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Biomedical subjects

H Rakowski

Publications and source records attributed to H Rakowski.

9 recordsLinked to original sources
PubMed1979

Two dimensional echocardiographic assessment of patients with bioprosthetic valves.

The clinical utility of two dimensional echocardiography in assessing bioprosthetic and left ventricular function was studied in 40 consecutive patients 1 week to 60 months after valve replacement surgery. These patients were referred to obtain normal baseline studies as well as to evaluate complications:suspected endocarditis, embolic phenomena and congestive heart failure of unknown cause. Independent M mode echocardiograms were also obtained in each patient. Confirmation of ultrasonic studies was by cardiac catheterization with angiography, surgery and pathologic study in 10 patients; cardiac catheterization with angiography alone in 7 patients; surgery and pathologic study in 3 patients; autopsy in 3 patients; blood cultures to confirm or exclude endocarditis in 10 patients; and confirmation on clinical grounds in 7 patients. Technically adequate two dimensional studies were recorded in 39 of 40 subjects. Two dimensional echocardiography accurately assessed 15 of 16 patients with an abnormal bioprosthetic valve and a normal left ventricle (1 of 16 patients had a false positive two dimensional echocardiogram); 8 of 8 patients suspected to have prosthetic valve or left ventricular dysfunction but who were normal; 7 of 7 patients with a normal prosthesis and an abnormal left ventricle; the one patient with an abnormal valve and left ventricle; and 7 of 7 clinically normal patients who were referred for baseline studies. In summary, the two-dimensional echocardiogram demonstrated a 97 percent diagnostic accuracy rate which was significantly greater than the 67 percent (P less than 0.001) for M mode echocardiography in the same group of patients. It is concluded that two dimensional echocardiography has excellent diagnostic accuracy in assessing bioprosthetic and left ventricular function and is superior to M mode echocardiography in evaluating patients after such valve replacement.

Adolescent↗
PubMed1979

Diagnosis of left ventricular thrombi by two-dimensional echocardiography.

Sixteen patients had two-dimensional echocardiographic diagnosis of the presence or absence of left ventricular thrombi and anatomical, radiological, or clinical confirmation of the diagnosis. Eleven patients had positive diagnoses, which were confirmed in 10 and possibly incorrect in one. Five other records were reviewed because the patients had undergone aneurysmectomy after two-dimensional echocardiograms: three were true negative and two were false negative studies.

Adult↗
PubMed1978

Localization of pericardial effusion with wide angle phased array echocardiography.

Twenty-eight patients with proved pericardial effusions were studied in the left lateral decubitus position with an 80 degrees phased array sector scanner to determine the distribution of pericardial effusions of various sizes. Twenty-one of 28 patients were studied 2 minutes after assuming the sitting position to determine the change in the distribution of the effusions with postural change. In small volume effusions, the fluid was truly posterior at and below the atrioventricular groove. With moderate-sized effusions a more uniform distribution of the fluid was found, and with large effusions more fluid was visualized apically, posteromedially, laterally and anteriorly. Upright redistribution of the fluid was seen with moderate to large nonloculated effusions. Assumption of a uniform distribution of pericardial effusion used for M mode quantification is most valid for moderate effusions and less valid for small and large effusions. Imaging was performed in two additional patients with cardiac tamponade to assess qualitative changes in short axis ventricular volumes with respiration. The introduction of a pericardiocentesis needle was visualized. Clinical implications are discussed.

Adolescent↗
PubMed1978

Single and two-dimensional echocardiographic visualization of the effects of septal myectomy in idiopathic hypertrophic subaortic stenosis.

Although the postoperative hemodynamic and echocardiographic features of idiopathic hypertrophic subaortic stenosis have been studied, the expected consistent postoperative thinning of the interventricular septum has not been reported. In this study, the short-term effects of septal myectomy were evaluated in 16 patients. All patients were assessed with pre- and postoperative hemodynamic studies and M-mode echocardiograms, and six of the 16 patients had pre- and postoperative two-dimensional echocardiograms. The mean resting preoperative gradient of 74 mm Hg (range 10--190 mm Hg), which fell to a mean resting postoperative gradient of 8 mm Hg (range 0--25 mm Hg), was associated with decreased end-diastolic interventricular septal thickness at the midventricular level in 14 of 16 patients and at the subaortic level in 16 of 16 patients by M-mode echocardiography. The group also demonstrated changes in left ventricular outflow tract configuration and dimension, mitral valve systolic anterior motion, mitral E-F0 slope and left ventricular percent fractional shortening by both M-mode and two-dimensional studies. In the two patients who did not show midventricular septal thinning on M-mode echocardiography, the two-dimensional echocardiograms revealed that the area of myectomy extended only through the subaortic region and not down to the midventricular septum. Thus, we have observed consistent postmyectomy septal thinning at both the midventricular and subaortic levels by M-mode echo. By defining the geometry of the septal myectomy in vivo with two-dimensional echocardiography, we can better interpret M-mode studies and identify factors that influence echocardiographic visualization of the region of myectomy.

Adolescent↗
PubMed1976

Mitral valve prolapse.

Mitral valve prolapse is a condition that is being recognized with increased frequency. It is not known whether its incidence is increasing, or whether we are better able to diagnose it today. In the idiopathic or familial variety, the mitral valve pathology is almost always that of myxomatous degeneration. Some authors have suggested the presence of a cardiomyopathy because of significant left ventricular dysfunction in many cases. Idiopathic prolapse occurs predominantly in females, often at a young age, and may be associated with chest pain, dyspnea, fatigue, presyncope, syncope, and/or sudden death. The clinical findings are variable and typically consist of a nonejection click and/or late systolic murmur, heard best at the cardiac apex. Diagnosis can be confirmed by echocardiography and/or ventricular cineangiography, the latter permitting accurate recognition of the anatomy of the prolapsed leaflets. The complications of infective endocarditis, severe mitral insufficiency, and life-threatening ventricular arrhythmias represent the major problems of management. It is important to distinguish the idiopathic form of mitral valve prolapse from that due to coronary artery disease and to realize that mitral valve prolapse may occur in Marfan's syndrome, Turner's syndrome, or in association with secundum atrial septal defect or ruptured chordae tendineae. Typical clicks and/or murmurs have also been described in patients with a history of rheumatic fever and in hypertrophic cardiomyopathy. Although much descriptive knowledge has accumulated over the past 15 years, many unanswered questions remain regarding the idiopathic type of prolapse. What is the nature and cause(s) of myxomatous degeneration? What is the relation of the valve pathology to the left ventricular dysfunction? What is the relation of both of these factors to disabling chest pain, electrocardiographic changes, and life-threatening arrhythmias? Hopefully, answers to these and other important questions regarding mitral valve prolapse will be forthcoming.

Electrocardiography↗