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Biomedical subjects

G S Reeder

Publications and source records attributed to G S Reeder.

At least 73 records · Page 4Linked to original sources
PubMed1993

Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. The Mayo Coronary Care Unit and Catheterization Laboratory Groups.

BACKGROUND: Immediate angioplasty and the administration of a thrombolytic agent followed by conservative treatment are two approaches to the management of acute myocardial infarction, but these methods have not been compared prospectively. METHODS: We enrolled 108 patients with acute myocardial infarction in a randomized trial designed to test the hypothesis that immediate angioplasty (without previous thrombolytic therapy) may result in greater myocardial salvage than the administration of a thrombolytic agent followed by conservative treatment. The primary end point was the change in the size of the perfusion defect as assessed at admission and discharge by tomographic imaging with technetium-99m sestamibi, a myocardial perfusion agent that can measure myocardium at risk and final infarct size. RESULTS: End-point data were available for 56 patients randomly assigned to receive tissue plasminogen activator (mean [+/- SD] time to start of infusion, 232 +/- 174 minutes after the onset of chest pain) and 47 patients randomly assigned to receive angioplasty (first balloon inflation at 277 +/- 144 minutes). In the case of anterior infarction, myocardial salvage as assessed by imaging with technetium-99m sestamibi was 27 +/- 21 percent of the left ventricle for 22 patients in the thrombolysis group, as compared with 31 +/- 21 percent for 15 patients in the angioplasty group. For infarcts in all other locations, myocardial salvage was 7 +/- 13 percent for 34 patients in the thrombolysis group and 5 +/- 10 percent for 32 patients in the angioplasty group. After adjustment for infarct location, the difference in mean salvage between groups was 0 (P = 0.98), with a 95 percent confidence interval of +/- 6 percent of the left ventricle. CONCLUSIONS: In patients with acute myocardial infarction, immediate angioplasty does not appear to result in greater myocardial salvage than the administration of a thrombolytic agent followed by conservative treatment, although a small difference between these two therapeutic approaches cannot be excluded.

Angioplasty, Balloon, Coronary↗
PubMed1993

Percutaneous balloon mitral valvuloplasty: comparison of double and single (Inoue) balloon techniques.

To assess relative merits of the double and single (Inoue) balloon techniques of percutaneous balloon mitral valvuloplasty for treating symptomatic mitral stenosis, 33 patients who underwent dilatation with the double balloon were compared retrospectively with 28 who underwent dilatation with the Inoue balloon. There were no baseline differences in mean left atrial pressure, mean mitral gradient, or calculated mitral valve area between the two groups. The procedure was successful in 89% of patients in the double balloon group and in 93% in the Inoue balloon group. Final mitral valve area and absolute increase in mitral valve area were significantly greater in the double balloon group, in which there was a nonsignificant trend toward greater incidence of acute complications. Final left atrial pressure and mitral gradient were not different. Both techniques are useful and safe.

Catheterization↗
PubMed1993

Chronic total obstruction and short-term outcome: the Excimer Laser Coronary Angioplasty Registry experience.

Percutaneous transluminal coronary angioplasty for chronic total obstructions is associated with significantly decreased success rates in comparison with those for dilation of subtotal stenoses. Failure usually results from inability to cross the occlusive lesion with a guidewire, although it may result from inability to pass the balloon catheter after the guidewire has been passed. In the Excimer Laser Coronary Angioplasty Registry, 172 chronic total obstructions were treated in 162 patients (10.3% of the 1,569 patients entered). For chronic total obstructions, passage of a guidewire is a prerequisite for laser angioplasty. Once a guidewire crossed an occlusion, the overall laser success rate for treatment of chronic total obstructions was 83%; the extent of stenosis decreased from 100% to 55 +/- 26%. Success was independent of length of the occlusive lesion. In 74% of patients, adjunctive percutaneous transluminal coronary angioplasty was used after laser angioplasty. A final procedural success, defined as residual stenosis of less than 50% and no major complication (coronary artery bypass grafting, myocardial infarction, or death), was achieved in 90%. Major complications were infrequent; 1.2% of patients required coronary artery bypass grafting, and 1.9% had a Q-wave myocardial infarction. Only one death occurred. The use of laser angioplasty may be of particular value when chronic total obstructions can be crossed with a guidewire but not with a conventional balloon catheter or when the occlusion is confirmed to be extremely long.

Adult↗
PubMed1992

Percutaneous transluminal coronary angioplasty in patients with cardiogenic shock.

