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Biomedical subjects

H A Wellons

Publications and source records attributed to H A Wellons.

At least 37 records · Page 2Linked to original sources
PubMed1984

Energy dose and other variables possibly affecting ventricular defibrillation during cardiac surgery.

Previous studies have suggested that shocks of 5-10 J are required for direct ventricular defibrillation during open heart surgery. However, the efficacy of shocks of less than 5 J, the effects of thermal, biochemical, and temporal factors, and the influence of disease process on defibrillation have not been fully investigated, particularly with modern techniques of myocardial preservation. The purpose of this prospective study in 150 adult cardiac surgical patients was to evaluate the energy, current, and myocardial resistance with low energy DC shocks of 1, 2.5, and 5 J and to relate which biochemical, temporal, thermal, or other factors influence the outcome of a DC shock. Twenty-eight percent of shocks of 1 J and 55% of shocks of 2.5 J produced defibrillation. Above 2.5 J, the success rate reached a plateau at 55%. Other factors associated with the success of DC shocks were high normal serum potassium levels, high PaO2, high ionized calcium levels, and longer reperfusion times at mean arterial and coronary perfusion pressures above 50 mm Hg. Disease process may also play a role because patients with valvular heart disease were more difficult to defibrillate. Heart weight and thickness of ventricular myocardium, measured angiographically, appeared less important in direct defibrillation, except with 1 J shocks when thinner-walled ventricles defibrillated more easily.

Blood Chemical Analysis↗
PubMed1983

Primary pulmonary artery sarcoma diagnosed noninvasively by two-dimensional echocardiography.

A 21-year-old white male was evaluated in our echocardiographic laboratory for presumed mitral valvular bacterial endocarditis. Electrocardiographic, physical, and initial two-dimensional echocardiographic findings suggested a left-to-right shunt at the atrial septal level. However, injection of contrast saline solution failed to demonstrate signs of an atrial septal defect. Continuation of the echocardiographic study led to the diagnosis of an unsuspected primary sarcoma of the pulmonary trunk, which was rapidly confirmed by computerized axial tomography. Therapeutic interventions were undertaken. This case highlights the usefulness of two-dimensional echocardiography.

Adult↗
PubMed1982

Percutaneous transluminal angioplasty: the treatment of choice for renovascular hypertension due to fibromuscular dysplasia.

Twenty-three renal artery stenoses in 21 hypertensive patients, caused by fibromuscular dysplasia, were treated with percutaneous transluminal angioplasty (PTA). Follow-up over a period of 1 to 30 months, including angiography, renal vein renin assay, and radionuclide flow studies, was performed in 8 patients, each with one stenosis. Dilatation was initially successful in all cases and was successfully repeated in 1 case. The mean systolic pressure decreased by 61.81 mm Hg and the mean diastolic pressure by 36.28 mm Hg in response to treatment. Thirteen patients were cured, 8 were felt to have better control of blood pressure on medication, and there was no failures. This study demonstrates that PTA is a clinically effective method of treating renovascular hypertension due to fibromuscular dysplasia.

Adult↗
PubMed1981

Critical analysis of the preoperative and operative predictors of aortocoronary bypass patency.

A prospective analysis of the angiographic and operative anatomic and reconstructive variables that influenced graft patency was undertaken at the University of Virginia Medical Center in 50 consecutive patients. Postoperative restudy showed that 18 of the 168 grafts performed were occluded due to venous disease, inadequate run-off, or sequential design error. Angiographic artery size was 27% larger than operative estimations; graft patency significantly increased with increasing distal artery diameter, with decreasing venous conduit diameter, and with good graftability rating of the vessels preoperatively. Ejection fraction, the degree of arterial stenosis, and the source of the saphenous vein conduit (the thigh or the lower leg) had no influence on graft patency. Simple grafts had a 96% patency, while sequential grafts had an 80% patency. When design error for sequential grafts was eliminated, the sequential patency rate rose to 88%. For revascularization of small circumflex vessels, consideration should be given to variation in the sequential grafting technique to improve patency in these vessels.

Coronary Angiography↗
PubMed1981

Percutaneous transluminal angioplasty in patients with renal artery stenosis: follow-up studies.

Fifty renal artery stenoses in 38 hypertensive patients were treated with percutaneous transluminal angioplasty. Follow-up over a period of 1 to 24 months (mean, 9 mo.), including angiography, renal vein renin determinations, and radionuclide flow studies, were performed in 24 patients (32 stenoses). The initial dilatation was successful in 90% of stenoses and redilatation was necessary in 22% with a success rate of 84%. The mean systolic pressure decreased by 65.83 mm Hg and the mean diastolic pressure by 35.88 mm Hg in response to the treatment. Sixteen patients were cured, 18 were felt to have better control of blood pressure on medication, and 4 were not helped. Percutaneous transluminal angioplasty appears to be a technically feasible and clinically effective method of treating renovascular hypertension.

Adolescent↗
PubMed1981

Emergency carotid endarterectomy for fluctuating neurologic deficits.

The merit of emergency carotid endarterectomy for patients with fluctuating neurologic deficits remains controversial. Twenty-four patients with fluctuating neurologic deficits underwent emergency carotid endarterectomy and were compared to 31 patients managed nonoperatively. Both groups were similar in age and sex distribution, indicence of hypertension (50%), myocardial infarction (16%), and diabetes mellitus (12%). The two groups were subdivided into patients with crescendo transient ischemic attack (CTIA) and patients with stroke in evolution (SIE). Within the operative CTIA group, all seven patients recovered completely. Among the five nonoperative CTIA patients, one recovered, three sustained moderate or severe neurologic deficits, and one died. Within the operative SIE group of 17 patients, none had a worsening of the deficit, four remained unchanged (24%), and 12 patients (70%) had complete recovery or only a mild deficit. One patient (6%) died postoperatively. Among 26 nonoperative SIE patients, five recovered or sustained mild deficits (19%), 17 had moderate or severe deficits (66%), and four died (15%). The 12 patients with complete or near recovery of neurologic function represented more than a threefold improvement (P less than 0.01) in the quality of life with endarterectomy. When compared with the natural history of fluctuating neurologic deficits, these data suggest that immediate operative intervention will result in better salvage.

