IV NTG) used to control ischemic chest pain usually is limited by hypotension from decreased preload. Herein we describe 2 patients who tolerated IV NTG without hemodynamic compromise but in whom severe impairment of blood oxygen content developed from methemoglobinemia noted during coronary bypass surgery. Methemoglobinemia must be suspected if chocolate-brown blood is encountered despite a normal arterial oxygen tension and calculated oxygen saturation. Before a methemoglobin level is available, the extent of hypoxemia can be determined by an oximetric oxygen saturation and therapy begun with intravenous administration of methylene blue. These case reports focus attention on the potential deleterious effects of undetected hypoxemia from methemoglobinemia in patients being stabilized with high-dose IV NTG for urgent cardiac surgery.

Aged↗
PubMed1987

Arterial bypass of the descending thoracic aorta with the BioMedicus centrifugal pump.

Bypass of the descending thoracic aorta is frequently advocated as an adjunct for repair of traumatic tears and degenerative aneurysms. Many methods of bypass have been proposed to provide distal perfusion and reduce left ventricular afterload during cross-clamp of the thoracic aorta. We describe a simple method of direct arterial (aortoaortic or aortofemoral) bypass using the BioMedicus centrifugal pump with limited systemic heparinization.

Aorta, Thoracic↗
PubMed1987

Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites.

Percutaneous transluminal angioplasty has been shown to be both feasible and efficacious for the treatment of aortic coarctation. Recent reports, however, have indicated that the development of aortic aneurysms at or near the coarctation segment may complicate attempts to treat this lesion by catheter-based intervention. Accordingly, we examined the light microscopic features of coarctation segments excised at surgery (n = 31) or obtained at autopsy (n = 2) in 33 patients with coarctation of the aorta. Cystic medial necrosis, defined as depletion and disarray of elastic tissue, was observed in each of the 33 specimens. In the majority of coarctation specimens (22 of 33 or 67%) the extent of cystic medial necrosis, graded semiquantitatively on a scale of 0 (normal aorta) to 3+, was severe (3+). The finding that cystic medial necrosis represents a consistent histologic feature of coarctation of the aorta provides a pathologic basis for the formation of aneurysms observed after balloon angioplasty of coarctation sites.

Angioplasty, Balloon↗
PubMed1985

Limb loss due to transvenous endocardial pacemaker therapy.

Although intravenous thrombosis frequently complicates placement of transvenous endocardial leads in patients with permanent pacemakers, clinical manifestations of upper extremity thrombosis are uncommon. Most, including upper extremity edema, cervical venous engorgement, and even superior vena cava syndrome, can be successfully managed with conservative therapy. In the patient described in the present report, clinical manifestations of pacemaker-electrode thrombosis were neither mild nor responsive to conservative therapies: in this patient, pacemaker-electrode thrombosis ultimately required amputation of the right upper extremity. Complications of the magnitude described in this patient emphasize the need for continual review of the indications for pacemaker therapy as understanding of the risk-benefit ratio of this procedure broadens.

Aged↗
PubMed1985

Laser photoablation of pathological endocardium: in vitro findings suggesting a new approach to the surgical treatment of refractory arrhythmias and restrictive cardiomyopathy.

In selected patients, malignant ventricular tachyarrhythmias have been successfully abolished by excision of subendocardial arrhythmogenic foci. Likewise, in certain patients in whom restrictive cardiomyopathy is due to endocardial thickening, endocardial resection has resulted in hemodynamic improvement. The present study was designed to explore the utility, in vitro, of laser photoablation of pathologically thickened endocardium. Endocardial photoablation was easily accomplished regardless of etiological or anatomical variations using either the focused beam of a carbon dioxide laser or argon laser light delivered through a 200-microns optical fiber. Photoablation of areas as large as 3.9 X 1.3 cm was performed within 40 seconds. The extent or depth of endocardial photoablation could be limited to 2 mm2 in area or 1 mm in depth using either form of laser therapy. These in vitro results suggest that either carbon dioxide or argon laser phototherapy can be successfully applied to the surgical treatment of refractory arrhythmias and restrictive cardiomyopathy. Advantages of laser photoablation include speed and precision. Furthermore, laser photoablation obviates the difficulty associated with conventional techniques in establishing tissue planes.

Argon↗
PubMed1984

Laser myoplasty for hypertrophic cardiomyopathy. In vitro experience in human postmortem hearts and in vivo experience in a canine model (transarterial) and human patient (intraoperative).

