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N J Fortuin

Publications and source records attributed to N J Fortuin.

At least 37 records · Page 2Linked to original sources
PubMed1981

Comparative analysis of noninvasive cardiac parameters in the detection and evaluation of adriamycin cardiotoxicity.

Serial electrocardiograms, phonocardiograms and echocardiograms were recorded in a prospective study of 45 closely-followed patients receiving chemotherapy with Adriamycin (doxorubicin hydrochloride, Adria Labs.). QRS voltage, systolic time intervals (STI), echocardiographic ejection fraction (EF) and rate of ventricular circumferential fiber shortening (Vcf) were compared as indicators of Adriamycin cardiotoxicity. Seven patients (16%) developed a decline in left ventricular function. Four of these seven patients (57%) developed symptoms and signs of congestive heart failure (CHF). The pre-ejection period/left ventricular ejection time (PEP/LVET) was earliest to change and was the least specific of the noninvasive parameters. The ejection fraction was the most specific parameter in predicting clinical cardiotoxicity. In every case of congestive heart failure, significant changes in ejection fraction, Vcf and PEP/LVET preceded the onset of symptoms, suggesting that measurement of the ejection fraction and systolic time intervals will allow early prediction and avoidance of heart failure. A fall in the ejection fraction of greater than or equal to 10% may represent sufficient grounds for discontinuing Adriamycin.

Adult↗
PubMed1979

Current management of atrial myxoma with emphasis on a new diagnostic technique.

Sixteen patients aged 22-64 years have undergone removal of atrial myxoma at the Johns Hopkins Hospital. The first two patients had myxomas removed by closed surgical approach, and both died. Fourteen consecutive patients have undergone operation with the aid of cardiopulmonary bypass, and all survived. There has been one late death unrelated to myxoma. Current surgical approach is excision of the tumor and its stalk or base and resection of the portion of intra-atrial septum to ensure complete removal. Recently a new diagnostic technique of two-dimensional phased array real time echocardiography has been used in four patients, including a pregnant woman, to confirm the clinical diagnosis of atrial myxoma. This technique provides a two-dimensional view of both atria and ventricles in cross section or sagittal view. This noninvasive method is painless, is independent of cardiac function and carries no risk or radiation hazard. The two-dimensional echocardiogram is superior to the standard one-dimensional or M-mode echocardiogram for diagnosis of myxoma in that it can evaluate simultaneously both right and left atria, can detect smaller space-occupying lesions because of better resolution and can more readily determine the size of the lesion and its stalk, can evaluate the mobility of the tumor and can determine more accurately the extent of tumor obstruction. Because of these qualities, we have relied on two-dimensional echocardiography as the definitive diagnostic procedure for detection of atrial myxoma. Currently operation for atrial myxoma is performed without cardiac catheterization or angiocardiography.

Adult↗
PubMed1979

Assessment of severity of mitral stenosis by echocardiographic leaflet separation.

Mitral valve area (MVA) determined at cardiac catheterization was compared with M mode echocardiographic measurements in 44 patients with mitral stenosis and no substantial mitral regurgitation. Despite statistically significant correlations, measurements of anterior leaflet motion, including rate of diastolic closure (EF slope) were not useful in predicting severity of stenosis. In contrast, maximal diastolic separation of anterior and posterior leaflets (SEP) was more closely correlated with MVA and appears to have some predictive value. Narrow separation was associated with severe mitral stenosis. Wide separation was associated with relatively mild stenosis. Intermediate values in 16 of 44 patients (36%) were not of predictive value. Recognizing this limitation, measurement of maximal diastolic mitral leaflet separation from M mode echocardiograms is proposed as a simple and useful method for assessing severity of mitral stenosis.

Adult↗