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Biomedical subjects

H F Tripp

Publications and source records attributed to H F Tripp.

At least 19 recordsLinked to original sources
PubMed2001

Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization.

The angiographic prevalence, clinical predictors, and sensitivity and specificity of a bilateral arm blood pressure differential for predicting proximal left subclavian artery stenosis were established in 492 patients undergoing cardiac catheterization. Seventeen subjects (3.5%) in the overall population and nine subjects (5.3%) with potential surgical coronary disease had proximal left subclavian stenosis. Precatheterization evidence of peripheral vascular disease (PVD) was the only predictor of subclavian stenosis in the overall population (P < 0.001; OR = 7.9; 95% CI = 2.6-24.3) and in patients with potential surgical coronary disease (P = 0.04; OR = 5.4; 95% CI = 1.1-27.2). Both a bilateral blood pressure differential of > 10 mm Hg and of > or =20 mm Hg had a good specificity but a poor sensitivity for predicting left subclavian stenosis. Thus, left subclavian angiography should be performed in patients with surgical coronary disease with either an arm blood pressure differential of > 10 mm Hg or with other precatheterization evidence of PVD. Cathet Cardiovasc Intervent 2001;54:8-11.

Aged↗
PubMed2000

Rhinolalia: an underappreciated sign of pneumomediastinum.

Thoracic surgeons are involved in the diagnosis and management of patients with mediastinal emphysema because of the potentially life-threatening conditions that either must be treated emergently or excluded. Although the classic findings of pneumomediastinum have been described for nearly 60 years, an underappreciated finding is the presence of rhinolalia. Case reports of this finding are sporadic and absent from the thoracic surgical literature. The presence of rhinolalia in association with spontaneous pneumomediastinum is highlighted in the following case presentation and prior reports are reviewed.

Adult↗
PubMed2000

Constrictive pericarditis after bypass leading to internal mammary graft failure.

Constrictive pericarditis is an infrequent consequence of cardiac operation. The etiology remains unknown, but the consequences include a restrictive process that leads to congestive failure and diminished cardiac output. In addition, the desmoplastic reaction, associated with fusion of the visceral and parietal pericardial layers, has been implicated in failure of saphenous vein grafts. We report a case of constrictive pericarditis, after coronary bypass operation, with occlusion of an internal mammary graft.

Humans↗
PubMed1999

The use of pulsatile perfusion during aortic valve replacement in pregnancy.

Cardiac operations are occasionally required during pregnancy. Despite a low maternal mortality, fetal mortality remains high. Previous reports have suggested maintenance of high perfusion pressure and flow rate as protective measures to maintain fetal viability. Recent experimental data suggest pulsatile perfusion may help preserve placental hemodynamic function. The successful use of pulsatile bypass to replace the aortic valve in a 25-year-old female at 14 weeks gestation, with both maternal and fetal survival, is presented.

Adult↗
PubMed1999

Unilateral iliac vein occlusion, caused by bladder enlargement, simulating deep venous thrombosis.

A variety of conditions cause unilateral leg swelling and thus mimic deep venous thrombosis (DVT). A heretofore-underappreciated condition that may lead to unilateral iliac vein compression, simulating DVT, is massive enlargement of the bladder caused by urinary retention. A case that demonstrates this condition is described. Although this disorder has been reported only three times before, its occurrence should be recognized by clinicians in light of the overall aging of our society. In addition, this case highlights the need for careful and thorough evaluation of patients who have unilateral lower-extremity edema.

Aged↗
PubMed1999

Pressure traps in femoro-popliteal reversed vein grafts. Are valves culprits?

BACKGROUND: Stenosis is a major cause of vein graft failure in peripheral arterial surgery. Our goal is to determine whether vein valves play a role in this process by creating a "pressure trap". METHODS: Seventeen patients with femoro-popliteal reversed saphenous vein grafts were studied intraoperatively. Flow and pressure in the grafts were measured, while the graft outflow was gradually occluded and released for 2-4 seconds. In 3 patients the graft flow was reduced by compressing calf muscles. RESULTS: Patients heart rates were 54-84 BPM, blood pressures 170/80-110/55 mm Hg, and normal graft flow was 40-180 ml/min. In 12 patients with competent vein valves, at reduced flow (<30 m/min) the valves opened and closed in each cardiac cycle. At each closure the pressure was "trapped" distal to the valve producing diastolic hypertension. Also the flow was stagnant for a considerable portion of the cardiac cycle. Maximum diastolic pressure gradient across the valve ranged from 35 to 60 mm Hg and the level of pressure trapped was inversely proportional to the graft flow. CONCLUSIONS: In patients in whom reversed vein grafts with competent valves are placed in the femoro-popliteal positions a "pressure-trap" develops in the distal segment. This segmental hypertension combined with the flow stagnation could play an important role in the graft thickening and stenosis.

