PubMed Health⌕ Search

Biomedical subjects

D Kimbiris

Publications and source records attributed to D Kimbiris.

At least 37 records · Page 2Linked to original sources
PubMed1982

Transluminal coronary angioplasty complicated by coronary artery perforation.

Transluminal coronary angioplasty may be associated with complications resulting from the dilatation catheter and inflation of the balloon. The most common complications are dissection, occlusion, and coronary spasm. We report an unusual complication of coronary artery perforation by the dilatation catheter resulting in acute pericardial tamponade. The complication was immediately recognized and confirmed by dye injection and hemodynamic measurements. Pericardiocentesis was performed, followed by successful coronary bypass surgery. The reasons for the perforation are unclear. We postulate that the acute angle of the perforated vessel was an important factor for this complication. The importance of a standby cardiac surgeon and operating room is emphasized.

Aged↗
PubMed1981

Assessment of left ventricular function in patients with isolated severe disease of the left anterior descending artery: clinical, electrocardiographic, hemodynamic, and angiographic correlations.

The purpose of this study was to define the spectrum of left ventriculographic (LV) abnormalities in 60 patients with isolated Greater Than or Equal To 90% diameter narrowing of the left anterior descending artery (LAD). The patients were divided into three groups: Group I (26 patients) had normal left ventricular (LV) function with ejection fraction (EF) of Greater Than 60% and no akinetic-dyskinetic segment representing abnormal contracting segments (ACS) of the left ventricular wall; Group II (15 patients) had mild to moderate LV dysfunction with EF of 40-60% and an akinetic-dyskinetic segment of Less Than 30% of the end diastolic perimeter (0-30%; mean, 11.6%) and Group III (19 patients) had severe LV dysfunction with EF Less Than 40%, or an akinetic-dyskinetic segment of Greater Than or Equal To 30% (30-81%; mean, 41.5%) or both. The data obtained from the history, physical examination, electrocardiogram (ECG), chest x-ray studies, hemodynamic studies, left ventriculography, and coronary arteriography were entered and filed on a memory disc in an IBM 370-168 computer. Analysis of the results showed: 1) more severe LV dysfunction is associated with increased incidence of large hearts, gallops, decreased cardiac output, and occlusion of the LAD. 2) ECG evidence of infarction is also associated with higher incidence of the abnormalities of the indices of LV dysfunction. 3) LAD occlusion (versus stenosis) has a higher incidence of severe LV dysfunction and prior infarction. 4) The site of LAD disease did not predict the extent of left ventricular dysfunction. 5) Collaterals did not protect against severe LV dysfunction.

Adult↗
PubMed1981

Coronary artery disease confined to secondary branches of the left coronary system.

Among 3,000 patients studied by coronary arteriography during a 4-year period, 31 patients (1%) had coronary artery disease limited to a diagonal branch of the left anterior descending (15 patients), marginal branch of the left circumflex (10 patients), or to both branches (6 patients). Ten patients had 50-69% and twenty-one had greater than or equal to 70% diameter narrowing. The suitability for grafting was noted in 20 patients as judged by the caliber and distribution of the diseased branches. Collaterals were noted in seven patients. Disease was present in 28 men and 3 women (age range 38-70 years). At least one major coronary risk factor was present in 27 patients. Angina was noted in 27 patients; prior myocardial infarction was noted in 5 patients by history and in 4 by ECG. The left ventriculogram was normal in 22 patients and showed mild segmental asynergy in 9; ejection fraction was normal in all. Exercise ECGs were positive in 12 of 25 patients; exercise 201thallium scans were positive in 13. All patients responded to medical therapy. In conclusion, among the population of patients who undergo catheterization, coronary branch disease is rare. The clinical findings are indistinguishable from patients with major coronary disease. Prognosis remains benign and patients respond to medical therapy.

Adult↗
PubMed1981

Concealed junctional bigeminy inducing pseudo 2:1 AV block.

