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Biomedical subjects

E Varnauskas

Publications and source records attributed to E Varnauskas.

At least 19 recordsLinked to original sources
PubMed2000

Atrial septal defect in adults. Thirty-eight-year follow-up of a surgically and a conservatively managed group.

This report describes the long-term (up to 38 years) outcome, in terms of mortality and cardiovascular morbidity, in a non-randomized clinical observation study of a surgically and a conservatively managed group of adult patients with shunt lesions at atrial level. Haemodynamic status was assessed at baseline and at repeat examination. Twelve patients underwent surgical repair of the lesion between these two heart catheterizations, resulting in a marked reduction in heart size and right ventricular systolic pressure. These changes were associated with improvement in functional class and a trend towards less risk of cerebrovascular incidents, but not atrial fibrillation, during follow-up. Among 12 patients not operated on between catheterizations, symptomatic deterioration was common, often necessitating later surgical repair. The results support the assumption that early surgery should be recommended for adults with a haemodynamically significant lesion, to reduce the risk of mortality and prevent symptomatic deterioration.

Adolescent↗
PubMed1992

The role of early surgery following myocardial infarction. European Coronary Surgery Bypass Group.

This co-operative study was a prospective randomised study to evaluate the role of coronary bypass surgery following acute myocardial infarction. The criterion for entry was an early positive exercise tolerance test. All patients who satisfied the clinical criteria of acute myocardial infarction but who were excluded had information on survival obtained after two years. A total of 4658 patients were assessed, with 3334 (71%) having a modified exercise test. This test was positive in 728 patients, of whom 598 then underwent coronary angiography. Three hundred and forty-eight patients were randomised (surgery 168, continuing medical treatment 180). At two years the survival in the medical group was 96% and in the surgical group was 93%. At five years the corresponding figures were 88% and 91%. Sub group analyses in terms of age, ejection fraction and extent of vessel disease failed to show any significant differences between those randomised to medicine or surgery. A positive exercise test early after infarction does help to delineate those more likely to require intervention, but a negative exercise test is not an indication for complacency.

Cardiac Surgical Procedures↗
PubMed1988

Twelve-year follow-up of survival in the randomized European Coronary Surgery Study.

We studied survival rates among 767 men with good left ventricular function who participated in the European Coronary Surgery Study, 10 to 12 years after they were randomly assigned to either early coronary bypass surgery or medical therapy. At the projected five-year follow-up interval, we observed a significantly higher survival rate (+/- 95 percent confidence interval) in the group that was assigned to surgical treatment than in the group assigned to medical treatment (92.4 +/- 2.7 vs. 83.1 +/- 3.9 percent; P = 0.0001). During the subsequent seven years, the percentage of patients who survived decreased more rapidly in the surgically treated than in the medically treated group (70.6 +/- 5.8 vs. 66.7 +/- 5.3 percent at 12 years). Thus, the improvement in the survival rate among patients with stable angina who were treated surgically appears to have been attenuated after five years. However, the gradually diminishing difference between the two survival curves still favored surgical treatment after 12 years (P = 0.04), despite the fact that 136 patients in the medically treated group had coronary bypass surgery and 23 in the "surgically treated" group did not. The benefit of surgical treatment tended to be greater, but not significantly so, as assessed by interaction analysis in the subgroups of patients who were older or who had signs of ischemia or previous infarction on the resting electrocardiogram, a markedly ischemic response to exercise testing, peripheral arterial disease, an absence of hypertension, and proximal obstruction in the left anterior descending artery. The reasons for the loss of a beneficial effect of surgery after five years are unknown and merit further study.

Age Factors↗
PubMed1988

Correlation of coronary arteriography after acute myocardial infarction with predischarge limited exercise test response.

