[Longevity of permanent transvenous cardiac pacemaker leads (author's transl)].
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Biomedical subjects
Publications and source records attributed to G Shindo.
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Complete disappearance of ventricular parasystolic beats by cardiac pacing with the rates of near multiples of the parasystolic rate was observed in 2 patients with ventricular parasystole. This finding represents a clinical counterpart of recently demonstrated experimental and mathematical models of electrotonic modulation of the parasystolic discharge.
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A method is described for quantifying pulmonary regurgitation. This method is based on a comparison of the right and left ventricular stroke volumes which are determined from biplane angiocardiograms. These techniques were applied to study 18 postoperative patients with tetralogy of Fallot. In patients with an outflow patch, regurgitant fraction was well correlated with regurgitant area. The RVEDV/LVEDV ratio was also correlated well with regurgitant fraction. Although majority of patients maintained normal RV ejection fraction, there were small number of patients with large regurgitant fraction and decreased RV ejection fraction.
Hemodynamic and angiocardiographic studies were performed in postoperative patients with tetralogy of Fallot. Pressure gradient between the right ventricle and pulmonary artery was correlated with the narrowest area in the pulmonary arterial pathway. Regurgitant fraction was also correlated with regurgitant area which was determined by preoperative area of the pulmonic annulus and width of the outflow patch. Follow-up study of postoperative patients with tetralogy indicated that those with pressure gradient less than 20 mmHg and regurgitant fraction less than 15% could be considered ideally corrected. A table was constructed for determining the most appropriate width of the outflow patch for the ideal correction.
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Total unilateral anomalous pulmonary venous connection with intact atrial septum is a rare form of congenital heart disease. Operative method to correct this anomaly varies according to the site of drainage of the anomalous pulmonary veins. Surgical experience in four patients are described.
Two cases of truncus arteriosus type I associated with truncal valve insufficiency were operated upon with the Rastelli's procedure. The first case of 3-year-old boy died from severe hemolysis which was caused by the regurgitant jet from the truncal valve running against the rough-surfaced Dacron patch for the VSD. The second case of 12-month-old girl was treated with a Dacron patch lined with an autologous pericardial pedicle. Her postoperative course was uneventful. The authors discuss the potential risk and prevention of postoperative hemolysis in corrective surgery of the truncus arteriosus with truncal valve insufficiency.