In cardiogenic shock complicating acute myocardial infarction, percutaneous transluminal coronary angioplasty has been reported to significantly improve the modest survival benefits afforded by emergency surgical revascularization and thrombolytic therapy. The records of all patients who underwent angioplasty for acute myocardial infarction complicated by cardiogenic shock were retrospectively reviewed to determine whether coronary angioplasty improves survival. Of the 45 patients, 28 (group 1, 62%) had successful dilation of the infarct-related artery and 17 (group 2, 38%) had unsuccessful angioplasty. The groups were similar in extent of coronary artery disease, infarct location, incidence of multivessel disease and hemodynamic variables. The overall hospital survival rate was 56% (71% in group 1 and 29% in group 2). Group 1 patients had more left main coronary artery disease, and group 2 patients were older and had a higher incidence of prior myocardial infarction. Multivariate analysis showed that the survival advantage in patients with successful angioplasty was statistically significant (p = 0.014) when these factors were taken into account. At a mean follow-up interval of 2.3 years (range 1 month to 5.6 years), there were five deaths (four cardiac and one noncardiac), for a 2.3-year survival rate of 80% in patients surviving to hospital discharge. During the follow-up period, 36% of hospital survivors had repeat hospitalization for cardiac evaluation, 8% had myocardial infarction, 8% had coronary artery bypass surgery and 24% had angina.

Actuarial Analysis↗
PubMed1992

Excimer laser coronary angioplasty: results in restenosis versus de novo coronary lesions. Excimer Laser Coronary Angioplasty Investigators.

There is limited information regarding the use of excimer laser coronary angioplasty (ELCA) in patients with restenotic lesions. The purpose of this investigation was to compare the results of ELCA in patients with restenosis following prior PTCA with results obtained in de novo (no restenosis) patients. A retrospective review was obtained of all patients undergoing attempted ELCA at each of the 12 participating clinical investigative centers. There were 620 patients in the prior restenosis group and 949 in the de novo group. Both laser success (88% vs 78%) and procedural success (92% vs 88%) were higher in restenosis lesions compared with de novo lesions (P less than 0.001). Six-month follow-up was available in 40% of patients. Restenosis occurred in 49% of the prior restenosis group vs 44% of the de novo group (P nonsignificant) but death was more common in the de novo group (2.2 vs 0.4%, P = 0.01). ELCA can be performed with a high success rate in patients with restenosis following prior balloon angioplasty but recurrent restenosis following laser procedure remains a significant problem.

Adult↗
PubMed1992

Recurrence of symptoms after percutaneous aortic balloon valvuloplasty: relationship to Doppler diastolic filling values.

Short-term follow-up after percutaneous aortic balloon valvuloplasty shows a high incidence of restenosis. Yet a high percentage of patients with restenosis continue to show symptomatic improvement. Those with decreased left ventricular function originally tend to have a recurrence of symptoms. In this study Doppler-derived diastolic filling values at follow-up were most highly associated with symptom status, suggesting that change in diastolic filling after percutaneous aortic balloon valvuloplasty is one of the factors related to symptoms.

Aged↗
PubMed1992

Fixed subaortic stenosis in atrioventricular canal defect: a Doppler echocardiographic study.

OBJECTIVES: The objectives of this retrospective study were to describe the Doppler and echocardiographic features of fixed subaortic stenosis in the setting of atrioventricular (AV) canal defect and to document the de novo occurrence of subaortic stenosis and progression of this lesion over time on the basis of sequential echocardiographic studies. BACKGROUND: The coexistence of fixed subaortic and AV canal defect has been sporadically noted, but no single or multicenter experience with this constellation of abnormalities has been previously described. METHODS: All patients with a diagnosis of subaortic stenosis and complete or partial AV canal defect who had one or more Doppler echocardiographic examinations were identified from a computer data bank. Retrospective analysis was performed, including review of patients' charts, operative notes, recorded videotapes and hard copy recordings when available. RESULTS: Twenty-one patients with both subaortic stenosis and AV canal defect were identified over a 13-year period. Fifteen were female and the mean age at diagnosis of subaortic stenosis was 16 years. Fifteen patients had partial AV canal defect with prior repair in 10; 6 patients had complete AV canal defect with prior repair in 4. The mean interval from prior repair to recognition of subaortic stenosis was 6.8 years. In six patients, serial examinations demonstrated the de novo occurrence of subaortic obstruction over a period of 10 to 87 months. In five patients, progression of known subaortic stenosis was documented over a 10- to 59-month period. Surgical resection of subaortic stenosis was performed in 16 patients; the echocardiographic diagnosis was confirmed in 15 of the 16. CONCLUSIONS: In the largest reported echocardiographic series of this lesion complex, it is concluded that subaortic stenosis can occur de novo, is often recognized only after repair of the canal defect and is progressive. Doppler echocardiography is the method of choice for diagnosis and serial follow-up of these patients.