This case report describes the electrocardiographic features of concealed junctional premature beats. When the junctional premature beats occurred in a bigeminal fashion, pseudo 2:1 AV block occurred. The presence of 2:1 AV block was related to the prematurity (H1-H2) of the junctional extrasystoles, in which coupling intervals less than 425 msec were concealed and those greater than 425 msec were manifest. This report is unusual in that persistent long runs of pseudo 2:1 AV conduction were established. In addition, the extrasystolic beats demonstrated exit block and the interectopic sinus beats (n) followed the formula 2n-1.

Aged↗
PubMed1981

A simplified valve formula for the calculation of stenotic cardiac valve areas.

We have simplified the Gorlin formula and have compared our measurements of the aortic or mitral valve area, using the original Gorlin formula and the simplified valve formula in 100 consecutive patients. The valve area was measured by the simplified formula as cardiac output (l/min) divided by the square root of pressure differences across the valve. In patients with aortic stenosis of varying severity there were excellent correlation between the original Gorlin formula and the simplified formula (r = 0.96, y = 0.99x + 0.01, SEE = +/- 0.10, p less than 0.001). The correlation was unchanged when the peak gradient was used instead of the mean gradient in the simplified formula. Excellent correlation was also seen in patients with mitral stenosis of varying severity (r = 0.94, y = 0.97x - 0.02, SEE = +/- 0.19; p less than 0.001). The simplicity of the formula makes it easy to memorize and use.

Adult↗
PubMed1981

Spasm of a saphenous vein bypass graft. A possible mechanism for occlusion of the venous graft.

The phenomenon of spasm in a venous graft was documented by angiographic study of the graft. This phenomenon has not been reported previously, and, therefore, its frequency of occurrence is unknown. Spasm of a venous graft may prove to play a significant role in the early development of myocardial infarction, closure of the graft, or recurrence of angina after initially successful surgery for aortocoronary bypass when venous grafts remain patent.

Angina Pectoris↗
PubMed1980

Myocardial ischemia after left ventriculography: pathophysiology and clinical significance.

The effects of contrast material on the left ventricular end-diastolic pressure (LVEDP) were evaluated in three groups of patients. Twenty patients (group I) with severe coronary artery disease (CAD) were found to have a change in LVEDP greater than or equal to 20 mm Hg; 15 patients (group II) with severe CAD had elevation of LVEDP less than 20 mm Hg; ten patients (group III) with normal coronary angiograms had a rise in LVEDP less than 20 mM Hg. The change in LVEDP was higher in group I than in groups II and III (P less than 0.005). Nineteen patients (95%) in group I complained of angina pectoris or had ST segment depression (or both) after ventriculography in association with the sharp increment in LVEDP. Angina or ST depression were seen in only two patients (13%) in group II and none in group III. We conclude that 1) elevation of LVEDP of 20 mm Hg or more after ventriculography may be seen in patients with severe CAD (most likely secondary to direct depressant effect of the contrast material on the myocardium) and 2) the abrupt and marked rise in LVEDP may produce myocardial ischemia due to reduction of coronary blood flow, especially to the subendocardial layer.

Aorta↗
PubMed1980

Myocardial bridging of the left anterior descending artery: evaluation using exercise thallium-201 myocardial scintigraphy.

Seven patients with myocardial bridging of the left anterior descending coronary artery were evaluated by mens of thallium-201 exercise scintigraphy. The degree of systolic narrowing was 60-70% in five patients and 75-80% in two patients. All patients had presented with chest pain. The resting electrocardiogram was normal in six patients; there were ST segment and T-wave abnormalities in one patient. No patient complained of chest pain during exercise. The exercise electrocardiogram was negative in six patients and inconclusive in one patient. Exercise myocardial scans were negative in all seven patients. We conclude that no evidence of ischemia was demonstrated in patients with myocardial bridging of the left anterior descending coronary artery as determined by exercise electrocardiography and stress thallium-201 scintigraphy.

Adult↗
PubMed1980

Pseudoaneurysm of the left ventricle complicated by Salmonella typhimurium infection. Recognition by two-dimensional echocardiography.

