PubMed Health⌕ Search

Biomedical subjects

J R Pluth

Publications and source records attributed to J R Pluth.

At least 73 records · Page 4Linked to original sources
PubMed1982

Replacement of the ascending aorta and aortic valve with a composite graft in patients with nondisplaced coronary ostia.

Composite graft replacement of the ascending aorta and aortic valve is indicated for a variety of conditions affecting the aortic root. In most cases, cephalad displacement of the coronary ostia permits direct reimplantation of the ostia into the composite graft. Occasionally, anatomical factors exist that preclude the safe advancement of the ostia to the graft for direct anastomosis. A method for dealing with this problem utilizing a short interposed polytetrafluoroethylene graft between coronary ostia and composite graft is presented.

Aorta↗
PubMed1982

Left ventricular performance before and after aortocoronary artery bypass surgery.

Left ventricular performance was studied before and late (mean 12-17 months) after aortocoronary artery bypass surgery by quantitative, computer-based videoangiography. We measured total function (left ventricular ejection fraction, volumes and end-diastolic pressure) at rest (in 60 patients) and before and after exercise (abnormal exercise hemodynamics preoperatively in 32 patients) and regional function (peak rate of systolic wall thickening) at rest (in 60 patients) and before and after administration of nitroglycerin (in 19 patients). Total left ventricular function at rest is usually unchanged postoperatively. Exercise hemodynamics are more sensitive indexes of performance and, if abnormal, usually improve postoperatively if revascularization has been complete and extensive myocardial infarction has not occurred. Regional myocardial function usually improves postoperatively if the bypass graft to the region is patent and has a blood flow of more than 60 ml/min (measured late postoperatively by videodensitometry) and if no previous infarction was present in the region. Myocardial infarction and graft blood flow of 40 ml/min or less are the two main factors that prevent improvement in abnormal regions defined by the regional wall thickening method when bypass grafts are patent. Regions supplied by occluded grafts show decreases in regional function. The preoperative wall-thickening response to administration of nitroglycerin can be used to distinguish ischemia and significant myocardial infarction and to predict the successful response to aortocoronary bypass graft surgery.

Blood Pressure↗
PubMed1982

Delayed rupture of the left ventricle after mitral valve replacement: report of two survivors.

Two patients, a man and a woman, with rupture of the left ventricular wall after mitral valve replacement are described. The postoperative course of the woman was complicated by respiratory and renal insufficiency from which she recovered; however, she developed fungal endocarditis and died. Both patients are reported as survivors of "delayed" rupture to show that such patients are occasionally salvageable, and to suggest that bypass grafting to the circumflex system distal to the site of injury will benefit immediate and long-term survival.

Journal Article↗
PubMed1982

Results of surgical treatment of ascending aortic dissections occurring late after cardiac operation.

Seven patients (one woman) have been seen with ascending aortic dissections at a mean of 8.8 years (6 months to 20 years) after cardiac operation. Previous cardiac operations included saphenous vein coronary artery bypass grafts (CAB) (two), aortic valve replacement (AVR) (one), aortic valvulotomy (one), AVR plus CAB (two), and patch closure of a ventricular septal defect and repair of a perforated aortic cusp (one). During the initial operation, three of seven patients had dilatation of the ascending aorta. Five of seven patients were hypertensive at the time of diagnosis of dissection. Six patients were managed by operation. A composite prosthetic aortic valve and ascending aortic graft with implantation of coronary ostia and saphenous vein grafts was utilized in three patients. In three the repair was by graft replacement of the ascending aorta alone. Five of six patients survived repair and were asymptomatic at discharge. Subsequent problems resulting from distal, descending thoracic, or abdominal aortic extension of the dissection were frequent and necessitated fenestration (one patient) or a graft replacement of the infrarenal aorta (one patient). We conclude that patients may be predisposed to aortic dissection occurring late after cardiac operation, possibly related to prior aortic valvular disease or systemic arterial hypertension. Operative repair is feasible and relatively safe. Follow-up for potential complications of distal aortic problems seems indicated. Techniques of operative repair in these patients are emphasized.

Adult↗
PubMed1982

Recurrence and rupture of an axillary artery aneurysm.

Aneurysm of the axillary is an uncommon type of peripheral artery aneurysm. most of these aneurysms are symptomatic and present with signs and symptoms of thromboembolism. Rupture of an axillary artery aneurysm is uncommon. We present a patient who ruptured a recurrent true axillary artery aneurysm four years after surgical treatment by exclusion and bypass of the aneurysm. We believe that the preferred treatment of an axillary artery aneurysm is resection and insertion of an end-to-end interposition graft.

