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Biomedical subjects

H Winer

Publications and source records attributed to H Winer.

6 recordsLinked to original sources
PubMed1993

Percutaneous left atrial to femoral arterial bypass pumping for circulatory support in high-risk coronary angioplasty.

Left atrial to femoral arterial bypass was evaluated as a means of supporting patients who were considered to be at high risk for the performance of percutaneous transluminal coronary angioplasty. A 20 French drainage catheter was inserted percutaneously into the left atrium via a modified transseptal technique. Blood was withdrawn from the left atrium and returned through a femoral arterial cannula using a roller pump. Thirteen patients were treated in this fashion with excellent circulatory support. Pump flows varied from 1.5 to 3 liters per minute and bypass time ranged from 27 to 106 min (mean = 43 +/- 17). Aortic mean pressure was well supported during balloon inflation. No significant complications were encountered. Neither an oxygenator nor a perfusionist is required. The ability to obtain direct left ventricular decompression offers a major potential advantage. Further evaluation of this technique for the support of such patients is indicated.

Aged↗
PubMed1984

Use of two-dimensional echocardiography during transseptal cardiac catheterization.

Inadvertent puncture of the intrapericardial aorta is a serious complication of transseptal catheterization. Two-dimensional echocardiography allows delineation and spatial resolution of the aorta and interatrial septum. Thirteen patients underwent transseptal catheterization with simultaneous monitoring of needle and catheter position using fluoroscopy and two-dimensional echocardiography. The interatrial septum was demonstrated in the short-axis and four chamber views, and clearly separated from the ascending aorta. The transseptal needle and catheter were visualized by echocardiography while the needle tip was manipulated into the fossa ovalis avoiding puncture of the aortic root. In some cases, under pressure from the needle tip just before puncture, the interatrial septum appears to bulge toward the left atrium. Saline solution contrast echocardiography helped to confirm the needle position in the right atrium, and in the left atrium after puncture. These data suggest that two-dimensional echocardiography is a useful adjunct to fluoroscopy during transseptal catheterization that may improve its safety and prevent complications.

Adult↗
PubMed1982

Spasm of a normal or minimally narrowed coronary artery in the presence of severe fixed stenoses of the remaining vessels: clinical and angiographic observations.

Four patients with medically refractory unstable angina are presented. Each patient had ST-segment abnormalities during some episode of pain. Three patients had at least one episode of documented ST-segment elevation with their spontaneously occurring chest pain. One had recurrent ventricular tachycardia. Two patients had prior myocardial infarction. Angiography demonstrated localized left ventricular akinesis and a severe fixed stenosis in the coronary artery supplying the abnormal segment. There were severe, fixed lesions in two coronary arteries in two patients and in one vessel in two patients. After i.v. ergonovine maleate, coronary artery spasm was documented in a normal or minimally diseased coronary artery in each patient. In two patients, ergonovine-induced spasm not only occluded the vessel, but also markedly decreased retrograde filling of a vessel with severe, fixed narrowing. Each patient's characteristic symptoms appeared with the ergonovine-induced spasm. Thus, ergonovine maleate can provoke spasm of a normal coronary artery, even in the presence of severe fixed stenoses of the remaining vessels. This observation may have an important role in the diagnosis and clinical management of patients with chest pain.

Adult↗
PubMedDate not supplied

Isolated diagonal artery disease.

The clinical, electrocardiographic, angiographic, and hemodynamic features of seven patients with isolated, severe (greater than 75% of diameter) narrowing of a diagonal branch of the left anterior descending artery are presented. The incidence of this entity was 0.5% among patients with arteriosclerotic heart disease undergoing coronary angiography. Angina was severe in two patients, moderate in four, and mild in one. One patient had unstable angina. Stress tests were abnormal in two of three patients. Six patients had normal left ventricular angiograms, and one had a mildly decreased ejection fraction. All patients survived a mean follow-up of 18 months (range 6 to 32). No patient suffered a myocardial infarction. Five became asymptomatic on medical therapy; one patient with mild and another with moderate angina were unimproved. This rare anatomic subset of patients with coronary artery disease has a favorable short-term prognosis.

Adult↗