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Biomedical subjects

F E Fyke

Publications and source records attributed to F E Fyke.

18 recordsLinked to original sources
PubMed1995

Doppler guided extrathoracic introducer insertion.

Recent reports have raised concern over the use of standard subclavian puncture for placement of permanent pacing leads. This study reports the initial experience of one implanter in 59 consecutive, unselected patients undergoing implantation of a variety of pacing leads in whom a simple Doppler flow detector was used to guide extrathoracic venipuncture of the lateral subclavian/axillary vein. A total of 100 leads were placed for 48 right- and 11 left-sided systems. Lead insertion by this technique was successful in all patients. One small pneumothorax and two uncomplicated arterial punctures occurred. One patient's leads were revised electively because of unacceptable loss of redundancy when standing. There have been no infections or other late complications. A simple Doppler flow detector appears to be useful in identifying the lateral subclavian/axillary vein for extrathoracic pacemaker lead placement.

Aged↗
PubMed1993

Maleficent magnets and mangled megabytes.

Personal computers have become common-place in physicians' practices and their use in cardiac pacing for programming and follow-up is increasing. The most commonly used media for mass data storage are ferromagnetic. That the toroidal and bar magnets used to activate reed switches pose a threat to such data is well known but the degree of care necessary in handling magnets around storage media, especially the vulnerable floppy diskettes, is not generally appreciated. The basic principles of magnetic data storage discussed herein elucidate the mechanism of data alteration by extraneous magnetic fields. The properties of the surface coatings, the requirements of applicable industry standards, and the field strengths of the pacemaker magnets suggest that data on diskettes should be secure if kept at least 6-7 cm from an isolated pacemaker magnet. Experiments with typical bar and toroidal magnets demonstrated that data recorded on representative diskettes actually remained unaltered until the magnets were placed < 1 cm from the recording surfaces.

Compact Disks↗
PubMed1992

Total anomalous pulmonary venous connection: surgical correction in a 66-year-old man.

A cyanotic, debilitated 66-year-old man was referred as an emergency because of embolic arterial occlusion of the left lower extremity. Subsequent investigation revealed total anomalous pulmonary venous connection. Complete surgical correction was accomplished. Despite a difficult postoperative hospital course, more than 3 years after operation he continues to experience improved quality of life with better exercise tolerance, freedom from further emboli and symptomatic arrhythmias, and no need for his previously routine phlebotomies.

Age Factors↗
PubMed1992

Why not simple ventricular pacing? The hemodynamics of cardiac pacing for noncardiologists.

For many years, cardiac pacing consisted primarily of implanting and following fixed-rate ventricular systems. While this mode of pacing restored a more acceptable rate and in fact reduced mortality, prevented syncope, and brought clinical improvement in patients with acquired complete heart block, that it often failed to restore the degree of wellness provided by the normal electrical conduction sequence became increasingly apparent. This paper contrasts normal cardiac mechanics to those of simple ventricular pacing, making clear why clinical outcome with the latter is often disappointing. An approach to selecting pacing modes for specific abnormalities is outlined. The legitimate role of simple ventricular pacing continues to diminish as physicians turn to more hemodynamically efficient atrial and dual chamber pacing with sensor-mediated rate modulation where appropriate.

Cardiac Pacing, Artificial↗
PubMed1991

Comparison of exercise performance in left main and three-vessel coronary artery disease.

From a consecutive series of patients who underwent rest and exercise radionuclide angiography over several years, we retrospectively identified 34 patients with left main coronary artery disease and 103 patients with three-vessel coronary artery disease who did not have significant left main disease. The results of gated equilibrium radionuclide angiography were compared in these 2 groups. Multiple exercise hemodynamic, exercise electrocardiographic, and exercise radionuclide angiographic parameters were considered in an attempt to separate the 2 groups. The only parameter that was significantly different between the 2 groups was exercise heart rate. However, no value of the exercise heart rate could meaningfully separate the 2 groups. Despite their known difference in prognosis, patients with left main and three-vessel disease had very similar exercise performance and could not be distinguished from one another by exercise electrocardiography or exercise radionuclide angiography. The inability to distinguish these two groups is a clear limitation of noninvasive exercise modalities.

