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Biomedical subjects

O Topaz

Publications and source records attributed to O Topaz.

At least 73 records · Page 4Linked to original sources
PubMed1991

Complete left main coronary artery occlusion: angiographic evaluation of collateral vessel patterns and assessment of hemodynamic correlates.

An angiographic study of eight patients with total occlusion of the left main coronary artery identified six patients with chronic occlusion and two with acute complete occlusion. In each of six patients, there were two to six different intercoronary collateral pathways. Altogether, a total of 13 specific collateral channels were recognized. One patient had evidence of unique homocollaterals represented by enlarged vasa vasorum, which created a vascular cuff that surrounded a totally obstructed left main artery. The ventricular function and hemodynamic parameters in these patients not only depend on the collateral vessels but may also be affected by the severity of coronary artery disease in the artery that supplies collaterals.

Aged↗
PubMed1991

Absent left main coronary artery: angiographic findings in 83 patients with separate ostia of the left anterior descending and circumflex arteries at the left aortic sinus.

Among 20,332 adult patients who underwent consecutive cardiac catheterization and coronary arteriography, 83 (0.4%) were angiographically identified as having an absent left main coronary artery. The angiographic characteristics of this coronary anomaly include: (1) the presence of two well-separated coronary ostia at the left aortic sinus resulting in separate origin of the left anterior descending and circumflex arteries; (2) an increased incidence of left coronary dominance; (3) a higher (6%) than usual (0.5% to 1.5%) incidence of myocardial bridging; (4) lack of a high incidence of congenital heart anomalies; and (5) an incidence of atherosclerotic coronary artery disease similar to that of patients whose left main artery is intact. In 39% of the patients difficulties in selectively cannulating the separate ostium of the circumflex artery and adequately opacifying this vessel resulted in a need to change the diagnostic catheter size. Recognition of this coronary anomaly is needed to ensure accurate angiographic interpretation and is important for patients undergoing cardiac surgery to selectively perfuse these separate vessels during cardiopulmonary bypass.

Cardiac Catheterization↗
PubMed1991

Myocardial calcifications in neonates and infants: a unique tissue reaction.

The deposit of calcium salts into myocardial cells represents the process of dystrophic calcification. Once it causes alterations in cellular calcium hemostasis, it can initiate deleterious events leading to ischemic myocardial injury and cell death. Myocardial calcifications in infants are markedly different from those in adults; calcifications are significantly more frequent in cases of myocardial necrosis in the young, and can be demonstrated microscopically without removal of necrotic fibers and scar formation, which are the adult's usual stages of response to myocardial necrosis. Important functional and clinical implications in myocardial calcification, other than serving as a marker for necrosis, relate to accelerated myocardial calcification after cardiac surgery in infants.

Calcinosis↗
PubMed1990

Coronary angioplasty of anomalous coronary arteries: notes on technical aspects.

Five patients with significant atherosclerotic lesions of anomalous coronary arteries underwent coronary angioplasty of the anomalous vessel. Four patients had anomalous circumflex artery and 1 had an anomalous right coronary artery. Angiographic and clinical success was achieved in all 5 patients. To ensure adequate equipment selection special consideration should be given to angiographic characteristics of these vessels, such as the orifice configuration, exit angulation, the route the artery traverses and the location of the stenotic lesions. Major determinants for successful angioplasty in these patients are guiding catheter selection and advancement of the balloon catheter to the very proximal portion of the anomalous vessel to subsequently facilitate guide wire advancement. This data indicates that balloon angioplasty can be successfully utilized in patients with significant atherosclerotic disease of anomalous coronary arteries.

Aged↗
PubMed1989

Percutaneous transluminal coronary angioplasty using a combined "balloon-on-a-wire" system and exchange guidewire technique.

