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Biomedical subjects

E R Giuliani

Publications and source records attributed to E R Giuliani.

At least 55 records · Page 3Linked to original sources
PubMed1980

Role of echocardiographic studies in the ambulatory patient.

M-mode echocardiography has been extremely useful in confirming the clinical diagnosis of a wide variety of both congenital and acquired heart diseases. With the present state of the art and science of echocardiogarphy, it is the opinion of the author that M-mode coupled with phonocardiography, external arterial and venous tracings, and two-dimensional ultrasonic cardiac imaging are complementary and together provide the most information in a given patient. Two-dimensional imaging of the heart is superior in the evaluation of congenital heart disease, particularly when used in conjunction with injection of indocyanine green dye43 and with cardiac catheterization. With improvement in technology and greater clinical experience, two-dimensional ultrasound cardiac imaging will ultimately replace M-mode echocardiography in the noninvasive evaluation of cardiac disorders.

Adult↗
PubMed1980

Preoperative M-mode echocardiography as a predictor of surgical results in chronic aortic insufficiency.

A group of 80 patients were studied retrospectively to determine whether preoperative echocardiography is useful in predicting operative results in patients with aortic valve replacement for chronic aortic insufficiency. One year after operation, percent change of left ventricular dimension (%delta D) and ejection fraction (EF) were higher and end-systolic left-ventricular internal dimension was smaller in patients with good results than in those who had poor results (p less than 0.05). Regarding probability of 5 year survival, patients with a %delta D of more than 35% had good prognosis, those with 31% to 35% had a fairly good prognosis, and those with 30% or less had increased risk of death, especially if they were in New York Heart Association (NYHA) Functional Class III or IV. All deaths occurred in patients with preoperative values of 31% or less. Patients with EF of 60% or more had a better prognosis than those with a value of less than 60%. In addition, 10 early postoperative echocardiographic studies showed no correlation between early regression of end-diastolic left ventricular internal dimension and long-term operative results; 18 late postoperative studies showed reduction in this dimension in patients with good surgical results, and the only one with a poor result had an enlarged dimension. Thus echocardiographic indices of left ventricular function (%delta D) and EF) may be useful as prognostic indicators in patients undergoing aortic valve replacement for aortic insufficiency.

Adolescent↗
PubMed1980

Echophonocardiographic findings in patients with prosthetic heart valve malfunction.

This report represents a retrospective analysis of preoperative echophonocardiographic studies in 118 patients who had surgery for the repair or replacement of malfunctioning prosthetic valves. A variety of prostheses implanted in the mitral, aortic, and tricuspid positions were assessed. The most frequent prosthetic malfunctions were regurgitation, thrombosis, ball variance, and infective endocarditis. There were echophonocardiographic abnormalities in 71% of the cases. The retrospective diagnosis of prosthetic dysfunction varied according to the type of prosthesis, type of malfunction, and site of implantation of the valve. A high percentage of the prostheses did have echophonocardiographic abnormalities, and consideration of these, in conjunction with clinical data, may help the clinician in the evaluation of prosthetic heart valves.

Adult↗
PubMed1980

Atrial myxomas: a review of clinical experience in 40 patients.

We have reviewed the Mayo Clinic experience in the diagnosis and management of 40 cases of atrial myxoma seen over a 20-year period, 1957 to 1977. The diagnosis of atrial myxoma was seldom made clinically on the basis of history, physical examination, chest roentgenogram, or electrocardiogrammthere was no reduction in the time interval from onset of symptoms to operation between patients seen in the period 1957-1967 and those seen in 1968-1977. Although myxomas are rare, they should be considered in the differential diagnosis of patients with suspected mitral valve disease and congestive heart failure or constitutional disturbances who are in sinus rhythm. The greater number of patients diagnosed preoperatively in the second 10-year period, 1968-1977, reflects the introduction of echocardiography as a noninvasive diagnostic procedure. Echocardiography should be performed on all young patients with embolic disease and on those in whom the diagnosis of myxoma needs to be ruled out before exploratory or definitive surgery is undertaken so that unnecessary and potentially serious complications can be avoided. Surgical excision of the myxoma can be performed with low mortality (1 death occurred in 37 cases or 2.7%), and it provides excellent and sustained symptomatic relief. The recurrence rate is low (5.4%), but long-term follow-up and serial echocardiography are advisable.

Adolescent↗
PubMed1979

Assessment of left ventricular function in secundum atrial septal defect by computer analysis of the M-mode echocardiogram.

