Biomedical subjects

H E Saner

Publications and source records attributed to H E Saner.

9 recordsLinked to original sources

PubMed1995

Isolated right atrial tamponade after open heart surgery: role of echocardiography in diagnosis and management.

Ten patients with isolated right atrial tamponade complicating open heart surgery were identified over a 3.5-year period at three institutions. Clinical manifestations varied but were typically those of decreased perfusion with elevated central venous pressure. Hemodynamically these patients had systemic hypotension and tachycardia with elevated central venous pressure but without elevation of pulmonary artery or pulmonary artery wedge pressures. The correct diagnosis in each case was established by echocardiography; 7 via the transthoracic and 3 via the transesophageal approach. The typical echocardiographic feature was an extrinsic extracardiac mass compressing the atrium. Doppler findings included high flow velocities through the right atria, and color flow demonstrated narrow color jets through compressed, slit-like right atria. Surgical exploration confirmed these findings in each case. We conclude that the combination of clinical awareness and appropriate hemodynamic evaluation can alert the physician to the possibility of isolated right atrial hematoma causing decreased perfusion and/or shock following open heart surgery. Echocardiography using either the transthoracic or transesophageal approach can establish the diagnosis and lead to timely surgical intervention.

Aged↗

PubMed1989

Increased peripheral vasoconstrictor reaction upon local cold in patients with coronary heart disease.

A local cold exposure test of the nailfold capillaries produces a typical flow stop reaction in 88% of patients with Raynaud's phenomenon. We applied this test to 12 patients with variant angina and compared the results with the findings in 2 control groups of 12 patients each, matched for age and sex: One group with chronic stable angina and one without heart disease. We found a flow stop with cold exposure in 9/12 patients with variant angina (mean duration 24 s), in 6/12 patients with chronic angina (mean 11 s), and in 1/12 normal controls without heart disease (mean 1 s). The frequency and duration of the flow stop was significantly higher in patients with variant angina (p = 0.002) and in patients with chronic stable angina (p = 0.02) than in normal controls. Patients with variant angina also tended to have an increased frequency and longer duration of the flow stop than those with chronic stable angina (p = 0.09). Administration of sorbidilate preparations and nifedipine resulted in a decrease of the mean flow stop duration from 23.5 to 10.8 s in patients with variant angina (p = 0.03). The strong association of a vasoconstrictive reaction in finger microcirculation and coronaries in patients with variant angina suggests a vasospastic tendency with manifestation in different vascular regions.

Adult↗

PubMed1988

Relation between serum digoxin concentration and the electrocardiogram.

The relation between serum digoxin concentration and the electrocardiogram was assessed by correlating computerized measurements of electrocardiographic parameters (PR, QRS, QT and QTc intervals, ST segment, and T-wave amplitude) with the serum digoxin concentration in 97 patients on digoxin maintenance therapy and in 40 nondigitalized control subjects. None of the patients had unstable ischemic heart disease, electrolyte disorders, medication known to influence the ST segment, and/or the presence of a bundle-branch block or ventricular hypertrophy. We found a trend toward lengthened PR interval and shortened QT and QTc intervals in digitalized versus nondigitalized patients. Increasing serum digoxin concentrations were associated with progressive depression of the ST segment and decreased T-wave amplitude (p less than 0.001). A normal ST segment in four leads (I, aVF, V5, V6) excluded the presence of a serum digoxin concentration greater than 1.3 ng/ml in our patients, whereas severe ST-segment depression with a J point of greater than or equal to 100 microV was a strong indicator for the presence of a serum digoxin concentration greater than 2.0 ng/ml in our selected patient population (specificity 99%, sensitivity 30%, predictive accuracy 85%). We conclude that computerized electrocardiographic analysis of the ST segment may provide clinically useful information for the management of selected patients on digitalis therapy and may therefore increase the diagnostic yield of the electrocardiogram in predicting the presence of higher serum digoxin concentrations in a small but significant percentage of patients.

Adult↗

PubMed1987

Two-dimensional echocardiographic identification of complicated aortic root endocarditis: implications for surgery.

Two-dimensional echocardiography successfully displayed the location and extent of aortic root complications, annular abscess or mycotic aneurysm in nine patients with aortic valve endocarditis. Five of the nine patients had prosthetic valve endocarditis and four had native valve endocarditis. The infective process extended into the paravalvular structures, including the interventricular septum (seven patients), right ventricular outflow tract (three patients), interatrial septum (one patient) and anterior mitral valve leaflet (four patients). The amount of aorto-left ventricular discontinuity caused by these complications was quantitated in degrees of annular circumference on the parasternal short axis image and in distance on the parasternal long axis image. The echocardiographic findings were confirmed at surgery and were helpful in the preoperative anticipation of the type of surgical procedure required: aortic valve replacement or composite aortic valve and root replacement. Five patients had prosthetic valve endocarditis with calculated aorto-left ventricular discontinuity of 173 +/- 55 degrees on parasternal short axis images and 1.36 +/- 0.72 cm on parasternal long axis images. Initial surgical repair included three composite aortic root-valve prosthesis implants, one reconstructive procedure with valve replacement and one simple aortic valve replacement. During a follow-up period of 18 months (range 1 to 35), a second reparative procedure was required for only one patient to repair an aortic conduit to coronary artery venous bypass graft. Four patients had native valve endocarditis with calculated aorto-left ventricular discontinuity of 100 +/- 17 degrees on parasternal short axis images and 0.88 +/- 63 cm on parasternal long axis images. Initial surgical repair included two reconstructive procedures with valve replacement and two simple aortic valve replacements. During a follow-up period of 30 months (range 16 to 42), three of these four patients required a second reparative procedure: one each for repair of a paraprosthetic leak, a ventricular septal defect and persistent aorto-left ventricular discontinuity. Two-dimensional echocardiography accurately detected aortic annular abscess and mycotic aneurysm complicating aortic valve endocarditis and the resultant degree of aorto-left ventricular discontinuity. Circumferential aorto-left ventricular discontinuity with these complications is greater for prosthetic than native valve endocarditis and predicts a more extensive surgical repair.(ABSTRACT TRUNCATED AT 400 WORDS)

Abscess↗

PubMed1987

Aortic dissection presenting as pericarditis.