Aged↗
PubMed1982

Systemic thromboembolism in mitral and aortic Starr-Edwards prostheses: a 10-19 year follow-up.

Our study comprised 302 consecutive patients seen between 1962 and 1971 who underwent mitral (MVR) (132 patients) or aortic valve replacement (AVR) (170 patients) with a Starr-Edwards prosthesis because of advanced mitral or aortic incompetence. The follow-up interval was 10-19 years. For more recent valve models (1200/1260 aortic or 6120/6310 mitral), the probability of a surviving patient remaining free of systemic thromboembolism after 10 years was 70% for MVR and 74% for AVR. The probability of freedom from thromboembolism was less than this for the earlier valve models; the probability for the entire group at 10 years was 66% and at 15 years was 58%, with no significant difference between AVR and MVR. About one-fourth of the patients with an embolism (20% MVR, 27% AVR) had more than one embolic event. Of all emboli, most (86% MVR, 84% AVR) were cerebral, about half (48% MVR, 57% AVR) left a neurologic deficit, and about one-tenth (11% MVR, 10% AVR) led to death. Of the predictive factors reviewed, the incidence of emboli was significantly higher only in patients with MVR considered to have inadequate anticoagulation (p less than 0.01) and in patients receiving model 6000 mitral prosthesis (p less than 0.02). This long-term follow-up study of patients with a Starr-Edwards prosthesis reveals that systemic embolism is a persistent and significant problem.

Adolescent↗
PubMed1982

Cardiovascular effects of protamine sulfate in man.

Systemic hypotension is commonly observed in association with the administration of protamine after cardiopulmonary bypass. Previous studies have not conclusively demonstrated whether protamine induces its effect by altering myocardial performance or by changing systemic vascular resistance (SVR) or both. To elucidate the hemodynamic effects of protamine sulfate administration (150 mg/m2 body surface area), we studied 22 patients following cardiopulmonary bypass. In Group I (N = 8) protamine was infused over 30 seconds and while in Group II (N = 8), over 60 seconds. Group III (N = 6) received calcium chloride (20 mg/kg) prior to protamine administration. The hemodynamic response was assessed by continuous recording of myocardial contractile element velocity (maximal value-Vpm), aortic blood flow, systemic and pulmonary arterial and right atrial pressures, and electrocardiogram. A significant (p less than 0.05) decrease in the systolic, diastolic and mean blood pressure was observed in all groups. A significant increase in cardiac index and a significant decrease in SVR was observed in all groups. A small depression in Vpm was detected in those patients who experienced a mean blood pressure fall greater than 10 mm Hh. Heart rate and left ventricular end-diastolic pressure (LVEDP) did not change significantly. The response to protamine sulfate among the three groups was similar. These results demonstrate that protamine-induced hypotension is primarily the result of peripheral vasodilatation only partically compensated by an increase in cardiac index. In some patients, these changes were associated with a small decline in myocardial contractile state. Hemodynamic changes were transient (less that 3 to 4 minutes), unrelated to the rate of administration, and not prevented by preinjection of calcium chloride.

Blood Pressure↗
PubMed1981

Permanent pacemaker infections: characterization and management.

From January 1974 to June 1980, a total of 46 patients were treated for infections involving permanent pacing systems. Demographic characteristics, types of infecting organisms, specific clinical features, significance of an infected foreign body and various medical and surgical treatment methods are described. Likely infecting organisms depend on the mode of presentation and the time course of the infection. Optimal treatment for the large majority of patients requires removal of the entire infected pacing system. In a subgroup of patients, a short course of antibiotic therapy followed by one stage surgery involving implantation of a new pacing system and concurrent explanation of the infected pacemaker was used safely with excellent results.

Adult↗
PubMed1981

Decannulation from the tenuous aorta.

Arterial decannulation from a diseased aorta at high pressure can be hazardous. A technique increasing the safety of this maneuver is described.

Aortic Diseases↗
PubMed1981

Extrinsic obstruction of the Björk-Shiley valve in the mitral position.