Carotid Arteries↗
PubMed1980

Evaluating candidates for ventricular aneurysmectomy.

Forty consecutive patients having left ventricular (LV) aneurysmectomy were evaluated for surgical risk predictors and were then followed up after operation. Factors evaluated included age, time since last myocardial infarction, NYHA classification, principal indication for surgery, LV end diastolic pressure, LV "A" wave size, number of coronary systems with greater than 70% stenosis, number of coronary bypass grafts, location of aneurysm, and ejection fraction of the nonaneurysmal or "contractile segment," determined by a modification of the method of Watson et al (MCSEF). There was 100% follow-up. There were four perioperative deaths and two late deaths. Operative mortality was 3.4% in patients with MCSEF greater than or equal to 45% and 37.5% in patients with MCSEF less than 45% (P less than .05). None of the other factors evaluated significantly affected mortality independent of MCSEF. Survivors had a mean follow-up of 22 months with a mean improvement in symptoms of 1.6 NYHA class (from 3.3 to 1.7). Forty-four percent have returned to their previous occupations. It is concluded that: (1) the MCSEF is of prime importance in evaluating risk for LV aneurysmectomy; (2) for patients with MCSEF greater than or equal to 45%, LV aneurysmectomy is a low-risk procedure; and (3) LV aneurysmectomy results in sustained relief of symptoms in most patients.

Heart Aneurysm↗
PubMed1980

Percutaneous transluminal dilatation of the renal arteries: techniques and results.

The techniques and results of percutaneous transluminal angioplasty (TPA) of the renal arteries were evaluated in 20 hypertensive patients with 25 renal artery stenoses. Follow-up angiograms have been obtained in nine patients. Many patients had evidence of both essential and angiotensinogenic hypertension. Eleven patients had evidence of severe diffuse atherosclerotic disease, and nine patients had evidence of renal insufficiency. The mean systolic pressures before and after PTA were 203.80 and 150.30, respectively. The mean diastolic pressures before and after PTA were 117.45 and 85.95, respectively. Ten patients were cured. Six patients with long histories of hypertension and a recent increase in blood pressure were classified as having blood pressure easier to control with antihypertensive medication following PTA. Three patients failed to respond to PTA, and one patient was a technical failure. The advantages of this technique include avoidance of general anesthesia and a major surgical procedure, decreased cost, and a shortened hospital stay. The technique can be easily repeated if necessary, and future surgical intervention is not precluded if the method is unsuccessful.

Adult↗
PubMed1980

The axillary approach to percutaneous renal artery dilatation.

The axillary approach to percutaneous transluminal angioplasty of the renal arteries is described. This technique simplifies renal dilatation in patients with severe atherosclerotic disease in the vessels distal to the renal arteries.

Arteriosclerosis↗
PubMed1980

Carotid arterial trauma.

The English-language literature, from 1952 to 1979, was surveyed for all papers concerned with vascular trauma penetrating wounds of the neck, or carotid injuries in particular, and all valid, first-hand, adequately detailed cases of carotid arterial trauma were abstracted. The valid, first-hand, adequately detailed cases of carotid arterial trauma were abstracted. The current status of all our own hospital survivors who had been treated for carotid artery injuries was also established to add needed longitudinal perspective. In all, 722 cases were available for analysis. The mean age was 28 years, and the overall mortality rate was 21%. One hundred and eighty-six patients presented with severe neurological deficits. If they underwent arterial repair, 34% were better; if they had a carotid ligated, or were not treated surgically, only 14% improved (P = 0.01). Shock or coma, independently, were significantly ominous (P less than 0.001), but there was no evidence to support coma as a contraindication to restoring arterial continuity. Similarly, in the patients with preoperative neurological deficits, no data could be found to substantiate the contention that prompt arterial repair would yield better results than delayed repair. Follow-up status at 1 year was available for only 40 cases from the results than delayed repair. Follow-up status at 1 year was available for only 40 cases from the entire literature. Assessment of our own patients, at a mean of 4.6 years after injury, uncovered multiple, persistent neurological defects, one stenotic arterial repair, two aneurysms, and an arteriovenous fistula.

Adult↗
PubMed1980

Employability--a new indication for aneurysmectomy and coronary revascularization.

Increasing governmental concern with containment of medical costs prompted us to evaluate the efficacy and cost effectiveness of ventricular aneurysmectomy and coronary revascularization. Sixty-six patients underwent ventricular aneurysmectomy between August 1973 and June 1978. Their classification according to the New York Heart Association criteria, their employment status (fully employed, working part time or totally disabled) and their salaries and disability payments for the 11-month periods before and after surgery were compared. There were five hospital deaths (7.6%) with a 40-month actuarial survival of 74%. Ninety-five percent percent of the survivors were class I or class II 20 months (average) postoperatively, full employment increased form 33% preoperatively to 63% postoperatively and total disability decreased from 60% preoperatively to 29% postoperatively. The efficacy of surgery in this group of patients in terms of financial implact on the community was analysed: the cost of surgery averaged $10,537.00 per patient. Computing the income actually earned by the entire group of patients, the disability payments to the individual patients and the lost tax revenues through disability shows that the cost of surgery for the whole group could be paid by 1.68 years of improved postoperative productivity.

Adult↗