This study of post-acute myocardial infarction (AMI) patients compared the extent and distribution of coronary narrowings and left ventricular dysfunction in 45 patients who had greater than or equal to 1 mm ST-segment depression on a predischarge low-level exercise test (positive-result group) with those found in 78 patients who had less than 1 mm ST depression (negative-result group). Cardiac catheterization was done 50 +/- 20 days (mean + standard deviation) after AMI. Patients with positive responses more often had multivessel coronary artery disease (80 vs 47%, p = 0.001) and a greater than or equal to 75% narrowing in the left anterior descending (LAD) (87 vs 62%, p = 0.003) and left circumflex (71 vs 37%, p = 0.001) arteries, as well as in the proximal LAD segment before the first septal branch (58 vs 29%, p = 0.002). Among patients with positive responses 93% had normal or hypokinetic wall motion in the vascular territory of a severely diseased coronary artery (viable but potentially ischemic myocardium) while 63% of the negative-result group had these findings (p = 0.001). No difference in ejection fraction could be identified between the 2 groups (54 +/- 15% vs 54 +/- 16%). Prior studies of AMI patients have shown that ST-segment depression on a predischarge low-level exercise test will identify patients at higher risk of subsequent cardiac death. Our observations have identified differences in cardiac angiographic findings between patients with positive and negative responses to this test that may explain this difference in outcome.

Coronary Angiography↗
PubMed1987

Clinical course, serum concentrations and elimination rate in a case of massive sotalol intoxication.

A young woman had been on antiarrhythmic treatment with sotalol 80-160 mg daily for three years because of ventricular tachycardia. After a quarrel she ingested an overdose of sotalol, estimated to be 13-14 g, and was immediately brought to hospital, where the first ECG was taken 25 minutes after the ingestion. The clinical course, including the relationship over time between pronounced bradycardia, QT prolongation and malignant ventricular tachyarrhythmias is described. Serum concentrations were obtained regularly between 11 and 54 hours after the ingestion. After initially very high levels, the concentrations decreased in a strictly exponential manner to arrive at therapeutic concentrations 39 hours after the ingestion. Calculations revealed that over 12 g of sotalol was absorbed into the circulation, while the half life was 9.2 h and the oral clearance 294 mg min-1. The heart rate normalized about 24 hours after the repolarization variables, which supports the opinion that the class III action of sotalol is unrelated to the beta-blockade. In sotalol intoxication, malignant tachyarrhythmias appearing during excessive prolongation of the QT interval, most often in combination with hypokalemia, ethanol intoxication or concomitant antiarrhythmic treatment, may need emergency defibrillation but seem to disappear within a few hours. Thus, while massive sotalol intoxication may be fatal, early treatment promotes a successful outcome even when very high doses have been ingested.

Adult↗
PubMed1986

Transseptal left heart catheterization: a review of 278 studies.

In our laboratory, we performed 278 transseptal left heart catheterizations in adult patients over a period of 13 years. The left atrium was entered in 91.4% of the intended left heart catheterizations. Of 252 attempts, the left ventricle was entered in 96.1%. Major complications were aortic puncture (0.7%), pericardial puncture/suspected tamponade (3.2%), systemic arterial embolism (1.1%), and suspected perforation of the inferior vena cava (0.4%). There were no deaths. Although less frequently performed during the last decade, the transseptal catheterization technique has a complication rate of the same magnitude as during periods when this method was more commonly applied.

Adolescent↗
PubMed1985

Paroxysmal vagally mediated AV block with recurrent syncope.

Paroxysmal complete atrioventricular (AV) block without associated electrocardiographic (ECG) abnormality is not a well recognized entity. A mother and her daughter had recurrent syncopal episodes, but a normal ECG. The episodes were preceded by nausea and vomiting. ECG during these episodes revealed complete heart block. In the mother, one episode was promptly reversed by atropine. Electrophysiological evaluation of the sinus and AV nodal function and atrial and ventricular effective refractory periods before and after autonomic blockade was normal. Provocative manoeuvres failed to induce AV block. Paroxysmal AV block was vagally mediated in one of the patients, as indicated by prompt response to atropine. In the second case, the vagal dependence could not be proved but appears to be the most likely explanation. It thus appears that paroxysmal, vagally mediated complete AV block should be seriously considered in patients with unexplained syncope.