Four recently seen patients with acute, extrinsic obstruction of a Björk-Shiley prosthesis in the mitral position are described. In 2 of them, the disc occluder was stuck in the closed position by a strand of chordal tissue, which was compressed between the disc edge and valve rim. In another patient, sticking of the disc by a similar mechanism was caused by a suture that migrated into the valve orifice. Intermittent malfunction of the valve in the fourth patient was related to interference with valve opening by ventricular myocardium and occurred when the patient lay on his right side. The mechanism of extrinsic obstruction of the Björk-Shiley valve and their recognition, treatment, and prevention are discussed.

Aged↗
PubMed1981

Cardiac papillary fibroelastomas. Two-dimensional echocardiographic recognition.

Papillary fibroelastomas are benign tumors of the heart and are most often incidental findings at cardiac surgery or autopsy. Rarely, symptoms or even sudden death can occur. We report two cases of cardiac papillary tumors diagnosed by two-dimensional echocardiography and successfully excised. One patient was asymptomatic and had a 1-by 1-cm papilloma of the mitral valve. The other patient had intermittent chest pains and diaphoresis associated with a 1.5- by 1-cm aortic valve papilloma.

Adult↗
PubMed1981

Infected epicardial pacemaker systems. Partial versus total removal.

Nine patients with infected epicardial pacemakers are described. All of the patients had infection localized to the generator pocket. Staphylococcus epidermidis, the most common organism isolated, was found in seven (77.8%). Conservative nonsurgical treatment was initially attempted in five patients. This failed in all and necessitated subsequent operation. At the time of the initial operation, lead transection and partial removal of the system was performed in seven patients. In four of them (57%), persistent infection necessitated further operation and complete extraction to eradicate the infection. In contrast, in all six patients (100%) in whom total removal was achieved (two at the time of initial operation and four at the time of subsequent operation), there was successful resolution of the infection. Therefore, complete extraction of the entire pacing system should be carried out, whenever possible, to achieve the greatest likelihood of eradicating the infection.

Aged↗
PubMed1981

False aneurysm of the left coronary artery.

The case of a 65-year-old white man with a large false aneurysm of the left coronary artery resulting from spontaneous rupture of the circumflex coronary artery is described. An abnormal chest roentgenogram resulted in initial evaluation, and a coronary aneurysm was then suspected on the basis of two-dimensional echocardiography. Cardiac catheterization demonstrated a large, saccular false aneurysm arising from the left coronary artery and diffuse aneurysmal disease of the right coronary artery. The patient underwent surgical resection of the aneurysm and saphenous vein aorta-coronary bypass grafting but failed to survive the postoperative period. Pathological examination documented histologic proof of a false aneurysm. The optimal treatment for coronary artery aneurysms is unknown but must be based on symptomatic associated arteriosclerotic heart disease and the risks of complications related to the aneurysm, including the risk of rupture with formation of a false aneurysm as documented in this case.

Aneurysm↗
PubMed1980

Use of the cardiac-catheterization laboratory in a defined population.

We evaluated trends in the use of the cardiac-catheterization laboratory from 1973 through 1977 in a well-circumscribed population in southeastern Minnesota. A total of 346 patients (248 male and 98 female patients) underwent coronary arteriography, left ventriculography, or cardiac catheterization, and there were 369 visits to the catheterization laboratory. The total number of catheterization-laboratory visits per 10,000 population increased from 4.3 in 1973 to 11.5 in 1977. According to individual category, the rates for coronary arteriography increased more than fourfold during the five-year period, whereas the rates for cardiac catheterization period, whereas the rates for cardiac catheterization showed no substantial change. On the basis of the 1977 rate for all visits to the catheterization laboratory and under conditions similar to those in this community, a population of approximately 230,000 would be required to ensure use of a catheterization laboratory at the suggested minimum level of 300 adult examinations per year.

Angiography↗
PubMed1980

The role of echocardiography in the selection of mitral valve prosthesis.

Assessment of the left ventricular outflow tract was made echographically in 70 patients who subsequently received a mitral prosthesis. Group A (44 patients) had normal left ventricular outflow tract width (greater than 20 mm.); 13 received the Starr-Edwards prosthesis and nine received the Braunwald-Cutter prosthesis. There were two patients with low cardiac output syndrome and no hospital deaths. Group B (26 patients) had a narrow left ventricular outflow tract (less than 20 mm.). Thirteen patients received the Starr-Edwards prosthesis. One patient had low cardiac output syndrome, and there were no hospital deaths. We conclude that the use of the ball-and-cage prosthesis in the mitral position in patients with a narrowed left ventricular outflow tract (less than 20 mm.) measured echographically is not associated with an increased surgical risk.

Adult↗