Biomedical subjects

J C Fulop

Publications and source records attributed to J C Fulop.

3 recordsLinked to original sources

PubMed1989

Aortic regurgitation: a common complication after surgery for hypertrophic obstructive cardiomyopathy.

Surgical ventriculomyectomy and ventriculomyotomy by the aortic approach are safe and effective methods of relieving symptoms and obstruction to left ventricular outflow in patients with hypertrophic obstructive cardiomyopathy. With the addition of Doppler ultrasound to the routine follow-up assessment of these patients an unexpectedly high occurrence of aortic regurgitation was found in the postoperative patients. Because aortic regurgitation has been reported to rarely accompany this condition, 67 patients with hypertrophic obstructive cardiomyopathy were studied clinically and with Doppler echocardiography for the presence and severity of aortic regurgitation. Severity of the regurgitation was quantitated by pulsed or color Doppler echocardiography according to the length and width of the regurgitant jet in at least two views. In 37 patients with hypertrophic obstructive cardiomyopathy who did not undergo surgery, aortic regurgitation was detected in only 1 (3%) by Doppler ultrasound and in none clinically. In 52 patients who did undergo surgery and were studied a mean of 7.8 years postoperatively, aortic regurgitation of trivial to moderate degree was common, being detected in 28 (54%) by Doppler ultrasound and in 6 (12%) clinically. In a subgroup of 22 patients who were studied preoperatively and again early postoperatively (mean 6 weeks), new aortic regurgitation was found in 8 (36%) and was graded as trivial in all. Aortic regurgitation is a common complication related to ventriculomyectomy and ventriculomyotomy in patients with hypertrophic obstructive cardiomyopathy. Although initially trivial, the regurgitation may progress in severity over time. The regurgitation has been well tolerated in all patients studied to date.

Aortic Valve↗

PubMed1987

Aortic valve replacement with a small prosthesis.

A small aortic prosthesis can be inserted in selected patients with excellent symptomatic improvement. A prospective evaluation was performed on 321 consecutive patients undergoing isolated aortic valve replacement between January 1982 and December 1984. Smaller prostheses (19 or 21 mm, predominantly pericardial valves, 132 patients) were inserted in older patients (p = .0001), women (p = .0001), smaller patients (body surface area: p = .0001), and patients with aortic stenosis (p = .0001). Twelve patients died in-hospital (3.7%) and 33 died during the follow-up period, producing an actuarial survival of 80% +/- 4% at 48 months. Survival was independently predicted by advancing age (p = .009), the preoperative NYHA functional class (p = .04) but not valve size (p = .28). Eighty-nine percent of patients were NYHA class I or II postoperatively compared with 22% preoperatively. Symptomatic recovery was similar for those with smaller size valves. Postoperative Doppler echocardiography in 57 patients revealed significant differences in aortic valve areas and gradients between the valve sizes. The 19 mm pericardial valves had the smallest areas (1.0 +/- 0.3 cm2) and the highest gradients (34 +/- 20 mm Hg). The aortic valve gradient was significantly related to cardiac output and valve size (p = .0001 by analysis of covariance). Linear regression analyses were used to estimate the aortic valve gradient during exercise (a 50% increase in cardiac output). The estimated exercise gradient was disturbingly high for the 19 mm valves (55 +/- 16 mm Hg), but the estimated exercise gradients for the 21, 23, and 25 mm valves were similar, all below 30 mm Hg. Aortic valve replacement with a small prosthesis resulted in excellent symptomatic improvement and acceptable resting valve gradients. However, a 19 mm prosthesis may produce prohibitive gradients during exercise, which may limit symptomatic recovery and should be avoided in active patients.

Actuarial Analysis↗

PubMed1986

Persistent ventricular adaptations in postoperative coarctation of the aorta.

To evaluate ventricular performance and myocardial contractility after surgical correction of congenital coarctation of the aorta, we studied 25 patients (16 men and 9 women, mean age 26.1 years [range 19 to 34]), an average of 10.6 years (range 2 to 25) after repair. Radionuclide ventriculography at rest and exercise and digitized, quantitative two-dimensional echocardiography were performed. Data from derived, high resolution time-activity curves by radionuclide ventriculography, combined with noninvasive hemodynamic/ventricular volume data, were compared with values in an age- and sex-matched normal population. Despite essentially identical baseline and exercise hemodynamics, postoperative coarctation subjects demonstrated enhanced ventricular contraction, as determined by the peak ejection rate at rest (-3.79 versus -3.20 stroke volume/s, p less than 0.01) and exercise (-3.00 versus -2.90 stroke volume/s, p = NS), and overall ejection fraction at rest (56.4 versus 48.0%, p less than 0.01) and exercise (70.8 versus 59.3%, p less than 0.01). An intrinsic activation-contraction delay was observed, as illustrated by a prolonged time to peak ejection rate at rest (27.7 versus 21.5% of the RR interval, p less than 0.01) and exercise (28.4 versus 21.2% of the RR interval, p less than 0.01), and total systolic time at rest (50.2 versus 43.4% of the RR interval, p less than 0.01) and exercise (56.8 versus 50.4% of the RR interval, p less than 0.01). Although left ventricular meridinal wall stress was statistically indistinguishable (62 versus 74 mm Hg/mm2, p = NS), intrinsic myocardial contractility, as assessed by the peak systolic pressure/volume ratio, was increased in the postoperative coarctation group (1.88 versus 2.87 mm Hg/ml, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