The feasibility of performing a myotomy/myectomy for hypertrophic cardiomyopathy (HC) by means of laser phototherapy was evaluated experimentally in vitro and in vivo, and the procedure then applied to a patient intraoperatively. In vitro experience revealed that the beam of an argon laser, delivered directly or via an optical fiber, could both cut and vaporize myocardium, producing a myotomy/myectomy morphologically similar to that produced by the conventional blade technique. In vivo experiments, in which the beam of an argon laser was delivered via an optical fiber to the ventricular septum of a canine heart, confirmed that a laser myoplasty could be achieved in 4 of 5 dogs by a transarterial approach. Finally, laser myoplasty was performed intraoperatively in a patient with HC, using a 200-mu fiber interfaced with an argon laser. Measured laser power was 1.5 W; cumulative exposure was less than 4 minutes; the myoplasty was 4 X 1 X 0.5 cm. These investigations establish the feasibility of using laser therapy to create a myoplasty trough that is similar in appearance to that typically achieved by the conventional blade technique. Illumination of the intraventricular operative field and precise modeling of the myoplasty trough constitute the principal advantages of laser myoplasty for HC.

Adult↗
PubMed1984

Combined discrete subaortic stenosis and ventricular septal defect in infants and children.

Eight patients, aged 1 to 8 years, with discrete subaortic stenosis (DSS) and ventricular septal defect (VSD) were studied by 2-dimensional (2-D) and M-mode echocardiography. Initial cardiac catheterization and angiocardiography showed VSD and other associated cardiac lesions, including coarctation of the aorta and patent ductus arteriosus. None had evidence of DSS. Six patients underwent surgical repair of the associated lesions, but none required closure of the VSD. Ultimately, 6 patients had spontaneous closure of VSD, and 2 had a residual small VSD. Subsequent serial echocardiography showed evidence of subaortic membrane, prompting repeat cardiac catheterization, which confirmed moderate to severe peak systolic pressure gradients between the left ventricle and ascending aorta. Surgical resection of the membrane was performed in 5 patients. Thus, in patients with small or spontaneously closed VSDs, DSS may develop. Evaluation of the left ventricular outflow tract area is recommended in patients with small or closed VSD in whom a significant heart murmur or electrocardiographic abnormality remains.

Abnormalities, Multiple↗
PubMed1980

Atrial pacing during intraaortic balloon pumping.

Intraaortic balloon pumping and atrial pacing are both useful in treating postoperative low output syndrome. However, the electrocardiographic atrial pacing spike can interfere with the electrocardiogram tracking mechanism of many balloon consoles. Bipolar epicardial pacing can avoid this problem and allow simultaneous atrial pacing and intraaortic balloon pumping.

Assisted Circulation↗
PubMed1978

Intermuscular abdominal implantation of permanent pacemakers in infants and children.

Pacemaker implantation in infants and young children presents technical problems because of the relatively large size of the units. Various implantation sites have been employed to avoid the problems of unsightliness, migration, skin necrosis with infection, and patient discomfort. We are presenting a new technique which obviates these difficulties. The pacemaker generator is located in a space developed between the muscles and fascia of the abdominal wall. This site will accept even the largest of demand pacemakers with cosmetically acceptable results.

Abdominal Muscles↗
PubMed1978

Transverse femoral arteriotomy for intraaortic balloon insertion.

A technique for intraaortic balloon placement employing a transverse femoral arteriotomy is described. After balloon removal, the arteriotomy can be closed primarily. Avoidance of retained graft material or use of a vein patch reduces the likelihood of vascular complications.

Assisted Circulation↗
PubMed1975

Evaluation of prosthetic grafts of different porosity for arterial reconstruction.

Autogenous jugular veins and Dacron grafts of different porosities were implanted as short bypass grafts around ligated femoral arteries in the dog. Patency rates for periods up to eight months were: vein, 79 per cent; DeBakey Dacron (lowest porosity), 39 per cent; Wesolowski Weavenit (imtermediate porosity), 56 per cent; high porosity Dacron, 8 per cent. The failure of sixteen of the twenty-four high porosity grafts was related to perigraft hematomas that occurred two to seven days after operation and later thrombosis. The higher the porosity of the graft, the better the healing pattern as evidenced by fibrous bonding of the inner and outer linings of the grafts through the interstices. In the spectrum of grafts with increasing porosity there is apparently an optimal porosity beyond which late bleeding counterbalances the better healing properties of the higher porosity graft.

Animals↗