Adolescent↗
PubMed1992

Occult cardiac tamponade detected by transesophageal echocardiography.

Transesophageal echocardiography is a safe, minimally invasive procedure that should be considered when the diagnosis of cardiac tamponade is a possibility and when conventional methods fail to provide conclusive diagnostic information. In this report, we describe a 74-year-old man in the intensive-care unit whose condition was unstable postoperatively because of an occult loculated pericardial effusion and cardiac tamponade. Routine noninvasive and invasive monitoring, including hemodynamic monitoring and transthoracic echocardiography, failed to confirm definitively the suspected diagnosis of cardiac tamponade. In addition, because of the hemodynamic instability of the patient, transporting him for definitive tests (such as fast computed tomographic scanning of the mediastinum, which could not be performed at the bedside) for assessment of cardiac tamponade was relatively contraindicated. In our patient, the diagnostic information obtained by transesophageal echocardiography may have been lifesaving.

Aged↗
PubMed1992

Initial and long-term outcome of 354 patients after coronary balloon angioplasty of total coronary artery occlusions.

BACKGROUND: Coronary balloon angioplasty of chronic total occlusions is associated with relatively low success rates and a high incidence of restenosis. Whether there is long-term benefit in performing angioplasty of these lesions is unknown. The purpose of the present report was to analyze the long-term outcome of a large series of patients undergoing this procedure. METHODS AND RESULTS: A computerized database analysis of 354 consecutive patients (from 1979 to 1990) who underwent coronary angioplasty of a chronic total coronary occlusion was performed (mean age, 62.3 years). Initial technical success was achieved in 69%; in 66%, success was achieved without procedural death or need for coronary artery surgery. During hospitalization, six patients suffered myocardial infarction, nine required emergency bypass surgery, and nine patients died. During a mean follow-up period of 2.7 years, no difference was found in survival or freedom from myocardial infarction among 234 successfully dilated patients compared with 120 patients with a failed attempt. However, the use of coronary artery bypass surgery was significantly less after successful dilation (p less than 0.0001 versus failed attempt). No significant difference in the cumulative incidence of severe angina was observed between these two patient populations, with the majority remaining asymptomatic. Restenosis occurred in 59% of 69 patients who returned for follow-up angiography. CONCLUSIONS: Successful recanalization is achieved in the majority of patients undergoing angioplasty of chronic total occlusions and reduces the need for coronary artery bypass surgery. However, no major impact on either survival or incidence of myocardial infarction was noted after successful recanalization when patients with surgery were included.

Angioplasty, Balloon, Coronary↗
PubMed1992

Effect of completeness of revascularization on long-term outcome of patients with three-vessel disease undergoing coronary artery bypass surgery. A report from the Coronary Artery Surgery Study (CASS) Registry.

BACKGROUND: Complete revascularization after coronary artery bypass surgery is a logical goal and improves symptomatic outcome and survival. However, the impact of complete revascularization in patients with three-vessel coronary disease with varying severities of angina and left ventricular dysfunction has not been clearly defined. METHODS AND RESULTS: The study was performed as a retrospective analysis of 3,372 nonrandomized surgical patients from the Coronary Artery Surgery Study (CASS) Registry who had three-vessel coronary disease. Group 1 (894 patients) had class I or II angina (Canadian Cardiovascular Society criteria) and group 2 (2,478 patients) had class III or IV angina. In group 1, adjusted cumulative 4-year survivals according to the number of vessels bypassed were 85% (one vessel), 94% (two vessels), 96% (three vessels), and 96% (more than three vessels) (log rank, p = 0.022). Adjusted event-free survival (death, myocardial infarction, definite angina, or reoperation) was not influenced by the number of vessels bypassed, nor was the anginal status among patients remaining alive after 5 years. In group 2, adjusted cumulative 5-year survivals were 78% (one vessel), 85% (two vessels), 90% (three vessels), and 87% (more than three vessels) (log rank, p = 0.074). Adjusted event-free survivals after 6 years were 23% (one vessel), 23% (two vessels), 29% (three vessels), and 31% (more than three vessels) (p = 0.025); at 5 years, those with more complete revascularization were more likely to be asymptomatic or free of severe angina. Among group 2 patients with ejection fractions less than 0.35, 6-year survival was 69% for those with grafts to three or more vessels versus 45% for those with grafts to two vessels (p = 0.04). Placing grafts to three or more vessels was independently associated with improved survival and event-free survival in group 2 but not group 1 patients. The case-fatality rates among 529 patients experiencing a myocardial infarction during follow-up was significantly higher for patients with less complete revascularization. CONCLUSIONS: Complete revascularization (grafts to three or more vessels) in patients with three-vessel coronary disease appears to most benefit those with severe angina and left ventricular dysfunction.