Anastomosis, Surgical↗
PubMed1998

Phrenic nerve injury following cardiac surgery: a review.

Phrenic nerve injury following cardiac surgery is variable in its incidence depending on the diligence with which it is sought. Definitive studies have shown this complication to be related to cold-induced injury during myocardial protection strategies and possibly to mechanical injury during internal mammary artery harvesting. The consequences are also variable and depend to a large extent on the underlying condition of the patient, particularly with regard to pulmonary function. The response of the patient may range from an asymptomatic radiographic abnormality to severe pulmonary dysfunction requiring prolonged mechanical ventilation and other associated morbidities and even mortality. Two cases are presented to demonstrate the variability in clinical responses to diaphragmatic dysfunction secondary to phrenic nerve injury from cardiac surgery. In addition, treatment strategies are reviewed including early tracheostomy and diaphragmatic plication, which appear to be the most effective options for patients who are compromised by phrenic injuries.

Cardiac Surgical Procedures↗
PubMed1998

Current therapy of catamenial pneumothorax.

Catamenial pneumothorax, or monthly recurring pneumothorax associated with menstruation, has been reported with increasing frequency in recent years. A representative case illustrates the clinical syndrome, particularly the intraoperative findings. Characteristic of this disorder are a peak incidence in the late twenties or early thirties, recurrent right-sided pneumothoraces occurring at the onset of menstruation, and an association with pelvic endometriosis. Pathologically, there is a consistent pattern of intrathoracic, especially diaphragmatic, foci of ectopic endometrial tissue. There is also a strong association with diaphragmatic fenestrations, though their significance is controversial. Traditional therapy has involved treatment with estrogens, danazol, or thoracotomy with mechanical pleurodesis. These methods have proven, through a large meta-analysis, to be associated with a relatively high rate of recurrence. Subsequent advances in hormonal therapy, along with the development of minimal access surgery, have led to an evolution in management. Despite uncertainty as to the etiology of catamenial pneumothorax, diagnosis of the condition is straightforward and modern treatment is successful in preventing recurrence.

Adult↗
PubMed1998

Axillary artery aneurysms.

Aneurysms of the axillary artery are rare but potentially dangerous lesions that threaten the upper extremity with vascular and neurologic compromise. Most can be treated effectively with surgical excision and vascular grafting. An illustrative case is presented. These aneurysms may arise as pseudoaneurysms secondary to trauma or iatrogenic complications, or as degenerative lesions often secondary to the chronic use of crutches. They may also arise as postobstructive lesions in patients with thoracic outlet syndrome. Signs and symptoms vary with the cause of the aneurysm and may include mass effects with brachial plexus compression and thromboembolic events involving the hands and fingers. Arteriography is the mainstay of diagnosis, and treatment should be considered in most of these lesions as soon as they become apparent to prevent limb loss or dysfunction.

Aneurysm↗
PubMed1997

Transected thoracic aorta: age-specific differences in incidence and possible reasons.

The objective of this study was to determine the incidence of aortic transaction in relation to age, and to examine possible reasons for the observed differences. Data from the North Carolina Medical Database over a 7-year period were examined for the total number of motor vehicle accident victims and for the subset with aortic rupture, based on age at presentation. Data were then divided into 10-year intervals and the differences analyzed using chi-square analysis. Differences among various age groups were statistically significant (P = 0.0001). The highest rate was in the 21-30-year-old age group and average incidence for all ages was 0.7%. High incidence of aortic transaction in the 21-30-year-old group may be due to an increase in high-risk behaviors in such persons, to an improved survival compared with other age ranges, or to an inherent susceptibility of the aorta at this stage of life. These data have important implications for the diagnosis and treatment of aortic transaction and should be taken into account when developing practice guidelines for its management.

Accidents, Traffic↗
PubMed1997

Resection of a bronchogenic cyst involving the wall of the mainstem bronchus and repair utilizing a pedicled pericardial flap.

Symptomatic bronchogenic cysts should be completely resected because of uncertainties in diagnosis, to prevent recurrence, and to avoid late complications. Infrequently, these cysts may involve the proximal tracheobronchial tree. Often such cysts are incompletely excised with less than optimal results. A case of a patient with a bronchogenic cyst involving the wall of the right mainstem bronchus is presented. The cyst was completely excised and the bronchus repaired using a pedicled pericardial flap. The procedure may serve as the preferred method of reconstruction in such circumstances.

Adult↗
PubMed1996

Revascularization of the proximal circumflex coronary artery.

In complex coronary bypass procedures it is often desirable to target the left circumflex coronary distribution at a site other than the obtuse marginal and terminal branches. Reluctance to bypass into the circumflex artery in the atrioventricular groove is due to difficulty in exposure and possible injury to the coronary sinus. Herein is presented our technique for exposure and anastomosis into the proximal circumflex artery, which avoids these pitfalls. This technique has been consistently simple to perform with excellent results.