Left ventricular function in 53 patients with secundum atrial septal defect was assessed by computer-assisted analysis of the left ventricular echocardiogram and by cardiac catheterization. The patients were divided into two groups, those younger and those older than 60 years, to investigate the effect of aging on left ventricular function. Cavity size was significantly smaller than normal (p less than 0.01) and septal motion was abnormal in 86%, but values for cardiac index, left ventricular end-diastolic pressure, velocity of circumferential fiber shortening, left ventricular filling rate, and duration of rapid filling were normal in both groups. Regional dynamics assessed in terms of peak rates of systolic thickening and diastolic thinning of the septum and posterior wall were also normal in both groups. We concluded that, although left ventricular minor dimensions are small, and septal motion is reversed in the majority of patients with atrial septal defect, left ventricular function is normal, and it does not appear to deteriorate with increased age, pulmonary hypertension, or the presence of right ventricular failure. The abnormal septal motion appears to be compensated for by enhanced septal and posterior wall percentage thickening.

Adolescent↗
PubMed1979

Cardiac valve replacement in congestive heart failure due to infective endocarditis.

From January 1961 to July 1974, 138 patients underwent cardiac valve replacement because of complications of infective endocarditis. The overall operative mortality was higher in patients with Class IV cardiac functional disability (17%) than in patients with Class III (7%) or II (8%). The mortality for patients who had undergone aortic valve replacement with Class IV disability was higher (22%) than that for patients with Class III (0) or II (6%). When compared with patients without infective endocarditis who had undergone cardiac valve replacement, the operative mortality per valve replacement was approximately the same when the degree of cardiac disability was the same at the time of surgery for both groups of patients. Patients with aortic regurgitant murmurs caused by infective endocarditis should be observed closely for the onset of heart failure, especially during the first month of disease. In patients with aortic or mitral incompetence, if heart failure develops or progresses during the first month, we believe that prompt cardiac valve replacement should be considered, because even heart failure that may initially appear mild often progresses to severe heart failure during this period.

Aortic Valve Insufficiency↗
PubMed1979

Ebstein's anomaly: the clinical features and natural history of Ebstein's anomaly of the tricuspid valve.

The clinical features and natural history of Ebstein's anomaly are analyzed on the basis of experience with 67 consecutive patients who have had a mean follow-up of 12 years. Of the total group, 26 (39%) of the patients remained in functional Class I or II and 41 (61%) progressed at some time into Class III or IV. Death occurred in 14 (21%) of the patients, and these were characterized by one or more of the following features: (1) they were in functional Class III or IV, (2) they had moderate to severe cardiomegaly with a cardiothoracic ratio greater than 0.65, (3) they had cyanosis or an arterial oxygen saturation of less than 90%, and (4) they were infants when the diagnosis was made (10 patients, of whom 5 died). In patients in Class III or IV, a comparison was made between patients treated medically (10) and those treated surgically--either with tricuspid valve replacement (15) or with a modified tricuspid annuloplasty (16). It appears that modified tricuspid annuloplasty is the procedure of choice, because despite an operative mortality of 25% (4 patients), 12 of the 16 patients so treated improved clinically or had a reduction in heart size.

Adolescent↗
PubMed1978

Hyperuricemia in congenital heart disease.

Gout is rarely noted as a clinical problem in secondary polycythemia-- even if profound polycythemia exists, as in cyanotic congenital heart disease. A retrospective study of 81 patients with congenital heart disease was done to assess the incidence of hyperuricemia. Twenty of 46 patients with cyanotic congenital heart disease had serum levels of uric acid greater than 8 mg/dl. Thirteen of 16 (81%) cyanotic male patients more than 15 years old had serum levels greater than 8 mg/dl. For cyanotic patients, serum levels of uric acid were related directly to the degree of polycythemia (r = .44; P less than .02). Impaired renal function or drug therapy did not seem to account for the hyperuricemia. Because levels of uric acid greater than 10 mg/dl probably are nephropathic, many of these patients may be incurring subclinical uric acid nephropathy.

Adolescent↗
PubMed1978

Idiopathic hypertrophic subaortic stenosis in the young.

Thirty-six young patients with idiopathic hypertrophic subaortic stenosis were studied. Twenty-seven patients were male and 9 female, and their mean age was 11.3 years (range 5 months to 20 years). Twenty-three patients (64 percent) had symptoms, the most common being dyspnea, angina and syncope. Diagnostic difficulties were encountered frequently in younger patients, especially those with right heart involvement, and in asymptomatic patients with murmurs suggestive of other cardiac defects. Patients were classified retrospectively into three groups on the basis of management. The first group consisted of 16 patients who were operated on; 4 of these patients died, 1 operatively and 3 suddenly late postoperatively (at 1.6, 2 and 10 years). The 12 long-term survivors (average follow-up period 6.2 years) have had good relief of symptoms. The second group comprised seven patients treated with propranolol; none of these died. The 13 patients in the third group received no therapy; 7 of these patients died, 6 suddenly and 1 from congestive cardiac failure. Idiopathic hypertrophic subaortic stenosis is a serious disorder that may present at any age and that may be difficult to diagnose. All patients with this disorder should be treated with propranolol; surgical intervention, although it does not totally abolish the risk of sudden death, appears to offer symptomatic improvement in most cases over a long-term follow-up period.

