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Biomedical subjects

D T Kelly

Publications and source records attributed to D T Kelly.

15 recordsLinked to original sources
PubMed1979

Serial exercise thallium myocardial perfusion scanning and exercise electrocardiography in the diagnosis of coronary artery disease.

Serial exercise thallium-201 myocardial perfusion scanning (exercise and 4-hour redistribution) was compared to rest and exercise electrocardiography (ECG) for the detection of coronary artery disease in 125 patients with known or suspected coronary artery disease. All patients underwent coronary arteriography and 108 were found to have significant coronary artery lesions. The serial exercise thallium scan was significantly more sensitive than rest and exercise ECG in detecting coronary artery disease (94% v. 83% P less than 0.01). The sensitivity of a reversible thallium perfusion scan abnormality and a positive exercise ECG for detecting exercise induced myocardial ischaemia in coronary artery disease was similar (69% v. 63%). The exercise thallium scan complemented the exercise ECG, and the sensitivity of the combined test was significantly greater than the exercise ECG alone (84% v. 63% P less than 0.001). The specificity for coronary artery disease of the exercise ECG was 65% and that of the exercise thallium-201 myocardial perfusion scan was 82% (P = NS). Thallium-201 myocardial perfusion scanning complements the rest and exercise ECG in the non-invasive detection of coronary artery disease.

Adult↗
PubMed1979

Multivessel coronary artery spasm.

A 60-year-old patient with variant angina was shown to have myocardial ischemia in two different regions supplied by separate major coronary arteries. Neither artery had significant coronary atherosclerotic obstruction. Ventricular fibrillation was noted during ST-segment elevation in anteroseptal leads. The attacks of pain and arrhythmias disappeared during nifedipine therapy.

Angina Pectoris↗
PubMed1979

Preoperative and postoperative technetium-99m pyrophosphate myocardial scintigraphy in the assessment of operative infarction in coronary artery surgery.

The incidence of operative myocardial infarction was assessed by electrocardiogram (ECG) and technetium-99m pyrophosphate (99mTc-PyP) myocardial scintigrams in 89 consecutive patients undergoing coronary artery bypass grafting (CABG). Myocardial scintigrams were performed on the day before operation and repeated 2 to 3 days postoperatively. All patients survived operation, with three in-hospital deaths not related to myocardial infarction (mortality rate 3 percent). Operative infarction was assessed to have occurred in four of 89 patients (4 percent). Two had new Q waves and positive scintigrams; one, major ST-T wave changes and a positive scintigram; and the fourth, new Q waves without a positive scintigram. Three further patients (3 percent) had Q waves and positive scintigrams postoperatively, but myocardial infarction was evolving before anesthesia and operation. Twenty-seven of 89 patients (30 percent) were found to have abnormal scintigrams preoperatively. In two patients, both operated upon with evolving myocardial infarction, the scintigram was worse postoperatively. In 13 patients the scintigram was improved after operation. In 12 patients (13 percent) the abnormal preoperative scintigram was unchanged after operation. Preoperative and postoperative myocardial scintigrams and ECG's must be compared to assess the incidence of operative myocardial infarction in patients undergoing CABG.

Adult↗
PubMed1978

Myocardial perfusion scanning with thallium--201 for the non-invasive diagnosis of coronary artery disease.

Thallium--201 myocardial perfusion scanning has been evaluated in Australia in patients with coronary artery disease. Myocardial scans reliably detect both acute myocardial infarction and the transient myocardial ischaemia of angina pectoris. The non-invasive nature, ease of study, and the ability to scan patients with conventional cameras makes thallium--201 an attractive additional diagnostic agent for patients with suspected coronary artery disease. Although thallium--201 reliably indicates perfusion defects in the myocardium, its diagnostic use at the moment should be reserved to clarify such diagnostic problems in patients with coronary artery disease which cannot be satisfactorily explained by conventional investigation.

Angina Pectoris↗
PubMed1978

Radionuclide imaging to assess myocardial damage during open heart surgery.