Angina Pectoris↗
PubMed1991

Patient age and results of balloon aortic valvuloplasty: the Mansfield Scientific Registry experience. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators.

Patients enrolled in the Mansfield Scientific Aortic Valvuloplasty Registry were followed up a mean of 7 months after balloon aortic valvuloplasty. Results were compared for patients less than 70, 70 to 79 and greater than or equal to 80 years of age at time of valvuloplasty. As assessed by aortic valve area indexed to body surface area, stenosis was more severe in the older patients and the incidence of congestive heart failure was also greater in those aged greater than or equal to 80 years. The results of valvuloplasty were comparable in all three age groups, and indexed final valve area was not significantly different among the groups. In-hospital mortality ranged from 4.2% to 9.4%, but this and other complications were not significantly different among the groups. Total 7 month mortality was 23%. As performed in this registry study, balloon aortic valvuloplasty produced similar results in older and younger patients, despite initially more severe disease in the older patients.

Age Factors↗
PubMed1991

In-hospital mortality after balloon aortic valvuloplasty: frequency and associated factors.

Percutaneous balloon aortic valvuloplasty has been accompanied by significant early periprocedural morbidity and mortality. Identification of factors associated with increased mortality might allow for improved selection of patients. The Mansfield Scientific Balloon Aortic Valvuloplasty Registry was analyzed to identify the frequency of in-hospital death and the factors associated with it. Of 492 patients undergoing the procedure, 37 (7.5%) died during the hospital stay in which valvuloplasty was performed. Twenty-four of these patients died within the first 24 h and the remainder died within 7 days after the procedure. There were significant differences in baseline clinical and hemodynamic characteristics as well as procedural and postprocedural variables between patients dying and those surviving the in-hospital period. Multivariate analysis identified four factors associated with increased mortality: 1) the occurrence of a procedure-related complication, 2) a lower initial left ventricular systolic pressure, 3) a smaller final aortic valve area, and 4) a lower baseline cardiac output. Thus, baseline hemodynamic, procedural and postprocedural variables and complications can be identified that are associated with increased mortality.

Aged↗
PubMed1991

Efficacy of percutaneous mitral balloon valvuloplasty with the inoue balloon.

Percutaneous mitral balloon valvuloplasty has become an accepted technique for use in selected patients with severe, symptomatic mitral stenosis. Recently, a new balloon catheter with an "hourglass" shape and specially designed guidewires and dilators has become available (Inoue balloon). The design of this balloon provides ease of manipulation and self-stabilization across the mitral valve during inflation. These features should decrease the incidence of complications associated with the procedure. Preliminary results in 12 consecutive patients who underwent percutaneous mitral balloon valvuloplasty with the Inoue balloon are presented. The mitral valve area increased from 0.92 +/- 0.21 cm2 before the procedure to 1.75 +/- 0.40 cm2 after the procedure. No complications occurred from the procedure, including no increase in severity of mitral regurgitation or creation of an atrial septal defect. Further follow-up is necessary to determine the long-term efficacy with this new balloon. Nonetheless, the preliminary results are encouraging.

Adult↗
PubMed1991

Transesophageal echocardiography and cardiac masses.

Although transthoracic two-dimensional echocardiography has been a procedure of choice for diagnosing cardiac mass lesions, the advent of transesophageal echocardiography (TEE) provided better visualization of cardiac structures, especially those at a considerable depth from the chest wall, and lesions that involve the left atrial appendage. In this study, we examined the experience at our institution with TEE imaging of cardiac mass lesions (excluding valvular vegetations) from April 1988 to July 1990. TEE studies detected 83 lesions (in 80 patients), which we characterized by type and site: 46 left atrial, 16 right atrial, 7 left ventricular, 2 right ventricular, and 12 extracardiac mass lesions. Of the 46 left atrial lesions, 9 were tumors and 37 were thrombi that involved the body of the left atrium, the left atrial appendage, or both. Associated mitral valve disease, chronic atrial fibrillation, or spontaneous microcavitations were common. Of the 16 right atrial mass lesions, 4 were tumors and 12 were thrombi, including "string" thrombi characteristic of venous thromboembolism. Of the seven left ventricular mass lesions, six were thrombi and one was a papilloma. Of the 12 extracardiac mass lesions, 2 were pericardial cysts and the rest were solid lesions. TEE added new or important clinical information beyond that derived from transthoracic echocardiography in left atrial thrombi, right atrial masses, and extracardiac lesions and was assessed to have influenced the management of patients most in these areas also. TEE is a useful addition to transthoracic echocardiography for diagnosis and clarification of cardiac mass lesions in selected patients.

Academic Medical Centers↗