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Biomedical subjects

E G Butchart

Publications and source records attributed to E G Butchart.

At least 55 records · Page 3Linked to original sources
PubMed1988

Left atrial ball thrombus: echocardiographic features and clinical implications.

The echocardiographic features of left atrial ball thrombus associated with mitral stenosis are reviewed, and some previously unpublished cross-sectional echocardiographic findings presented. In one patient who had a large free-floating ball thrombus there was variation in its echocardiographic appearance; the thrombus was removed uneventfully at surgery. In another patient who had a pedunculated but immobile ball thrombus, a stalk was identified which attached it to the inter-atrial septum; this patient died suddenly before surgery could be performed, due to detachment of the thrombus and obstruction of the mitral valve orifice. Cross-sectional echocardiography is clearly superior to M-mode imaging in the detection of atrial thrombi, and variable appearances may help differentiation of thrombus from myxoma. Whether or not a ball thrombus appears mobile, emergency thrombectomy and mitral valve replacement is indicated, because of the risk of obstruction of the mitral valve.

Echocardiography↗
PubMed1988

The control of post-thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo-analgesia.

This is a comparative study of two methods to relieve postoperative thoracotomy pain. Continuous thoracic epidural infusion of fentanyl produced superior analgesia when compared with cryo-analgesia of the relevant thoracic nerves. Linear analogue pain scores were consistently lower in the epidural group reaching significance (p less than 0.05) at 32 and 40 hours after operation. All 36 patients in the cryo-analgesia group required additional analgesia, while 12 out of the 32 patients in the epidural group did not. This difference was significant at p less than 0.001. Respiratory and cardiovascular measurements were similar in both groups and the only side effect attributable to the epidural fentanyl was itching but this was not a problem.

Analgesia↗
PubMed1988

Low risk of thrombosis and serious embolic events despite low-intensity anticoagulation. Experience with 1,004 Medtronic Hall valves.

One thousand four Medtronic Hall valves (601 mitral, 398 aortic, and five tricuspid) were implanted in 847 patients between December 1979 and June 1987. Total experience at the end of June 1987 was 2,640 patient-years of follow-up. Prothrombin time ratios were reviewed for all patients (16,866 observations), and these ratios were found to be therapeutically low (median international normalized ratio, 2.6) and highly variable (lower 10th percentile, 1.6; upper 10th percentile, 3.9). During the follow-up period, there were no valvular thromboses; the 95% confidence limit for the risk of thrombosis (0.14 per 100 patient-years) is below that reported for other mechanical prostheses. Sixty percent of all thromboembolic events left no residual deficit, and 75% of all bleeding events did not require treatment. Only 11% of thromboembolic events and 7% of bleeding events were fatal. The linearized rate of fatal bleeding was 0.2% per year, and the linearized rate of moderate to severe bleeding was 0.5% per year. Five-year actuarial embolic-free rates were 92%, 84%, and 83% for aortic, mitral, and double valves, respectively. The low risk of valvular thrombosis and of serious thromboembolic events in the Medtronic Hall valve, regardless of the range and variability of anticoagulation, offers greater patient safety than other mechanical prostheses, provides a credible alternative to bioprostheses, and may be particularly relevant to third-world populations.

Actuarial Analysis↗
PubMed1987

Poststernotomy pseudo-arthrosis due to foreign body reaction to bone wax.

A case of repeated pseudo-arthrosis of the sternum following two median sternotomies for coronary artery bypass surgery is reported. This was due to a chronic foreign body reaction to the bees' wax used during the first operation to reduce bleeding from the sternal edges.

Coronary Artery Bypass↗
PubMed1987

The incidence and significance of early pericardial effusion after open heart surgery.