Adolescent↗
PubMed1978

Anticoagulant therapy and central nervous system complications in patients with prosthetic valve endocarditis.

Among 52 cases of prosthetic valve endocarditis, adequate anticoagulant therapy was administered in 38 and discontinued or given in subtherapeutic dosage in 14. Our data suggest that anticoagulant therapy does not appreciably increase morbidity or mortality in patients with prosthetic valve endocarditis. On the contrary, in our patients the incidence of major clinical CNS (central nervous system) complications was increased and the mortality was higher if anticoagulant therapy was discontinued. CNS complications occurred in 10 of the 14 patients without adequate anticoagulant therapy and in three of the 38 with adequate anticoagulant therapy. Mortality was 57% among those treated without adequate anticoagulation and 47% among those with adequate anticoagulation. At autopsy, CNS complications were thought to be the primary cause of five of the eight deaths in cases without adequate anticoagulation.

Adolescent↗
PubMed1978

Cardiac function in the normal newborn: additional information by computer analysis of the M-mode echocardiogram.

Computer analysis of the M-mode echocardiogram in 50 normal newborns provided measurements of wall thicknesses and chamber size and, in addition, assessment of right and left ventricular wall, septal, and cavity dynamics throughout the cardiac cycle. Data obtained with this new technique indicated that (1) right and left ventricular cavity functions are similar in the normal newborn, (2) right and left ventricular cavity filling and emptying vary directly with peak rates of septal and ventricular wall thinning and thickening, respectively, and (3) there is a close time relationship among maximum left atrial dimension, minimum left ventricular dimension, and mitral valve opening. This analysis, which is the first complete analysis of the echocardiogram in the newborn, provides a normal range of septal and ventricular wall dynamics as well as right and left ventricular and left atrial function and has clinical implications in that it may allow early recognition of both congenital and perinatal myocardial disease.

Atrial Function↗
PubMed1978

Valve replacement in patients with active infective endocarditis.

Eleven of 138 patients with infective endocarditis (IE) who underwent cardiac valve replacement for IE during a 12 1/2-year period had active IE. Eight of the 11 (all with aortic IE) had positive blood cultures within 48 hours preoperatively; six of the eight had positive Gram stains and cultures of the excised cardiac tissue. All 11 patients had Class IV cardiac functional disability (New York Heart Association classification) at the time of surgery. Staphylococci (three patients with Staphylococcus aureus and one with S. epidermidis) were the most frequent isolates. Three patients died; two of these three deaths occurred in patients who had a sudden onset preoperatively of severe aortic regurgitation and heart failure. In one patient (S. epidermidis infection) prosthetic valve endocarditis developed. Cardiac valve replacement may be performed successfully in patients with active IE even when blood cultures are positive in the immediate perioperative period. The hemodynamic status of patients with IE should be the determining factor in the timing of cardiac valve replacement, rather than the activity of the infection or the length of preoperative antimicrobial therapy. A radical surgical procedure may be necessary in patients with myocardial or aortic abscesses in whom conventional aortic valve replacement is not possible.

Adolescent↗
PubMed1978

The Marfan syndrome and cardiac surgery.

Of 31 patients with Marfan's syndrome and cardiovascular complications, 25 had ascending aortic aneurysms, five with aortic dissection; 26 had aortic regurgitation, two with aortic stenosis; and eight had mitral regurgitation, five with aortic regurgitation. Surgery included prosthetic aortic valve replacement in 24 patients and aortic valvular bicuspidization in two; 19 had resection of aneurysm with Dacron tube replacement, three had lateral aneurysmorrhaphy, and two had circumferential strip excision with end-to-end anastomosis. Four patients underwent mitral valve replacement. Operative complications occurred in 10 patients. There were nine (29 percent) hospital deaths, but only one death occurred in 12 patients operated upon since 1970. Late complications included prosthetic leak in six patients (23 percent) with reoperation in five; all survived. Five late deaths occurred (16 percent); one was unrelated and one was of unknown cause. Although risk of cardiac surgery remains high, our recent results support an aggressive surgical approach, particularly in patients with advanced or deteriorating cardiovascular complications.

Adolescent↗
PubMed1978

Unusual echocardiographic findings in a patient with left atrial myxoma.

A 53-year-old patient is presented who had left atrial myxoma with unusual echocardiographic findings. The patient had been regarded for 10 years as having mitral stenosis. This error in diagnosis was due in part to misinterpretation of his echocardiograms. This report is presented to emphasize not only the unusual echocardiographic findings but also the subtle findings on the phonocardiogram and apexcardiogram which should have led to the correct diagnosis.

Echocardiography↗