Biomedical subjects

J Gorcsan

Publications and source records attributed to J Gorcsan.

59 records · Page 4Linked to original sources

PubMedDate not supplied

A double-blind trial of glycopyrrolate for transesophageal echocardiography.

Glycopyrrolate is an anticholinergic agent used to dry oral secretions and has been advocated for routine use with transesophageal echocardiography (TEE). To evaluate the safety and efficacy of glycopyrrolate for this unique application, a prospective double-blind placebo-controlled study of glycopyrrolate was performed in 61 patients who were awake while undergoing TEE. Thirty patients were randomized to the standard dose of glycopyrrolate (0.2 mg intravenously), and 31 patients received 1 ml of saline solution as placebo. Intravenous midazolam was used for sedation in all but one patient. Heart rate, electrocardiogram, blood pressure, and oxygen saturation were continuously monitored before, during, and after TEE. The patients scored their comfort immediately after TEE and were interviewed at 24 hours for side effects. The operator scored the ease of performing the TEE. No complications occurred in either group. Changes in vital signs and oxygen saturation were similar in both groups. The operator ease and patient comfort was similar in both groups. A significantly higher incidence of the following side effects was observed at 24 hours in patients who received glycopyrrolate versus those who received placebo: sore throat, 63% versus 19%; dry mouth, 43% versus 6%; and urinary retention, 16% versus 0% (p < 0.05 for all). No benefit from glycopyrrolate was noted in operator ease or patient comfort. In conclusion, glycopyrrolate is not recommended for routine use when performing TEE on patients who are awake.

Adult↗

PubMedDate not supplied

Estimation of left ventricular function in patients with a left ventricular assist device.

Patients with profound left ventricular (LV) dysfunction supported by a left ventricular assist device (LVAD) may have recovery of LV function, but current methods for assessing this are difficult or not readily available. A new method to estimate LV performance was tested in 6 patients on LVAD (age, 47 +/- 12 years). Simultaneous measures of LV cross-sectional area (substitute for volume) using transesophageal echocardiographic automated border detection and femoral arterial pressure (substitute for LV ejection pressure) were recorded during brief periods on and off LVAD. During the LVAD off period, femoral arterial pressure and LV area signals were combined on-line to generate arterial pressure-LV area loops. The slope of the linear regression line connecting the end systolic points generated during LV filling after LVAD off was used as an estimate of end systolic elastance denoted by Ees. The average Ees was 3.8 +/- 3.1 mmHg/cm2. These values are significantly lower than those of 13 control patients (22.3 +/- 15.4 mmHg/cm2). This method of estimating Ees may be clinically useful in assessing LV recovery in patients on LVAD after extended support.

Adult↗

PubMedDate not supplied

Echocardiographic profile of the transplanted human heart in clinically well recipients.

Thirty-four clinically well heart transplant recipients, aged 21 to 60 years, were selected for echocardiographic study at 12 +/- 2 months after transplantation. All had normal findings at stress thallium scintigraphy and at radionuclide left ventriculography, and no endomyocardial biopsy evidence of rejection was found within 36 hours of study. Multiple echocardiographic measurements were compared with those from two control groups. The first control group consisted of 15 normal subjects of similar ages as the donors, and the second group consisted of 15 normal subjects of similar ages as the recipients. Left ventricular mass (193 +/- 55 gm) was significantly increased in the transplant recipients compared with both control groups (p less than 0.001). Left ventricular volumes and ejection fractions of the transplanted heart, however, were normal. Right ventricular diastolic wall thickness (0.6 +/- 0.1 cm) and chamber area in both diastole (23.3 +/- 3 cm2) and systole (15.7 +/- 4 cm2) were significantly increased in the transplant patients (p less than 0.001), but fractional area change was similar to that of the normal group. Both left atrial area (26.9 +/- 4 cm2) and right atrial area (20.7 +/- 4 cm2) were significantly increased in the transplant recipients (p less than 0.001). One year after transplantation, clinically well recipients are characterized by increased left ventricular mass, but normal volumes and ejection fraction, increased right ventricular wall thickness and cavity size, but normal right ventricular systolic function, and markedly dilated atria.

Atrial Function↗

PubMedDate not supplied

Transesophageal echocardiography. Application to the postoperative cardiac surgery patient.

Surgical outcome after an open heart procedure can be appraised using traditional diagnostic tests. Transesophageal echocardiography (TEE) is gaining popularity as a technique for evaluating cardiac function after open heart surgery. Expert assessment skills on the part of the nurse at the bedside will impact on the successful completion of this semi-invasive diagnostic procedure.

Cardiac Surgical Procedures↗

PubMedDate not supplied

Assessment of the response of right ventricular performance to decreasing levels of mechanical assistance by on-line pressure area relationships.

The rapid assessment of the response of right ventricular (RV) performance to decreasing levels of mechanical assistance may be an important adjunct in determining if a patient can tolerate the removal of such a device. This report describes the use of on-line pressure area relationships to assess RV function in a patient supported with an RV assist device (RVAD). Mid RV short axis cross-sectional area was measured on-line by transesophageal echocardiography with an automated endocardial border detection feature. RV pressure was measured with a high fidelity catheter. Pressure and area were plotted simultaneously on a computer workstation interfaced with the pressure and echo systems to yield on-line pressure area loops. The following indices of RV performance were calculated while RVAD flow was decreased in 1 L/min increments: stroke work' (SW' = integral of PdA)[mmHg*cm2], stroke area (SA = Maximum Area-Minimum Area)[cm2], and fractional area change (FAC = SA/Maximum Area*100)[%]. SW', SA, and FAC significantly increased with decreasing RVAD flow: SW'(from 32 to 61 mmHg*cm2), SA (from 2.58 to 4.37 cm2), and FAC (from 20 to 32%). In conclusion, the increase in these parameters of RV performance with decreasing mechanical assistance suggested that this patient would tolerate removal of the RVAD, which was subsequently successful. This method of on-line pressure area relationships may be useful to predict the need for further mechanical assistance.

Analog-Digital Conversion↗