The presence and severity of postoperative pericardial effusions were studied echocardiographically in 114 consecutive patients (70 males, 44 females; mean age 56 +/- 10 years). An effusion was present in 35 patients at 3-5 days. An effusion was less common when a drainage tube was inserted for 24-36 h in the posterior as well as the anterior mediastinum than when only an anterior drain was used. Patients with effusions differed from those without in having more supraventricular arrhythmias, more wound infections, smaller total blood drainage and longer postoperative hospital stay. Three patients with posterior pericardial effusions developed cardiac tamponade 5-18 days postoperatively. The data show that pericardial effusions are associated with postoperative complications and suggest that effusion formation can be reduced by using posterior as well as anterior chest drains.

Cardiac Surgical Procedures↗
PubMed1985

Metabolic damage to human saphenous vein during preparation for coronary artery bypass grafting.

Segments of saphenous vein from patients undergoing coronary artery by-pass graft surgery were frozen in liquid nitrogen immediately on dissection (control), after stripping of the adventitia and side branch ligation (manipulation), after distention with blood (distention), or at completion of the last proximal anastomosis (prepared vein). Vein was stored during the operation in patient's heparinised arterial blood at room temperature. Frozen vein was extracted with perchloric acid. ATP, ADP, and AMP, adenosine, inosine and hypoxanthine concentrations were measured by high pressure liquid chromatography. Prepared vein had ca 50% lower ATP concentrations and ATP/ADP ratio than control vein, higher concentrations of inosine and hypoxanthine and lower concentrations of AMP and adenosine. ATP concentration and ATP/ADP ratio did not correlate with the time elapsed between dissection and freezing of the prepared vein. The characteristic changes seen in prepared vein were not seen when control vein was simply stored in arterial blood at 23 degrees C, in normal saline at 23 degrees C or 4 degrees C, in Krebs-Ringer bicarbonate buffer at 37 degrees C or at St Thomas's Hospital cardioplegic solution at 4 degrees C. Distention with unlimited pressure did not distension at less than 300 mmHg gave rise to the same changes in ATP concentration and ATP/ADP ratio as in the prepared vein. These results show that vein suffered metabolic changes during preparation for bypass grafting and suggest that uncontrolled distention may contribute to these changes. Such biochemical measurements provide a quantitative estimate of tissue damage and allow objective comparison of different preparative techniques.

Adenine Nucleotides↗
PubMed1984

Comparative study of leg wound skin closure in coronary artery bypass graft operations.

A prospective randomised study of four different methods of leg wound skin closure after removal of the long saphenous vein was carried out in 113 patients undergoing coronary artery bypass grafting. These methods were: (1) continuous nylon vertical mattress suture (27 patients); (2) continuous subcuticular absorbable (Dexon) suture (29 patients); (3) metal skin staples (Autosuture) (27 patients); and (4) adhesive sutureless skin closure ("Op-site") (30 patients). All wounds were examined by two independent observers at five, 10, and 45 days after operation. At five days, inflammation, extent of oedema, discharge, and infection were assessed. At 10 days attention was paid to the state of wound healing and at 45 days to the final cosmetic appearance. The use of continuous subcuticular suture resulted in significantly less discharge than did the use of metal staples, nylon vertical mattress suture, or Op-site. The incidence of established wound infection was 4.5% overall, with no infection in the wounds closed with Dexon. Assessment of the healing process showed subcuticular Dexon to be more effective than metal staples or vertical mattress nylon suture. The final cosmetic result showed continuous subcuticular suture to be superior to nylon vertical mattress suture and skin staples but as effective as Op-site sutureless skin closure.

Coronary Artery Bypass↗
PubMed1983

Clinical and echocardiographic assessment of the Medtronic-Hall valve: experience with 370 implanted valves.