Adult↗
PubMed1985

Estimation of ventricular repolarization in man by monophasic action potential recording technique.

Myocardial monophasic action potentials (MAP) can be recorded with the aid of suction or contact electrodes applied endocardially via a catheter. The technique necessitates high input impedance amplifiers with infinite time constant. A bipolar technique improves signal quality with regard to electrical contamination around the rapid upstroke of the MAP. Mechanical artefacts in the recordings are common and may be explained by catheter movement induced by atrial or ventricular contractions. The MAP signal can be used for a precise measurement of time of local excitation and for the study of atrial as well as ventricular repolarization. The technique has mostly been applied in the exploration of atrial and ventricular repolarization in healthy hearts and during different cardiac arrhythmias. Furthermore, several studies have documented the electrophysiological action of antiarrhythmic drugs upon the human heart. Concluding from 576 different investigations we consider the technique to have no serious side-effects.

Cardiac Catheterization↗
PubMed1985

Survival, myocardial infarction, and employment status in a prospective randomized study of coronary bypass surgery.

This report from the European Prospective Randomised Study presents 8 year results on survival and 5 year results on myocardial infarction and employment status. The 768 recruited patients were all men under age 65 with mild or moderate angina, 50% or greater stenosis in at least two major coronary arteries, and a left ventricular ejection fraction of 50% or greater. One "surgical" patient was lost to follow-up immediately after randomization and is therefore excluded from the statistical analysis. Thus 394 patients allocated to surgery were compared with 373 patients allocated to medical treatment, regardless of what subsequently happened to the patients. The policy of early surgery improved survival significantly compared with the conventional medical treatment policy in the total population (89% to 80%, respectively; p = .0013) and in the subgroup with three-vessel disease (92% and 77%, respectively; p = .00015). Reclassification of vessel disease by greater than 75% instead of 50% or greater stenosis as the criterion was undertaken to facilitate comparison of these results with those of other studies, which apply 70% or greater stenosis as the criterion of significant disease. Of the 767 patients, a cohort of 711 were identified as having greater than 75% obstruction in one, two, or three vessels. A significant improvement in survival with surgery was found in the total cohort (89% and 80%, respectively; p = .0022), the subgroup with three-vessel disease (91% and 73%, respectively; p = .0044), and that with two-vessel disease in which one of the diseased vessels was the proximal segment of the left anterior descending artery (LAD) (90% and 79%, respectively; p = .013). There was no significant difference in survival between the two treatments in patients with one-vessel disease and those with two-vessel disease without proximal LAD stenosis. Four noninvasive prognostic variables were independently predictive of the effect of surgery: resting electrocardiogram (in 767 patients), ST segment response to exercise (in 656), history and physical signs of peripheral arterial disease (in 722), and age (in 767). A reduction in cardiac deaths was entirely responsible for the improved survival with surgery. The incidence of myocardial infarction in the medical group (11%) was not significantly different from that in the surgical group (15%). Repeat angiography in 71 patients showed 6% graft closure between 1 and 5 years of follow-up. Surgery did not influence the gradually increasing annual rate of retirement from work.

Adult↗
PubMed1985

European coronary surgery study.

The results of the European Study apply to the patients who met the inclusion criteria of this study: men, aged under 65, with angina pectoris of more than three months' duration, 50% or greater intraluminal diameter narrowing in at least two major coronary arteries and good left ventricular function (ejection fraction greater than or equal to 50%). The results imply that prophylactic coronary bypass surgery should be considered only for those patients with angina who are at risk of premature death defined by the non-invasive prognostic predictors (ischemic abnormalities in the resting ECG, marked ST-depression during exercise, peripheral arterial disease, age) and the extent and size of coronary obstructions. The severity of angina is of limited relevance in this context. The patients in a low risk phase of the disease do not require surgery unless they have unacceptable symptoms in spite of adequate medical treatment. No evidence emerges to support the assumption that coronary bypass surgery protects against future myocardial infarction. Although surgery relieves angina pectoris and improves physical performance, it does not significantly delay retirement from work over a period of five years.

Adult↗