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Biomedical subjects

P F Walter

Publications and source records attributed to P F Walter.

12 recordsLinked to original sources
PubMed1990

Treatment of ventricular tachycardia induced cardiogenic shock by percoronary chemical ablation.

Incessant ventricular arrhythmias pose an especially challenging therapeutic dilemma. We describe the successful treatment and follow-up of a patient with refractory ventricular tachycardia-induced cardiogenic shock with percoronary chemical ablation. After endocardial mapping was used to identify the "tachycardia-related" coronary artery, temporary termination of the arrhythmia with balloon occlusion and subselective intracoronary installation of iced saline as previously advocated was unsuccessful. This was probably due to a dual arterial blood supply to the arrhythmogenic focus. However, infusion of 2 cc ethanol (99%) permanently terminated the arrhythmia. Contrary to previous experience, ethanol-induced arrhythmia termination did not result in arterial occlusion, further supporting a direct toxic effect on the myocardium as its mode of action. Use of standard angioplasty balloon inflation prevents "backwash" of distally infused ethanol and more generalized cell death. The only complication of this procedure was temporary third-degree AV block, requiring permanent pacemaker implantation.

Angioplasty, Balloon, Coronary↗
PubMed1988

Operating room scheduling data base analysis for scheduling.

A methodology to determine and maintain the schedule times used in a computer-based OR Scheduling System is presented. State-of-the-art equations to be used for different scheduling situations are presented and discussed with the attendant data base reduction methodology to provide the scheduling parameters. An example is given of the data reduction methodology as well as suggestions for maintenance of the data base.

Hospital Information Systems↗
PubMed1987

Intermittent mitral regurgitation: an indicator of severe Beall valve dysfunction.

The Teflon disc of Beall valves is subject to extraordinary wear and tear. Clinical evidence of valvular dysfunction is critical in following patients who have implanted Beall valves. We describe 4 patients with the interesting auscultatory finding of intermittent mitral regurgitation. Each of these patients demonstrated severe wear of the Teflon disc with abnormal intermittent disc tilting noted at cardiac catheterization. Intermittent mitral regurgitation in patients with Beall valves in the mitral position heralds severe valvular dysfunction and should prompt urgent cardiac catheterization and valve replacement.

Adult↗
PubMed1985

Influence of left ventricular function on signal averaged late potentials in patients with coronary artery disease with and without ventricular tachycardia.

Left ventricular dysfunction has been suggested as a cause of late potentials on the signal averaged ECG of patients with coronary artery disease. We compared the averaged surface ECG with angiographic findings in 57 patients with coronary artery disease and left ventricular dysfunction. Sixteen patients had sustained ventricular tachycardia and 41 had no documented arrhythmia. These two patient groups were comparable with respect to age, mean ejection fraction, and wall motion score. Late potentials, defined as voltage less than 25 microV in the last 40 msec of the filtered QRS complex, were found in 10 of 16 patients with ventricular tachycardia and in 6 of 41 patients without arrhythmia (p less than 0.005). However, late potentials were independent of ejection fraction, wall motion score, or presence of dyskinesis in both groups. There was no correlation between the total filtered QRS duration and ejection fraction or wall motion score in either patient group. In patients with coronary artery disease, late potentials are associated with ventricular tachycardia but are independent of global or regional left ventricular function. This finding has important implications for studies of the prognostic value of late potentials following myocardial infarction.

Action Potentials↗
PubMed1979

Ligation of the superior vena cava for recurrent pulmonary emboli.

A patient with polycythemia vera developed chronic thrombosis of the superior vena cava and had life-threatening pulmonary emboli despite anticoagulation and chemotherapy for the blood dyscrasia. After angiographic evaluation, the superior vena cava was ligated cephalad to the azygous vein. There have been no further clinical embolic episodes nor adverse effects over a three-year period of observation.

Humans↗
PubMed1978

Carotid sinus hypersensitivity and syncope.

Hyperactivity of the carotid sinus reflex is common in older men. However, an unequivocal diagnosis of carotid sinus syncope is difficult to establish because the symptoms are nonspecific, and both hyperactivity of the carotid sinus reflex and syncope are common. Twenty-one men were evaluated for episodes of lightheadedness or syncope, or both, associated with a hypersensitive carotid sinus reflex. Seventeen patients had the cardioinhibitory type, two the vasodepressor type and two both the cardioinhibitory and vasodepressor types. Patients with the cardioinhibitory type benefited from the insertion of a permanent pacemaker if they had multiple episodes of syncope. A history of syncope associated with some event capable of stimulating the carotid sinus was also helpful in selecting patients for pacemaker treatment. The combination of the cardioinhibitory and vasodepressor types may be missed unless carotid sinus stimulation is repeated after the administration of atropine. The results of electrophysiologic studies in 17 patients with the cardioinhibitory type suggest that intrinsic sinus nodal dysfunction is not the major cause for asystole after carotid sinus stimulation.

Aged↗