Technetium 99m Pyrophosphate imaging before and after open heart surgery was performed in 38 patients to estimate the incidence of peri-operative infarction. Positive images were present pre-operatively in 11 of 30 patients with coronary artery disease. In three patients the images changed from negative to positive and in two this was thought to be due to infarction produced at operation. The high incidence of positive pre-operative images emphasises that many patients with evolving myocardial infarction, unstable angina or severe heart failure are now operated upon without delay. Because many patients have positive images before surgery pre-operative and post-operative images must be compared to assess myocardial damage due to surgery.

Adult↗
PubMed1977

"Hot spot" myocardial scanning: experiences with a mobile nuclear camera in a coronary care unit.

Twenty-nine patients with suspected or actual myocardial infarction have had myocardial "hot spot" scans with technietium 99m pyrophosphate, using a mobile nuclear camera in a coronary care unit. Nine patients with transmural infarcts had positive scans. Nine out of 12 patients thought to have had endocardial infarction had positive scans. Two patients who had had intramuscular injections presented with chest pain and abnormally high serum enzyme levels, but had negative scans. Myocardial radionuclide scanning with a mobile nuclear camera is a rapid, easy, repeatable, non-invasive method of helping to confirm or exclude the diagnosis of myocardial infarction and, used together with other available tests, is a valuable additional diagnostic aid.

Adult↗
PubMed1976

Long-term follow-up of valvulotomy for congenital aortic stenosis.

The data were reviewed of 42 patients who had valvulotomy for severe aortic valve stenosis before 1968. All were over age 2 years (mean age 11.3 years). The mean time of follow-up after surgery was 10.6 years (range 6 to 16.3 years). No patient died at operation. Two late deaths were from endocarditis with aortic regurgitation, and one patient with severe arotic regurgitation died suddenly; three patients had valve replacement for aortic regurgitation and one required repeat valvulotomy. Five patients could not be traced. Major symptoms were alleviated in all patients. Left ventricular pressures were obtained in 15 patients before and after operation; the mean gradient averaged 100 mm Hg before and 43 mm Hg after operation. No patient had significant aortic regurgitation before operation. Twelve had moderate to severe regurgitation after operation. The incidence of late valve calcification at a mean time of 10.6 years after operation was small, and restenosis was uncommon. Because moderate or severe incompetence can be produced and stenosis is often incompletely relieved, the operation is palliative, but the low morbidity and mortality rates suggest that it is an effective procedure if stenosis is severe and life-threatening.

Action Potentials↗
PubMed1976

Kartagener's syndrome with corrected transposition. Conducting system studies and coronary arterial occlusion complicating valvular replacement.

An 18-year-old man whose sister has classic Kartagener's syndrome was found to have sinusitis, bronchiectasis, and corrected transposition with normal visceral situs. Congenital complete heart block was secondary to absence of conducting-system pathways between a small posterior atrioventricular node and the transposed His bundle and bundle branches. No anterior atrioventricular node was present. Prosthetic valvular replacement of the left-sided (morphologic right) atrioventricular valve was complicated by coronary arterial occlusion by suture, with subsequent myocardial infarction. The case appears to represent an unusual variant of Kartagener's syndrome with the abnormality of laterality being expressed as corrected transposition.

Adolescent↗
PubMed1975

Role of sublingual nitroglycerin in patients with acute myocardial infarction.

Fourteen patients with acute myocardial infarction were given 0.3 mg sublingual nitroglycerin within the first 12 hours of their acute myocardial infarction. Five minutes after sublingual nitroglycerin mean arterial pressure fell 9 mmHg (1.2 kPa) and remained significantly reduced for 30 minutes. Pulmonary capillary wedge pressure fell from a mean control value of 17 to 12 mmHg (2.3 to 1.6 kPa) and also remained reduced for 30 minutes. Heart rate was significantly raised and stroke work index reduced at five minutes. Patients with a stroke work index of greater than 55 g m per m-2 b.s.a. responed to nitroglycerin with a fall in both pulmonary capillary wedge pressue and strokework index while in those with a stroke work index of less than 55 g m per m-2 b.s.a. stroke work index did not fall concomitantly with the fall in pulmonary capillary wedge pressure. In one patient, nitroglycerin led to a precipitious fall in arterial pressure andrecurrence of chest pain.