Coronary Angiography↗
PubMed1989

Chronic lung collapse: a predictable impediment to ipsilateral lead placement.

Implantation of a permanent transvenous pacemaker was undertaken in a patient with longstanding, complete collapse of the right lung. Unanticipated distortion of the lead path prevented entirely introduction of a right subclavian sheath and rendered lead placement from a right cephalic venotomy extremely difficult. An angioplasty guidewire substituted for the standard stylets proved useful in positioning the lead. This report describes the predictable venous deformity, illustrates the consequent impediment to ipsilateral lead placement, and discusses why contralateral entry sites should be superior in cases of massive loss of lung volume.

Aged↗
PubMed1988

Noninvasive identification of severe coronary artery disease using exercise radionuclide angiography.

The ability of exercise radionuclide angiography to predict the risk of having significant left main or three vessel coronary artery disease was examined in 681 patients who underwent both radionuclide and coronary angiography. There were significant differences in multiple variables between patients with or without such disease. Logistic regression analysis identified seven variables as independently predictive of the presence of left main or three vessel disease. Using these variables, low, intermediate and high probability groups could be identified. The four most important variables--the magnitude of exercise ST segment depression, peak exercise ejection fraction, peak exercise rate-pressure product and sex of the patient--can provide practical estimates of the risk of having left main or three vessel disease. Exercise radionuclide angiography can provide a clinically useful noninvasive estimate of the risk of having significant left main or three vessel disease.

Angiography↗
PubMed1988

Simultaneous insulation deterioration associated with side-by-side subclavian placement of two polyurethane leads.

During implantation of a bipolar dual chamber pacing system, two polyurethane leads were placed side-by-side through a single left subclavian vein puncture. The costoclavicular space was restrictive at the insertion site, and binding of the leads in this region made positioning difficult. Eleven months later, although pacemaker function remained normal, deterioration of both leads' insulation was noted on routine chest roentgenogram. Sixteen months after implantation, both leads failed. Insertion of polyurethane leads through a tight costoclavicular region should be avoided as subsequent mechanical stressing of the insulation may result in delayed lead failure.

Clavicle↗
PubMed1987

"Syndrome myxoma": a subset of patients with cardiac myxoma associated with pigmented skin lesions and peripheral and endocrine neoplasms.

From January 1954 to December 1985 cardiac myxoma was diagnosed in 75 patients at the Mayo Clinic. The clinical presentation was typical in 70 cases and was referred to as "sporadic myxoma". Forty four other cases of cardiac myxomas (five from the Mayo Clinic) presented with a combination of distinctive clinical features and these cases are described as "syndrome myxoma". The patients with syndrome myxoma were younger (mean age, 25 vs 56 years) and had unusual skin freckling (68%), associated benign non-cardiac myxomatous tumours (57%), endocrine neoplasms (30%), and a high frequency of familial cardiac myxoma (25%) and familial endocrine tumours (14%). The two types of cardiac tumour were different (syndrome vs sporadic): atrial location, 87% vs 100%; ventricular location, 13% vs 0%; single tumour, 50% vs 99%; multiple tumours, 50% vs 1%; and recurrent tumour, 18% vs 0%. It is concluded that patients with syndrome myxoma represent a distinctive subgroup in which there are important clinical, surgical, and genetic implications. More importantly, syndrome myxoma appears to be only one expression of a much larger disease entity.

Adolescent↗
PubMed1985

Venous air embolism. Life-threatening complication of orogenital sex during pregnancy.

Vaginal insufflation in pregnant women leading to acute venous air embolism has been appreciated by obstetricians and pathologists for several decades. Initially described as a complication of powder insufflation for treatment of trichomonal vaginitis, insufflation-induced air embolism has been more recently associated with orogenital sex. The case herein illustrates a typical history that is almost pathognomonic. Clinical and laboratory abnormalities as well as treatment measures are briefly described. Familiarity with this syndrome is essential if prompt and appropriate therapy is to be rendered.

