Cardiac valvular chondroma.
The case of a 36-year-old woman with a tricuspid valvular tumor is presented. The lesion was successfully resected through the right atrium. Histologic examination showed a chondroma arising in a cardiac valve.
Adult↗
Biomedical subjects
P Sundram
Publications and source records attributed to P Sundram.
Factors influencing immediate results, complications, and short-term follow-up status after Inoue balloon mitral valvotomy: a North American multicenter study.
Clinical trials with the Inoue mitral valvotomy balloon have recently begun in the United States. We assessed the effects of 17 demographic, echocardiographic, procedural, and hemodynamic variables on the immediate results, complications, and short-term follow-up of 200 patients in 15 centers undergoing valvotomy with this device. The study population had a mean age +/- SD of 53 +/- 15 years, and the total echocardiographic score was 7.2 +/- 2.4. Valvotomy was technically successful in 96.5% of procedures and increased the mean mitral valve area from 1.0 +/- 0.3 to 1.8 +/- 0.7 cm2 (p less than 0.001); 72% had an increase in valve area greater than or equal to 50%, and 67% had a final area greater than or equal to 1.5 cm2. Major procedural complications included cardiac tamponade during transseptal puncture (1.0%), systemic embolism (1.5%), and severe mitral regurgitation (2.4%); there were no procedural deaths and one hospital death. Multivariate analysis identified the absence of prior surgical commissurotomy and younger age as significant predictors of the gain in mitral valve area, but the correlation coefficients were low. Although the absence of subvalvular disease on echocardiograms was a predictor of a final valve area greater than or equal to 1.5 cm2, the total echocardiographic score did not correlate well with the immediate outcome (r = 0.01, p = NS). No variable was identified as predictive of restenosis, which occurred according to echocardiographic criteria in 14 of 66 (21%) patients evaluated 6 months after valvotomy. Good hemodynamic results with valvotomy were achieved in the majority of patients with low complication rates by many investigators with the use of the Inoue balloon device.(ABSTRACT TRUNCATED AT 250 WORDS)
Balloon Occlusion↗
Myocardial energetics and efficiency in patients with idiopathic cardiomyopathy: response to dobutamine and amrinone.
Nine consecutive patients having severe idiopathic dilated cardiomyopathy were studied for their response in ventricular function, coronary sinus blood flow and myocardial oxygen consumption, lactate extraction and efficiency following incremental doses of dobutamine, followed by the combination of dobutamine and the phosphodiesterase inhibitor amrinone. Results, presented as baseline and the response to the peak dose (15 micrograms/kg/min) of dobutamine and to the combination of dobutamine and amrinone (each at 15 micrograms/kg/min) (differences compared with baseline) were: wedge pressure decreased from 28 +/- 7 to 26 +/- 8 mm Hg (p = NS) and to 20 +/- 6 mm Hg (p less than 0.01); cardiac index rose from 1.47 +/- 0.44 L/min/m2 to 2.89 +/- 1.1 L/min/m2 (p less than 0.01) and to 3.64 +/- 1.05 L/min/m2 (p less than 0.001); myocardial oxygen consumption remained invariant (18 +/- 8, 17 +/- 5, and 19 +/- 5 ml/min) despite progressive increments in minute work from 2.96 +/- 1.1 to 6.98 +/- 3.9 kg - m/min (p less than 0.01) and to 9.38 +/- 4.3 kg - m/min (p less than 0.001); myocardial lactate extraction rose from 21 +/- 10% to 30 +/- 15% (p = NS) and to 35 +/- 10% with the addition of amrinone (p less than 0.01). No patient had net lactate efflux into the coronary sinus, and myocardial efficiency improved from 9.5 +/- 5% to 21.7 +/- 13.0% (p less than 0.01) and to 28.0 +/- 18.0% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Amrinone↗
Benefit of the perfusion catheter for emergency coronary artery grafting after failed percutaneous transluminal coronary angioplasty.
Of 2,102 consecutive patients who underwent percutaneous transluminal coronary angioplasty, 31 (1.5%) had emergency coronary bypass grafting for failed angioplasty. To determine the potential impact of different therapeutic strategies for controlling associated myocardial ischemia, 3 groups were analyzed. Group 1 comprised 11 patients (36%) in whom a "bailout" catheter was used to maintain anterograde coronary perfusion, group 2 included 16 patients (52%) in whom only intraaortic balloon counterpulsation was used and group 3 contained 4 patients (13%) in whom neither bailout catheter nor intraaortic balloon was used. Despite a longer average time to cardiopulmonary bypass, patients managed with the bailout catheter had a significantly lower incidence of Q-wave myocardial infarctions (9 vs 75%, p less than 0.05) compared with patients managed with intraaortic balloon counterpulsation alone. Those managed with the bailout catheter also had more consistent resolution of ST elevation and greater use of internal mammary artery grafts than patients supported by intraaortic balloon counterpulsation alone.
Aged↗
Myocardial energetics: experimental and clinical studies to address its determinants and aerobic limit.
The major determinants of myocardial oxygen consumption (MVO2) were examined in the isolated, servo-regulated, canine heart in which coronary perfusion pressure, heart rate, ventricular volume and pressure could be individually monitored and controlled. We found that the integral of systolic wall force and the time derivative of systolic force development were major determinants of MVO2, Net MVO2, seen in response to increments in contractility (dobutamine) and heart rate, were the result of the relative increments in each of these determinants. Additional studies were performed to assess the heart's metabolic reserve and aerobic limit (i.e., before the onset of lactate production). We found that with increments in left ventricular work, mediated by increments in filling volume, heart rate, and contractility (dobutamine), myocardial lactate production could be induced, but was dependent on the level of coronary perfusion pressure. When the aerobic limit of the myocardium was exceeded, its performance declined and pulsus alternans appeared. In patients with cardiomegaly and advanced heart failure given the phosphodiesterase inhibitors enoximone and piroximone we did not observe a rise in MVO2 or the appearance of lactate production in the majority of patients. When patients with documented idiopathic (dilated) cardiomyopathy and marked heart failure received hemodynamically significant doses of dobutamine alone or in combination with amrinone, there again was no evidence of lactate production or a rise in MVO2, while a marked improvement in ventricular function was noted. Thus, these agents served to improve the efficiency of the dilated failing heart. Hence we would conclude that in most cases, the dilated failing heart has an adequate metabolic reserve. It performance, and indeed its efficiency, can be improved with pharmacologic agents having positive inotropic properties without adversely altering myocardial energetics.
Aerobiosis↗