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Biomedical subjects

M Sesto

Publications and source records attributed to M Sesto.

15 recordsLinked to original sources
PubMed1979

Failure of aneurysmectomy to improve left ventricular function.

Biplane left ventricular angiography was performed in 22 patients with isolated obstructive disease of the anterior descending branch of the left coronary artery and with an anterior aneurysm following transmural myocardial infarction. Six patients were restudied between 6 and 10 months after aneurysmectomy. Left ventricular reserve was estimated by analysis of a spontaneous postextrasystolic beat. Using angiographic techniques a contractile section, a transitional section, and a noncontractile section were identified. From the surgical patients the excised aneurysm and a transmural needle biopsy of the transitional section were investigated by light microscopy. With increasing volumes of noncontractile and transitional sections, total end-diastolic volume (r = 0.81, P less than 0.001) and end-systolic volume (r = 0.94, P less than 0.001) increased linearly, while the ejection fraction decreased (r = 0.70, P less than 0.001). No relation was found between the combined volumes of the noncontractile and transitional sections on the one hand, and the end-diastolic volume, the end-systolic volume, or the ejection fraction of the contractile section on the other hand. After aneurysmectomy a significant decrease was found in end-diastolic volume (194 to 133 ml/m2, P less than 0.001) and end-systolic volume (124 to 83 ml/m2, P less than 0.001) but no change occurred in ejection fraction (35 to 37%) and left ventricular end-diastolic pressure (23 to 25 mmHg). Surgical resection included part of the transitional section, which before surgery had an average ejection fraction of 27 per cent during a normal beat, rising to 41 per cent in a postextrasystolic beat. The transitional section after surgery now formed a large akinetic area of the anterior wall. We conclude that aneurysmectomy in isolated left anterior descending artery disease with anterior aneurysm fails to improve left ventricular function because the effect of reduction of left ventricular volumes is offset by the destruction of contractile behaviour in the transitional section.

Adult↗
PubMed1979

Impaired left ventricular function in chronic aortic valve disease: survival and function after replacement by Björk-Shiley prosthesis.

Postoperative survival and left ventricular function were studied in 128 patients who underwent isolated aortic valve replacement by the Björk-Shiley valve between 1973 and 1977. The average follow-up was 2.1 years. Patients with associated coronary artery disease or mitral valve disease were excluded. Preoperative ejection fraction ranged from 15-84%. Forty-two patients were restudied by cardiac catheterization 9.1 +/- 1.1 months (mean +/- SEM) after valve replacement. The hospital mortality was 11%. Preoperative type of valve lesion, functional class, cardiothoracic ratio, and ejection fraction (EF) had no significant effect on postoperative survival up to 4 years. After operation, left ventricular mass (LVMI) and peak systolic wall stress (PSWS) fell significantly, while EF and mean normalized systolic ejection rate (MNSER) increased in aortic stenosis and in aortic insufficiency. Neither in aortic stenosis nor in aortic insufficiency was there a significant relation between preoperative ejection fraction and postoperative LVMI, EF, MNSER and PSWS. We attributed this to a marked improvement of left ventricular function in patients with preoperative impaired ventricular function. Six patients with paravalvular leak to restudy has a significantly lower EF and MNSER, and a higher PSWS than patients without leak. Patients without leak had normal EF, MNSER and PSWS when compared with 10 normal persons, but LVMI remained moderately elevated. Postoperative transprosthetic gradient was 11.9 mm Hg (range 0-64 mm Hg). We conclude that impaired cardiac function is completely restored after aortic valve replacement by Björk-Shiley valve, if valve function is good. Patients with impaired cardiac function preoperatively did not have a poorer prognosis after operation than patients with normal function.

Adolescent↗
PubMed1978

[Abolition of pacing induced akinesia after aorto-coronary bypass grafting in patients with stable angina (author's transl)].

Hemodynamic studies were performed in 6 normal individuals, 8 patients with severe obstruction (more than 85% stenosis) of the left anterior descending coronary artery (LAD), 10 patients with patent LAD grafts and 4 patients with stenosed or occluded LAD grafts. All patients were suffering from stable angina before operation. Monoplane ventriculograms and left ventricular pressure determinations were carried out at rest and immediately after ventricular pacing (170/min.). Anterior wall motion was determined from half-diameter shortening and ejection fraction was calculated using the area-length method. Heart rate and left ventricular systolic pressure were comparable in all 4 groups at rest and after pacing. Normal individuals and patients with patent grafts to the LAD showed no significant change of anterior wall motion, ejection fraction and left ventricular enddiastolic pressure after pacing as compared to rest. Patients with LAD stenosis showed a significant decrease of anterior wall motion, of ejection fraction and an increase of left ventricular end-diastolic pressure. Patients with graft failure revealed a drastic though not significant decrease of anterior wall motion. Decrease of ejection fraction and increase of left ventricular end-diastolic pressure were significant. Thus, in patients with stable angina and severe coronary stenosis regional and total left ventricular function may well be maintained at rest but become severely impaired after pacing. Successful revascularization abolishes this ischemic response.

Angina Pectoris↗
PubMed1978

Recovery from myocardial failure after aortic valve replacement.

