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Biomedical subjects

G M FitzGibbon

Publications and source records attributed to G M FitzGibbon.

36 records · Page 2Linked to original sources
PubMed1984

Aorta-coronary bypass in patients with coronary artery disease who do not have angina.

During an 8 year period we performed coronary bypass operations in 118 consecutive patients who were not experiencing angina when selected for surgical treatment. Their mean age was 45 years, collectively they had had 87 myocardial infarcts, and 42% had at least moderately abnormal ventriculograms. Considering 50% coronary stenosis "significant," 9% had single-, 23% double-, and 68% triple-vessel disease; 15% had left main coronary artery disease also. Operations, which involved placing a mean of 3.6 grafts per patient, included 39 endarterectomies and 11 ventricular aneurysm repairs. There were no operative deaths, but eight (6.8%) died during a mean 6.7 year follow-up. A retrospective comparison was made between these 118 patients and a consecutive series of 605 others, mean age 46 years, having angina and also treated surgically during the same period. Five (0.83%) of these latter patients died perioperatively and 42 (6.9%) during a mean follow-up of 6.4 years. The no-angina patients had significantly more prior myocardial infarcts and more abnormal ventriculograms; the angina group had a significantly higher reoperation rate. However, there were no significant differences between the two groups in age, coronary disease severity, results of treadmill testing, number of grafted vessels, endarterectomies, ventricular aneurysm repairs, perioperative infarcts, operative or late mortality, or early, 1 year, and 5 year graft patency rates. We have concluded that, with the exception of cardiac ischemia warning, our patients without angina, treated surgically, were similar in most important respects to patients in a concurrent series in which angina was one of the indications for operation. We believe that coronary bypass is safe for such individuals without angina and probably as as effective as for those with cardiac pain.

Adult↗
PubMed1981

Intrapleural positioning of esophagus for treatment of swallowing-induced arrhythmia.

Swallowing-induced atrial tachycardia is a rare phenomenon generally assumed to be caused by abnormal parasympathetic reflexes arising in the esophagus or pharynx. We describe a patient with intractable swallow tachycardia. Since certain features of the case suggested a mechanical rather than a reflex mechanism, he was treated by intrapleural repositioning of the esophagus to effect physical separation of esophagus and left atrium. Ten months after an uncomplicated procedure, the patient remains asymptomatic and free of arrhythmia.

Deglutition↗
PubMed1981

Perioperative myocardial infarction complicating coronary bypass. Clinical and angiographic correlations and prognosis.

To investigate the importance and the causes of myocardial infarction complicating the coronary bypass operation, we have reviewed clinical and preoperative angiographic data on 717 patients operated on over an 81/2 year period and postoperative angiography on all but one survivor. The hospital mortality was 0.6%. Of the 56 (7.8%) patients who sustained perioperative myocardial infarction, two died. Left ventricular angiography supported the diagnosis in 40 patients and aided in quantification of myocardial infarction. Age, preoperative symptomatic status, incidence of prior myocardial infarction, and perfusion and axoxia timed did not correlate with myocardial infarction, but extent of coronary disease, number of grafts, and associated endarterectomy did. There have been no late deaths in the 54 survivors of perioperative infarction, which appears usually to be a benign event. Graft occlusion was nearly three times commoner in patients with myocardial infarction, and in 42 of 54 survivors the myocardial infarction could be explained by new impairment of perfusion, usually owing to compromise of the grafted artery. The relationship of perioperative infarction to iatrogenic diminution of perfusion, of the infarcted segment suggests that technical factors, especially meticulous attention to the quality of the graft-coronary artery anastomosis might further reduce the perioperative infarction rate.

Coronary Angiography↗
PubMed1978

Coronary bypass graft fate: angiographic grading of 1400 consecutive grafts early after operation and of 1132 after one year.

All 1400 coronary bypass grafts, in 409 survivors of 414 patients undergoing 440 consecutive bypass operations, were selectively opacified in multiplane cineangiograms prior to hospital discharge and 1132 (81%) were restudied at one year. Grafts were graded A (excellent), B (fair) or O (occluded) by separate assessment of proximal and distal anastomoses and bypass trunks. In early graft studies 89% were patent (A and B), 79% graded A; at one year, 81% were patent, 74% graded A. Circumflex-marginal grafts fared less well early, but similarly late, compared with other grafts. Of all grafts graded B early, 37% became A, 39% remained B and 24% were occluded at one year; 90% of early graded A grafts remained so, 4% became B and 6% occluded; the grading system seems to have had useful predictive value. Distal anastomosis defects dictated early B grading in 81.3% of cases, trunk defects in 12.5% and proximal anastomosis defects in 2.7%. Trunk defects carried a worse prognosis for occlusion than did distal anastomosis defects. Side-to-side, vein-coronary anastomoses had a significantly higher patency rate than terminal end-to-side coronary anastomoses with the same veins.

Adult↗
PubMed1975

Photographic maps for coronary artery operations: how to make them easily.

A modification of the Tagarno 35-mm ciné-film projector has been devised primarily for the cardiac surgeon, to produce excellent pictures of opacified coronary arteries. A combined screen and photographic holder allows the surgeon to view an image 10.2 X 12.7 cm and to make positive prints of selected frames in a matter of seconds. No photographic experience is needed.

Cineangiography↗
PubMed1972

Surgical treatment of impending myocardial infarction: report of two cases.

Two men, aged 29 and 44, presented with clinical and electrocardiographic evidence suggesting impending myocardial infarction. Selective coronary angiography revealed serious obstructive coronary atherosclerosis including gross stenosis of the main left coronary artery in both. Emergency surgical operations were performed, a double aorto-coronary venous bypass in one and a single venous bypass combined with a Vineberg operation in the other. Neither patient sustained myocardial infarction. Both patients are very well more than six months after operation. Clinical, electrocardiographic and angiographic evidence of the effectiveness of these operations is presented.

Adult↗
PubMed1972

Delayed diagnosis of symptomatic coronary artery disease in young men.

Delay in making the diagnosis of symptomatic coronary artery disease was determined by studying the medical histories of 265 men aged 24.7 to 49.9 (mean 40.1) years with angiographically proven obstructive coronary atherosclerosis. The diagnosis of angina pectoris was delayed three times as often as the diagnosis of myocardial infarction, and for five times as long. The diagnosis of symptomatic coronary artery disease was delayed three and a half times more often in patients less than 35 years of age, than in patients over 45; the average time from presentation with symptoms to diagnosis was 30 times longer in patients under 35 years of age than in patients over 45.

Adult↗