Acute Disease↗
PubMed1975

Intravenous nitroglycerin in acute myocardial infarction.

Vasodilator therapy has been shown to improve ventricular function in patients with left ventricular failure complicating acute myocardial infarction. Sublingual nitroglycerin also improves ventricular function in these patients but its effects are transient and variable. Infusion of intravenous nitroglycerin in 12 patients with acute infarction resulted in a decrease in left ventricular filling pressure from a mean of 22 plus or minus 2 mm Hg to 12 plus or minus 1 mm Hg (P less than 0.001) associated with a 7 mm Hg decrease in mean arterial pressure (P less than 0.05). Since stroke work index did not change significantly, this represents and improvement in ventricular performance and/or an alteration in ventricular compliance. All six patients in whom serial precordial mapping studies were performed showed a decrease in sigma ST (P less than 0.001). These findings suggest that intravenous nitroglycerin improved left ventricular function and decreased the extent of myocardial ischemia. Longer infusion may act to preserve borderline ischemic myocardium and thus limit infarct size.

Administration, Oral↗
PubMed1975

Right ventricular dysfunction detected by gated scintiphotography in patients with acute inferior myocardial infarction.

Twenty-seven patients with acute myocardial infarction not complicated by cardiogenic shock and ten normal volunteers were studied with gated cardiac blood pool scans. The ratio right vetricular area/left ventricular area (RVA/LVA) determined from the left anterior oblique end-diastolic scans was examined. The ratio was 1.11 +/- .06 in the normal volunteers. In patients with anterior infarction the ratio fell to 0.75 +/- .12 (P less than .05) due to left ventricular enlargement. In those with inferior infarction the ratio was 1.12 +/- .23 which was greater than in those with anterior infarction (P less than .05) due to enlargement of both the left and right ventricles. Six patients with cardiogenic shock, three with inferior and three with anterior infarction were studied. The three with anterior infarction had left ventricular enlargement and a decrease in the ratio of RVA/LVA to 0.62 while the three with inferior infarction had an increase in the ratio to 2.05 suggesting right ventricular dilatation and dysfunction. These studies suggest a high incidence of right ventricular dysfunction in patients with inferior myocardial infarction.

Aged↗
PubMed1975

Identification of congenital malformations of the great arteries in infants by real-time two-dimensional echocardiography.

Real-time, two dimensional echocardiography was used to identify great artery relations in 23 infants and small children, including 16 patients with angiography documented transposition of the great arteries, tetralogy of Fallot, or pulmonary aresia. Using this technique, the heart was scanned perpendicular to its long axis at the origin of the great arteries. Great arteries cross-sectioned perpendicular to their long axes appear as circles; when sectioned longitudinally these arteries appeared as elongated sausage-shaped structures. I- patients with normally related great arteries, a curcular structure (aorta) always was positioned posterior to an elongated, sausage-shaped structure (distal right ventricular outflow tract and proximal main pulmonary artery). In transposition of the great arteries, two adjacent circular structures were observed; the anterior circle (aorta) was located to the right, left or directly anterior to the posterior circle (pulmonary artery). In pulmonary atresia or hypoplasis, a large posterior circle (aorta) was associated with an anteriorly positioned structure that was either short and small (atretic right ventricular outflow tract) or elongated with an area of severe narrowing (hypoplastic right ventricular outflow tract). Thus, real-time two-dimensional echocardiography provides a rapid, noninvasive means of accurately identifying congenital malformations of the great arteries in infants and small children and may be a useful adjunct to cardiac catheterization in the diagnosis of cyanotic congenital heart disease.

Child, Preschool↗