Acute Disease↗
PubMed1985

Primary cardiac tumors: experience with 30 consecutive patients since the introduction of two-dimensional echocardiography.

Experience with 30 consecutive patients who had a total of 32 primary cardiac tumors and who underwent two-dimensional echocardiographic examinations between January 1977 and June 1983 was reviewed. Most of the tumors were atrial myxomas (20 left and 4 right), and 30 were identified on echocardiography. Twenty-five patients, including 21 of 22 with atrial myxoma, underwent surgical resection on the basis of the echocardiographic examination, without preoperative angiocardiography. When the morphologic characteristics of the left atrial myxomas were studied statistically in relation to clinical abnormalities, large tumor size was most closely related to the number and type of associated clinical and laboratory abnormalities. The single exception was embolization, which correlated with echocardiographic tumor consistency. Since the introduction of two-dimensional echocardiography, the yearly incidence of cardiac tumor diagnosis at this clinic has increased several fold and the incidence of unexpected intraoperative diagnosis has been very low (one case). Echocardiography is the method of choice for clinical diagnosis. It has replaced angiocardiography for routine preoperative assessment, permits early diagnosis of cardiac neoplasms and provides insight into the pathophysiology of primary cardiac tumors.

Adolescent↗
PubMed1985

Detection of intrapericardial hematoma after open heart surgery: the roles of echocardiography and computed tomography.

Two patients who had right atrial compression caused by intrapericardial hematomas after coronary artery bypass grafting and aortic valve replacement are described. During the course of postoperative evaluation, each patient underwent an echocardiographic examination followed by computed tomography of the chest. Two-dimensional echocardiography visualized the hematomas in both cases. Computed tomography played a useful adjunctive role by further clarifying their nature, location and extent.

Aged↗
PubMed1983

Diagnosis of lipomatous hypertrophy of the atrial septum by two-dimensional echocardiography.

Originally described in 1964, lipomatous hypertrophy of the atrial septum currently remains a diagnosis established primarily at autopsy. Clinical interest in this disorder has centered on the reported association with supraventricular arrhythmias and sudden death. Because two-dimensional echocardiography allows detailed assessment of atrial septal configuration, we reviewed two-dimensional echocardiographic reports obtained over a 1 year period and identified 17 patients who had features consistent with lipomatous hypertrophy of the atrial septum. Nine were men and the average age was 70 years. Autopsy confirmation of the echographic findings was possible in one patient. In nine patients, ideal body weight was exceeded by 10% or more. The atrial septum viewed from the subcostal transducer position showed a distinctive echo-dense globular thickening sparing the valve of the fossa ovalis. The resultant tomographic image of the atrial septum had a characteristic dumbbell appearance. The mean thickness of the atrial septum was 21 mm (range 15 to 29). Seven patients had supraventricular arrhythmias, and eight had P wave abnormalities. The two-dimensional echocardiographic features described are distinctive and suggest that this technique is the procedure of choice not only for establishing the diagnosis of lipomatous hypertrophy of the atrial septum but also for providing a means for prospective follow-up of patients with this little known entity.

Aged↗
PubMed1983

Verapamil for refractory ventricular fibrillation during cardiac operations in patients with cardiac hypertrophy.

Calcium-entry blockers prevent ventricular fibrillation during acute myocardial ischemia in laboratory animals. They may be useful as an adjunct to cold cardioplegia by preserving the myocardium during cardiopulmonary bypass. Their use may limit myocardial infarct size. However, the clinical application of calcium-entry blockers for ventricular dysrhythmias associated with myocardial ischemia has been little explored, as yet. We describe four patients, all of whom had significant cardiac hypertrophy (two had idiopathic hypertrophic subaortic stenosis; one had transposition of great vessels; and one had aortic stenosis) and in whom ventricular fibrillation developed after rewarming or shortly after the termination of bypass. The dysrhythmias were refractory to multiple attempts at defibrillation and conventional pharmacologic interventions. However, in each case, defibrillation was successful after administration of verapamil.

Adolescent↗