In five patients with aortic dissection, signs and/or symptoms of pericarditis were part of the early manifestations of the aortic disease. Signs of inflammatory pericarditis were noted clinically in four patients and were found at autopsy in one. In the three nonoperated patients who died of aortic rupture leading to fatal hemopericardium, symptoms of pericarditis preceded fatal rupture of the aorta by four to five days. A fourth patient died after surgical repair of aortic dissection 35 days after the onset of pericarditis. In the fifth patient, manifestations of chronic constrictive pericardial disease occurred over a period of seven months after which old aortic dissection was first identified. In each case, the internal tear of classic aortic dissection was located in the ascending aorta. Microscopic evidence of cystic medial necrosis of the aorta was present in each case. In each of two cases, there was a congenital bicuspid aortic valve. The phenomenon observed represents acute aortic dissection in which slow penetration of blood into the pericardial space caused inflammatory pericarditis. The interval between the onset of pericarditis and rupture of the aorta may allow sufficient time for appropriate diagnosis and potentially lifesaving treatment of the aortic disease.

Adult↗

PubMed1986

Two-dimensional echocardiographic identification of left ventricular pseudoaneurysm.

Nine patients with proved left ventricular pseudoaneurysm after transmural myocardial infarction were studied by two-dimensional echocardiography. In all patients two-dimensional echocardiography successfully displayed the pseudoaneurysm. The unique two-dimensional echocardiographic characteristics of pseudoaneurysm include: a sharp discontinuity of the endocardial image at the site of the pseudoaneurysm communication with the left ventricular cavity, and the presence of a relatively narrow orifice in comparison with the maximum diameter of the pseudoaneurysm fundus; visualization of the maximum diameter of the pseudoaneurysm fundus frequently required a slightly different tomographic view than that required for demonstration of the orifice. The distinctive echocardiographic features of pseudoaneurysm in these patients and technical implications for optimal visualization are described. Most of the pseudoaneurysms we encountered and many of those previously described were located posteriorly. We found the use of inferior angulated view modified from the standard apical four-chamber view extremely helpful in detecting the orifice in patients with posterior or posterolateral pseudoaneurysms. We conclude that two-dimensional echocardiography is an important technique for diagnosis of left ventricular pseudoaneurysm.

Aged↗

PubMed1985

The disease-free wall in coronary atherosclerosis: its relation to degree of obstruction.

Coronary atherosclerotic lesions are more often located eccentrically (70%) than concentrically (30%). In this study, the configuration of eccentric coronary artery atherosclerotic lesions was assessed by means of computerized planimetry in 100 specimens of eccentric arterial lesions. Special attention was given to the relation between the disease-free wall and the severity of obstruction. The mean disease-free wall are length measured between 17 and 23% of the total vessel circumference in eccentric coronary artery lesions that obstructed 50 to 90% of the cross-sectional area. This ratio persisted irrespective of the location of the lesion within the vessel and was not significantly different with vessels of different sizes. The presence of disease-free arcs of coronary artery wall as observed in this pathologic study may relate to three factors in clinical coronary artery disease: The published observations of spasm in segments of arteries harboring structural obstructive lesions may be explained by the frequent presence of uninvolved arcs of coronary artery walls. Multiple views during coronary arteriography are necessary to accurately reflect the degree of obstruction. The results of percutaneous transluminal coronary angioplasty may be influenced by both the disease-free arc and the atheromatous obstruction.

Angioplasty, Balloon↗

PubMed1984

Two-dimensional echocardiographic detection of right-sided cardiac intracavitary thromboembolus with pulmonary embolism.

Five patients with pulmonary embolism, in whom right-sided intracardiac thromboembolus was detected by echocardiography and confirmed by either angiography, surgery or postmortem examination, are described. One of these patients died from massive pulmonary embolism after right heart catheterization. In two patients treated medically, either partial or total lysis of the thromboembolus was demonstrated echocardiographically; in another two patients, the right atrial thromboembolus was successfully removed surgically. Typical locations and echocardiographic characteristics of right-sided thromboemboli are described. The potential usefulness of two-dimensional echocardiography in both the diagnosis and the management of patients with right-sided intracardiac thromboembolism is discussed.

Adolescent↗

PubMed1984

Origin of anterior descending coronary artery from right aortic sinus. Intramyocardial tunneling to left side of heart.

We report a rare case of a coronary anomaly. All of the coronary arteries originated from a single ostium located in the right coronary cusp. The single coronary artery had a main branch corresponding to the usually dominant right coronary artery. The left anterior descending coronary artery arose from the right coronary artery and coursed intramyocardially within the right ventricular outflow tract to the anterior interventricular sulcus. The absence of evidence of myocardial ischemia in our patient, both clinically and at autopsy, and in three cases reported previously, suggests that the condition reported here was an unlikely cause of myocardial ischemia.

Coronary Vessel Anomalies↗