Coronary Vessels↗
PubMed1995

Aortic transection secondary to rodeo injury.

Aortic transection usually occurs in the course of automobile accidents. The authors present an unusual case of aortic transection in a 27-year-old male who was thrown from a bull during a rodeo competition. Surgical repair was successful. The mechanisms of sudden deceleration and blunt impact in the pathogenesis of aortic rupture are discussed. A high index of suspicion aids in the diagnosis of unusual or subtle cases. Plain chest films may suggest the diagnosis, but aortography is currently the gold standard for establishing the diagnosis. Surgical repair is mandatory, and the use of left atrial-to-femoral bypass may lower the incidence of complications such as paraplegia and renal failure. Newer issues in the diagnosis and management of aortic transection include the use of transesophageal echocardiography and the placement of endoluminal prostheses.

Adult↗
PubMed1987

Left ventricular dysfunction and dilatation resulting from chronic supraventricular tachycardia.

It has been suggested that patients with chronic supraventricular tachycardia may have impaired ventricular function, which returns to normal after surgical procedures that eliminate the tachycardia. The purpose of this study was to determine the functional consequences of prolonged supraventricular tachycardia in 12 awake dogs in which permanent asynchronous atrial pacemakers were implanted and programmed to a rate of 190 +/- 5 beats/min. Serial radionuclide angiograms were obtained immediately after pacemaker activation and at regular intervals over a 3 month period. Chronic tachycardia resulted in a significantly depressed ejection fraction (49% +/- 1% to 29% +/- 3%; p less than 0.0005) compensated for by a dramatic increase in left ventricular end-diastolic volume (69 +/- 4 to 105 +/- 9 ml, p less than 0.005). Stroke volume and cardiac output were not significantly changed. Five dogs were allowed to recover, and serial radionuclide angiograms were obtained for 12 weeks. Although ejection fraction returned to control values (50% versus 47%, p = no significant difference), end-diastolic volume remained persistently elevated after a 12 week recovery period in all animals (67 +/- 5 versus 91 +/- 6 ml, p less than 0.05). Thus prolonged tachycardia resulted in significant functional changes associated with cardiac enlargement, which were not immediately reversible.

Animals↗
PubMed1986

The effect of chemical ablation of the endocardium on ventricular fibrillation threshold.

The purpose of this study was to examine the effects of ablation of the superficial endocardium and Purkinje network on left ventricular fibrillation threshold. Lugol's solution was applied through small ventriculotomies to the left and right ventricular endocardium of 10 dogs on cardiopulmonary bypass. Two control groups of five animals each underwent either endocardial application of saline or epicardial application of Lugol's solution. Ventricular fibrillation threshold was measured before and after each intervention by the single-stimulus technique. Application of Lugol's solution to the endocardium resulted in a 102 +/- 15% increase in ventricular fibrillation threshold from a control value of 26 +/- 2 to 53 +/- 6 mA (p less than .005). In two animals, ventricular fibrillation could not be initiated postoperatively. In the control groups, there were no significant changes in ventricular fibrillation threshold. Histologic examination revealed that Lugol's solution obliterated less than 0.5 mm of superficial endocardium while sparing the adjacent myocardium. Electrophysiologic and rheologic data confirmed the discrete nature of the chemical injury. Thus ablation of the superficial ventricular endocardium with Lugol's solution results in a profound increase in the ventricular fibrillation threshold with only minimal tissue destruction.

Animals↗
PubMed1986

Effects of acute tachycardia on left ventricular adenine nucleotide levels and subsequent tolerance to ischemia.

Electrophysiologically guided surgical procedures for the ablation of supraventricular and ventricular dysrhythmias often require prolonged periods of tachycardia to complete intraoperative mapping studies. It is unknown whether tachycardia depletes the myocardium of high-energy compounds or alters subsequent tolerance to ischemia. In the present study, 12 anesthetized dogs were paced from the right ventricle at a cycle length of 250 msec for 60 minutes. In seven animals, drill biopsy specimens were taken from the left ventricular free wall for analysis of adenine nucleotide levels and their breakdown products before and after pacing and after 20 minutes of recovery from pacing. In the remaining five animals, the heart was made totally ischemic immediately after tachycardia and the time to the onset of ischemic contracture was determined and compared to that of five nonpaced control dogs. Acute tachycardia resulted in no significant reduction in adenine nucleotide levels compared to control values. Furthermore, in hearts rendered totally ischemic after tachycardia, the mean time to ischemic contracture was 65.6 +/- 1.3 minutes versus 63.6 +/- 2 minutes in nonpaced control animals (no significant difference). These data show that pacing-induced tachycardia in the normal heart does not decrease adenine nucleotide levels or affect subsequent tolerance to ischemia. These results may be clinically relevant to patients without coronary artery disease who undergo operative procedures necessitating prolonged periods of tachycardia for intraoperative mapping to identify the site of arrhythmogenesis.

Adenine Nucleotides↗