During a 34-month period, 370 Medtronic-Hall valves were implanted into 310 patients. Twenty-four percent of patients had additional operative procedures. Hospital mortality was 7% and late mortality to date is 3%. No deaths were due to thromboembolic complications or mechanical failure of the valve. The overall embolic rate was 2.5 per 100 patient years. For mitral valve replacement, the embolic rate was 3.5 per 100 patient years. Patients with isolated mitral valve replacement were subjected to detailed clinical and echocardiographic assessment. Eighty-nine percent of patients with 29 or 31 mm mitral prostheses improved one NYHA class or more and 33% improved 2 classes or more. For the 25 mm mitral prostheses, the figures were 91% and 38% respectively. The peak rate of increase of left ventricular dimension in diastole (dD/dt) was measured echocardiographically in subjects with normal native mitral valves and in patients with 29 or 31 mm Medtronic-Hall valves, Björk-Shiley valves and Starr-Edwards valves. Peak dD/dt in the native valves was 15.8 +/- 0.8, in Medtronic-Hall valves 13.9 +/- 0.8, in Björk-Shiley 11.6 +/- 1.0 and in Starr-Edwards 9.5 +/- 0.6. The Björk-Shiley and Starr-Edwards valves differed significantly from normal (p less than 0.05 and less than 0.001 respectively) but there was no significant difference between the Medtronic-Hall valves and the native ones. We conclude that the Medtronic Hall valve is a safe and hemodynamically effective valve in the mitral position.

Adolescent↗
PubMed1981

Bleomycin therapy and anaesthesia. The possible hazards of oxygen administration to patients after treatment with bleomycin.

Bleomycin is a cytotoxic drug used in the treatment of teratoma of the testis. This drug appears to sensitize the lungs so that acute lung damage occurs with concentrations of oxygen normally considered free from toxic effects. Two anaesthetics administered to the same patient undergoing thoracotomy are reported. No postoperative lung damage was produced on either occasion.

Adult↗
PubMed1981

Influence of contractility on myocardial water distribution during cardiopulmonary bypass.

Water equilibrium within heart muscle during cardiopulmonary bypass is an important aspect of ventricular physiology which must be considered in efforts to optimize myocardial protection. This study focuses on the influence of the inotropic state of the ventricle in determining the amount of heart water and its regional distribution within the free wall of the left ventricle. Experiments involving cardiopulmonary bypass were performed in 57 dogs. Three spontaneous levels of myocardial contractility were identified under conditions of standard preload, afterload, and heart rate. Each increase in level (grade) was associated with a significantly higher myocardial wet weight/drug weight (W/D) ratio. In addition, higher levels of contractility were associated with a marked shift in water distribution within the left ventricular wall; water tended to accumulate in the inner half of the better contracting left ventricular wall, the reverse of the distribution seen at lower levels of contractility. These three grades of contractility and myocardial water content were not associated with any significant differences in total or regional myocardial blood flow, as determined by the use off radioactive microspheres. Maintenance of low levels of contractility during cardiopulmonary bypass may be desirable in order to prevent the occurrence of subendocardial edema.

Animals↗
PubMed1980

The influence of prearrest factors on the preservation of left ventricular function during cardiopulmonary bypass.

Uniformly excellent myocardial protection during global ischemia in cardiac procedures requiring cessation of aortic root perfusion remains an elusive goal. This study establishes the importance of the preischemic inotropic state of the left ventricle and the arterial blood glucose concentration ([glucose]) immediately prior to an elective period of myocardial ischemia. Thirty-one experiments were performed on dogs subjected to 90 minutes of global ischemia on cardiopulmonary bypass at 28 degrees C with perfusion pressure constantly maintained at 90 mm Hg. The maximum rate of development of left ventricular pressure (LVdp/dtmax) at constant arterial and left atrial (LAP) pressures was used as a measure of contractility prior to ischemia. In a group of 18 of these dogs undergoing anoxic cardiac arrest, arterial blood [glucose], in conjunction with the preischemic LVdp/dtmax and the cross-clamp to asystole time interval (metabolic supply/demand index), significantly predicted (p less than 0.01) the functional result following the standard ischemic insult. In 13 other dogs with [glucose] greater than 120 mg/100 ml and treated with potassium cardioplegia, "normal" preischemic LVdp/dtmas (N = 7) was associated with a good functional result, but an elevated preischemic LVdp/dtmax (N = 6) produced severe functional impairment following ischemia. Optimum myocardial protection thus involves minimizing metabolic demands and maximizing metabolic supply immediately prior to and during the period of aortic cross-clamping.

Animals↗