Left ventricular hypertrophy and function were studied in 27 consecutive patients with chronic aortic valve disease before and 6.4 +/- 2.2 (S.D.) months after aortic valve replacement with Björk-Shiley prostheses. Four patients were excluded because of postoperative paravalvular regurgitation. Five patients had aortic stenosis (AS), seven patients AS plus insufficiency (AS-AI), and 11 patients aortic insufficiency (AI). Left ventricular muscle mass (LVMI), ejection fraction (EF), mean circumferential fiber shortening rate (VCF), mean normalized systolic ejection rate (MNSER), and peak systolic wall stress (PSWS) were determined angiographically. LVMI fell significantly after corrective surgery, whereas EF, VCF, and MNSER increased. PSWS decreased after the operation. Comparison of stress ventriculograms before and after surgery in six patients with predominant AS (isoproterenol infusion, 0.3 microgram per kilogram of body weight per minute) showed an increase of EF, VCF, and MNSER and a decrease of PSWS. We conclude that hypertrophy in chronic aortic valve disease regresses after aortic valve replacement, and thereby depressed cardiac function and reserve recover.

Adult↗
PubMed1978

[Vagal tone in symptomatic sinus node dysfunction (author's transl)].

Under investigation in this study were the role of vagal tone in symptomatic sinus node dysfunction and the relationship between hypersensitive carotid sinus reflex (HCSR) and sick sinus syndrome (SSS). In 168 symptomatic patients (pts) resting heart rate (HR), maximal corrected sinus node recovery time (CSRTmax) and maximal carotid sinus pressure results (CSPmax) were determined before and after Atropine, 1 mg i.v. (A). According to test results, 103 pts had HCSR (1), 33 had HCSR + SSS (II), 30 pts had isolated SSS (III) and 20 pts with normal test results served as controls (IV). Mean age was the same in groups I--IV (p greater than 0.05). Groups I--III had a HR less than or equal to 60 bpm, rising 31% after A in groups I--IV, but absolute values were below those in group IV. In groups I--III CSP normalized after A and CSRT remained unchanged (p greater than 0.05). We conclude that increased vagal tone plays but one role in groups I--III and the combination HCSR + SSS seems rather frequent. Specific testing clearly separated HCSR from SSS.

Adult↗
PubMed1978

[The significance of electrophysiologic findings and clinical course in symptomatic sinus node dysfunction (author's transl)].

Under investigation in this study were the relationship between hypersensitive carotid sinus reflex (HCSR) and sick sinus snydrome (SSS), the significance of clinical symptomatology versus electrophysiologic test results and the natural course of both syndromes. In 186 symptomatic patients (pts) resting heart rate, maximal corrected sinus node recovery time (CSRTmax) and maximal carotid sinus pressure results (CSPmax) were determined. According to test results, 103 pts had HCSR (I), 33 had HCSR + SSS (II), 30 pts had SSS (III), and 20 pts with normal test results served as controls (IV). Mean age was the same in groups I--IV (p greater than 0.05). Groups I--III had a heart rate less than or equal to 60 bpm. There was no correlation between patients test data and the occurrence of syncopes in each of groups I--III (p greater than 0.05). In 16 pts with SSS, test results remained unchanged 16 months later (p greater than 0.05). More pts (31%) in group II died in a shorter period of time after pacer application (1.4 +/- 1 year) than pts with AV III degrees block (25%, 1.8 +/- 1.6 years) after pacer application. We conclude that the combination HCSR + SSS seems rather frequent. Specific testing separated HCSR from SSS, but failed to predict syncopes and thereby cannot aid in the indication for pacer application. The 16 months prognosis of SSS proved unfavorable. Mortality after pacer application in HCSR + SSS seems less favorable than in AV III degrees block (p less than 0.05), but depends largely on the severity of associated diseases.

Adult↗
PubMed1977

Effects of nitroglycerin, postextrasystolic potentiation, and pacing-induced ischaemia on wall motion in patients with ischaemic heart disease.

The influence of nitroglycerin, postextrasystolic potentiation, and rapid ventricular pacing on total and regional ventricular function was studied in 32 patients with normal ventricular function and in 44 patients with left ventricular asynergy caused by obstructive coronary artery disease. Total ventricular function was assessed by ventriculography and regional ventricular function was analysed by use of 7 hemiaxes. Nitroglycerin increased ejection fraction and decreased left ventricular systolic and end-diastolic pressures in the normally functioning ventricles; apical wall motion increased, while basal wall motion remained unchanged after nitroglycerin in these ventricles. Pressures fell significantly in ventricles with asynergy after nitroglycerin; ejection fraction decreased while wall motion in asynergic areas was inconsistently influenced. Postextrasystolic potentiation augmented ejection fraction by a powerful and homogeneous increase of wall motion in normally functioning ventricles. Asynergic areas and normal areas in diseased ventricles showed identical augmentation of wall motion after a premature beat. Rapid venticular pacing produced a significant increase in end-diastolic pressure and a fall in ejection fraction in patients with obstructive coronary artery disease. Wall motion in normal areas perfused by arteries with critical stenoses was dramatically depressed after pacing, while asynergic areas and normal areas perfused by normal arteries remained unchanged. The results show that normal contractile behaviour can be detected by postextrasystolic potentiation in asynergic areas, suggesting that some normally perfused muscle exists in these areas. Pacing stress does not further deteriorate function in asynergic areas, which suggests the presence of viable and well perfused muscle (within scar tissue) whose function may not profit from revascularization. Pacing-induced asynergy identifies the functional significance of coronary stenoses and suggests that bypass surgery might be beneficial.

Cardiac Volume↗