A patient is described with a large posterior left ventricular pseudoaneurysm complicated by Salmonella typhimurium infection. M-mode echocardiography displayed a massive echo-free space behind the posterior left ventricular wall, and two-dimensional echocardiography specifically defined the orifice and saccular contour of the false aneurysm. These findings were confirmed by cardiac catheterization and surgery. The unusual features of Salmonella endovascular infection and the noninvasive methods to detect left ventricular pseudoaneurysms are reviewed.

Echocardiography↗
PubMed1980

Exercise myocardial scintigraphy with 201-thallium. Use in patients with mitral valve prolapse without associated coronary artery disease.

Thirty patients with angiographically documented mitral valve prolapse but without associated coronary artery disease, underwent exercise 201thallium myocardial scintigraphy. The resting ECG demonstrated ST segment abnormalities in 15 patients (50 percent). The exercise ECGs were abnormal in two patients (6.7 percent), normal in four (13.3 percent), and inconclusive in 24 patients (80 percent). Two patients (6.7 percent) had abnormal exercise myocardial scintigraphy (both patients had abnormal exercise ECGs). Two additional patients (6.7 percent) had perfusion abnormalities in the rest images that did not change with exercise. Twenty-six patients (86.4 percent) had normal scans. We conclude that the majority of patients with mitral valve prolapse have normal exercise 201thallium images in the absence of associated coronary artery disease and exercise electrocardiography is of limited value in patients with mitral valve prolapse because the results are frequently (80 percent) inconclusive.

Adult↗
PubMed1979

Exercise 201thallium myocardial scans in patients with disease limited to the secondary branches of the left coronary system.

Coronary disease (greater than or equal to 50% narrowing) confined to only the diagonal branch of the left anterior descending artery or to the marginal branch of the left circumflex artery, or both, is uncommon. Only 19 patients with disease as defined above were identified in a group of 1000 consecutive patients with an angiographic diagnosis of coronary heart disease. All 19 patients were studied because of angina pectoris and all underwent stress myocardial perfusion scintigraphy with 201Tl (201thallium) during maximal treadmill exercise testing (exercise electrocardiogram: E/ECG). Ten patients (52%) had positive E/ECG's; seven patients (36%) had positive 201Tl and 13 patients (68%) had one or both tests positive. In 12 patients, the diseased branch was small, i.e. it supplied a comparatively small portion of myocardium, and in seven patients it was determined to be large. The 201Tl test results were positive in four out of seven patients (57%) with large diseased branches, as compared with three out of 12 (25%) with small diseased branches (p: NS). Also, three out of seven patients (42%) with large diseased branches had positive E/ECG's as compared with seven out of 12 patients (58%) with small diseased branches (p: NS). Patients with branch disease may present with typical angina pectoris, however, they are rare and thus not likely to account for the majority of false-negative 201Tl test results among symptomatic patients with CHD. Approximately one-third of the patients with branch disease have positive 201Tl test results, one-half have positive E/ECG's, and in two-thirds, one or both tests are positive.

Adult↗
PubMed1979

Complete occlusion of the left main coronary artery.

In this report, we describe the clinical, hemodynamic, and angiographic findings in three patients with atherosclerotic complete occlusion of the left main coronary artery. This rare entity was only seen in three out of 7,000 coronary angiograms. The three patients had extensive right-to-left collateralization. Two patients underwent saphenous vein bypass surgery and are asymptomatic, while the third patient died awaiting surgery. We suggest that patients with complete left main occlusion must undergo surgery as soon as possible.

Adult↗
PubMed1979

Aneurysm of the sinus of Valsalva: its natural history.

This case demonstrates that complications develop with aneurysm of the sinus of Valsalva. The aneurysm is diagnosed almost exclusively only after rupture. We feel that echocardiography provides a convenient means to follow cases of suspected aneurysms. A change in aortic root size may indicate imminent rupture. Fluttering of the anterior leaflet of the mitral valve would suggest aortic insufficiency, while an increase in right ventricular size coupled with paradoxical septal motion would strongly suggest a left-to-right shunt. Change in a murmur or in the aortic silhouette probably warrants cardiac catheterization. If rupture is suggested by clinical findings and corroborated by catheterization, surgery is indicated to prevent progressive cardiac failure.

Adult↗