New balloon-on-a-wire dilation systems allow crossing of severely stenosed coronary arteries owing to their ultra-low profile. However, these systems do not allow for over-the-wire exchange to a larger balloon catheter or insertion of perfusion catheters, should the vessel close abruptly during dilation. Therefore, if the need for such catheters arises, the vessel must be left unprotected during attempts to recross the lesion. We describe a new technique using a combined balloon-on-a-wire system and an exchangeable guidewire, which permits the crossing and dilation of severely stenosed coronary arteries, while at the same time offering vessel protection and balloon catheter exchange.

Angioplasty, Balloon, Coronary↗
PubMed1989

Young adult survivors of sudden cardiac arrest: analysis of invasive evaluation of 22 subjects.

Twenty-two young adult (mean age 27.8 +/- 5.3 years) survivors of sudden cardiac arrest underwent invasive cardiac assessment. Initial evaluation by cardiac catheterization, coronary angiography, and hemodynamic studies identified two groups of young survivors. The first consisted of 13 (60%) subjects who had definable structural cardiac or lung disease accountable for a cardiac arrest event. Dilated cardiomyopathy dominated this group. Mitral valve prolapse, hypertrophic cardiomyopathy, left ventricular hypertrophy, anomalous origin of the right coronary artery, and tetralogy of Fallot were also encountered. The second group included nine subjects (40%) with normal cardiac structure and normal hemodynamic parameters. Electrophysiologic testing demonstrated in three of these patients the presence of Wolff-Parkinson-White syndrome. The electrophysiologic studies had a higher yield in reproduction of life-threatening arrhythmias among the subjects in the second group as opposed to the first group. The observation that 10 subjects (45%) from both groups had preceding symptoms varying from palpitations and chest pain to syncope and recurrent cardiac arrest events, is in contradiction to previous findings in the literature and raises a question of appropriate evaluation of young adults with cardiac symptoms.

Adult↗
PubMed1989

Acute ventricular septal rupture. Angiographic-morphologic features and clinical assessment.

Twenty patients with acute ventricular septal rupture underwent cardiac catheterization. Prior to catheterization, 17 patients were in Killip class 3-4. Mean cardiac index and cardiac output were 2.03 +/- 0.81 L/min/m2 and 3.55 +/- 1.33 L/min, respectively. Based on a recent pathologic description of septal rupture, we encountered by angiography and during surgery, two morphologic types of rupture: simple type which appears as a direct through-and-through communication between the ventricles, and complex type which presents hemorrhagic tracts in the septum with the opening into the ventricles at different levels. Considering the management of patients with septal rupture and the clinical outcome in our series, it is suggested that there is a need to minimize invasive angiographic procedures prior to early surgical correction of the ruptured septum.

Acute Disease↗
PubMed1988

The natural course of electrocardiographic stages of acute inferior myocardial infarction in regard to R/Q ratio group classification.

Forty-three patients with their first acute inferior wall myocardial infarction (IWMI) were divided into three groups according to the R/Q ratio in standard lead II. This was done to correlate these groups with the characteristic course of electrocardiographic stages. The R/Q ratio was measured on the ninth day of follow-up study, and the electrocardiographic stages were followed from the onset of the IWMI up until the ninth day. Patients with R/Q greater than 2 (group I) had a more rapid progression through the electrocardiographic stages, along with a better clinical course than patients with a lower R/Q ratio. Patients in group III, with R/Q less than 1, had a slower electrocardiographic stage progression, which correlates well with a more complicated clinical course. Group II was an intermediate group in both the electrocardiographic and clinical course. Rapid stage evolution in the first 12 hours of the IWMI was followed by a more rapid progression through stages during the rest of the follow-up period. It is suggested that the R/Q ratio in lead II can be used as a marker of the severity of IWMI, since it correlates well with the course of electrocardiographic stages. The greater the R/Q ratio, the more rapid the progression of electrocardiographic stages, and the better the clinical course. This may be an additional simple and inexpensive electrocardiographic tool for following the natural course of IWMI.

Adult↗
PubMed1988

Ventricular fibrillation complicating acute myocardial infarction. Two distinct clinical and electrocardiographic features.

