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Biomedical subjects

D KAVANAGH-GRAY

Publications and source records attributed to D KAVANAGH-GRAY.

13 recordsLinked to original sources
PubMed1965

OPEN-HEART SURGERY FOR MITRAL VALVE DISEASE.

The findings in and experiences with 19 consecutive patients subjected to open mitral valve surgery are described. All patients underwent a right-heart catheterization. In order to exclude multivalvular heart disease, a left-heart catheterization was performed in 10 patients and angiographic studies of the aortic valve area in 12. Pulmonary function studies were performed on 11 patients. The FEV (0.75 sec.) and the MMFR were found to correlate well with existing pulmonary reserves.Fourteen of the 19 patients subjected to open mitral valve surgery survived the operation and have been followed up for three months to 2(1/2) years. Four patients had a mitral valvuloplasty. Three of these four have deteriorated and will require a valvular replacement. Ten of 15 patients subjected to a mitral valve replacement are alive; five of these 10 have had signs and symptoms indicating peripheral embolization. Mitral valvuloplasty is preferable to a valvular replacement as far as embolic complications are concerned, while valvular replacements result in a more perfect and lasting hemodynamic repair. The high incidence of peripheral embolization following valvular replacements focuses attention on the need for improved mitral valve prostheses.

Angiocardiography↗
PubMed1965

CLINICAL MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION.

The mortality from acute myocardial infarction has remained unchanged over the past three decades. The records of 200 patients hospitalized because of acute myocardial infarction were analyzed at St. Paul's Hospital, Vancouver. Criteria for diagnosis were autopsy evidence and electrocardiographic evidence of acute muscle necrosis. Sixty-two patients died, 30 in the first three days and 41 in the first week; 33 of these deaths were due to cardiac arrhythmias, cardiac arrest or hypotension. Anticoagulants improved the mortality, but the degree of control was not a factor. Thromboembolism was significantly decreased by anticoagulants. Forty-nine patients died in shock; pressor amines did not improve the mortality in such cases. This study emphasizes the need for intensive care during the early critical period of the illness. Prompt adequate therapy of shock may improve the prognosis.

Acute Disease↗
PubMed1964

THE SIGNIFICANCE OF VENTRICULAR PREMATURE BEATS IN THE DIAGNOSIS OF SEPTAL INFARCTION.

Two hundred and twenty electrocardiograms containing premature ventricular beats were reviewed. Twenty of these contained premature ventricular beats of a myocardial infarction pattern, that is, one consisting of a significant Q wave followed by an R wave. A review of the case histories of these 20 patients disclosed that all 20 had angina pectoris and/or myocardial infarction. Postmortem examinations were performed in seven, and the presence of myocardial infarction was verified. In three instances, only the premature ventricular beat disclosed the myocardial infarction pattern while the normally conducted beats did not. In these three cases the postmortem examination confirmed the presence of septal infarction.

Cardiac Complexes, Premature↗
PubMed1964

THE PREOPERATIVE ASSESSMENT OF MULTIPLE VALVE DISEASE.

Representative case histories are used to discuss the difficulties in preoperative assessment of patients with multiple valve disease and the dangers of correcting one lesion when two or more valves are seriously damaged. Errors fall into three broad categories: existing second valve disease (1) may not be suspected, (2) may be considered insignificant or (3) may be considered a consequence of the first.Recommendations are offered to minimize these errors. The four valves should be studied physiologically, no matter how "normal" the other three may appear to be clinically, whenever open-heart surgery is contemplated. In bivalvular disease angiographic methods are preferable to pressure studies, for data so obtained are not dependent on cardiac output. Mitral and tricuspid regurgitation can never be attributed with certainty to a more distal lesion but require direct examination at time of operation for assessment.

Angiography↗
PubMed1964

COMPARISON OF CENTRAL AORTIC AND PERIPHERAL ARTERY PRESSURE CURVES.

Brachial artery and central aortic pressures were compared in 50 consecutive patients subjected to retrograde left heart catheterization in order to re-emphasize the fact that the two pressures are not necessarily identical. In 43 cases the systemic systolic pressure peaks exceeded those in the central aorta while in seven these pressures were equal. The average pressure difference was 22.6 mm. Hg. The greatest differences occurred in cases of aortic regurgitation and could be extreme, the brachial artery systolic pressure exceeding that in the aorta by more than 100 mm. Hg in some instances. The least differences occurred in cases of aortic stenosis but significant differences occasionally existed, leading to erroneous estimation of valve orifice size if the systemic rather than the aortic systolic pressure was used.

Adolescent↗
PubMed1963

ATRIAL SEPTAL DEFECT IN INFANCY.

The case histories of seven infants with atrial septal defect are presented to draw attention to certain features and possible dangers of this defect in infancy. Four infants were asymptomatic but one failed to thrive and two died suddenly. Five had ejection murmurs and two, with pulmonary hypertension, had loud pan-systolic murmurs with a thrill. In two infants murmurs were noted at birth, but in five they were first heard between the ages of 1 and 6 months. The second pulmonary sound was initially narrowly split in all, but became widely split between the ages of 12 and 20 months. Electrocardiograms and chest roentgenograms were of little help at the outset but later showed findings characteristic of the defect after one year. All infants were catheterized; a left-to-right atrial shunt was detected in each instance. Pulmonary hypertension was present in two infants, one of whom died.

Cardiac Catheterization↗