Two distinct electrocardiographic patterns of ventricular fibrillation (VF) complicating acute myocardial infarction (AMI) were observed in 34 patients during the first 24 hours from initial symptoms. Type 1 (seven patients) was characterized by fast disorganized ventricular activity, small voltage, and no clear identifiable QRS complexes (fine VF). Type 2 (27 patients) was defined as multiform QRS configuration (greater than 300/min) with marked changes in the amplitude (polymorphous VF). Type 1 rhythm was seen mostly during the hyperacute ischemic phase, probably associated with total coronary vessel occlusion; type 2 was observed when Q waves were already present in the electrocardiogram.

Adult↗
PubMed1987

Ischemic ST segment depression in leads V2-V3 as the presenting electrocardiographic feature of posterolateral wall myocardial infarction.

In this study of 14 patients hospitalized with a first event of myocardial infarction, maximal ST segment depression in precordial leads V2 and V3 was the sole ECG finding during chest pain in the first 24 hours of evolving posterolateral infarction, based upon further two-dimensional echocardiographic examination and cardionuclear imaging. Other ECG findings compatible with posterolateral infarction such as the appearance of Q waves in leads V5 and V6, increased R/S ratio in leads V1 and V2, and a diminution of R wave amplitude in leads 1, aVL, V5, and V6 were relatively delayed manifestations in the majority of patients. The clinical course of all patients was benign. It therefore seems reasonable to conclude that ST segment depression in leads V2 and V3 in the absence of reciprocal ECG changes may represent the initial ECG finding of posterolateral infarction in the suitable clinical context of an acute coronary event.

Adult↗
PubMed1987

Natural course of electrocardiographic components and stages in the first twelve hours of acute myocardial infarction.

Time course evolution of R, Q, T and ST components of the electrocardiogram during the first 12 hours of an acute myocardial infarction was studied. A comparison between anterior-extensive and anteroseptal wall infarctions (anterior group), and inferior-extensive and inferior wall infarction (inferior group) showed appearance of significant Q waves within two hours in both groups. R wave loss was nearly a mirror image of Q wave development in both groups. T waves became negative and ST more isoelectric earlier in the inferior than in the anterior group. When combined variations of the four electrocardiographic components were analyzed, four stages of acute infarction were delineated. Stage I--tall R, no Q, ST elevation and positive T; Stage II--significant Q wave appearance; Stage III--negativity of T waves; and Stage IV--ST isoelectric. The inferior group reached stages III-IV within 12 hours; the anterior group remained mostly in stage II. An early appearance of Q waves correlated well with rapid progression to stages III-IV within 12 hours in both infarction groups.

Electrocardiography↗
PubMed1987

Traumatic internal jugular vein cannulation.

A 63-year-old man with acute myocardial infarction complicated by atrioventricular block underwent an insertion of a temporary electrode for cardiac pacing. The posterior approach for right internal jugular vein cannulation was used. A 15-gauge needle was inserted under the sternocleidomastoid muscle aiming at the suprasternal notch with a 30-degree posterior angle of entry. An hour later the patient started to hiccup. The hiccups were resistant to drug therapy and to cessation of pacing. A chest radiograph revealed elevation of the right diaphragm and hematoma on the right side of the trachea, possibly compressing the right phrenic nerve on its route beneath the sternocleidomastoid muscle and the internal jugular vein. Within seven days the hiccups gradually ceased. Our case shows the advantages and complications of internal jugular vein cannulation.

Catheterization↗
PubMed1986

Myocardial calcifications in infants with congenital heart disease.

A histopathologic study of six hearts from infants with congenital heart disease and myocardial calcification revealed that foci of calcification were surrounded by normal-appearing myocardial tissue, ischemic myocardial tissue, or both. Inflammatory process, necrotic tissue removal process, and scar formation were not identified in the majority of these subjects. Three congenital heart anomalies are newly reported as associated with myocardial calcifications. The results of this study give evidence that necrotic tissue in the myocardium of some infants tends to become calcified rather than be removed and scarred as occurs in the adult. It also confirms that prenatal cardiac disease and trauma such as surgery might account for the presence of myocardial calcification.

Calcinosis↗