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Biomedical subjects

R C Boerth

Publications and source records attributed to R C Boerth.

At least 55 records · Page 3Linked to original sources
PubMed1978

Comparative influence of ouabain, norepinephrine and heart rate on myocardial oxygen consumption and inotropic state in dogs.

The purpose of this study was to compare the myocardial oxygen cost of augmented inotropic state produced by ouabain, norepinephrine, or increased heart rate. This problem was examined in dogs using an isovolumically contracting left ventricular preparation. Inotropic state was measured as the maximum observed contractile element velocity at the lowest common level of wall stress (MAX V). Peak left ventricular wall stress was maintained constant in each dog so that it would not influence changes in myocardial oxygen consumption (MVO2). Ouabain (4 X 10(-2) mumoles/Kg.) and norepinephrine (2 X 10(-3) mumoles/Kg./minute) always augmented inotropic state (MAX V) and increased MVO2. The positive slopes of the regression of MVO2 on MAX V for ouabain (45.4 +/- 12.5 microliter/beat/100 Gm./muscle length/sec; mean +/- SEM) and norepinephrine (34.5 +/- 5.6 microliter/beat/100 Gm./muscle length/sec; mean +/- SEM) were not significantly different, indicating that for an equal augmentation of inotropic state, ouabain increases myocardial oxygen demands to the same extent as does norepinephrine. When the results with ouabain or norepinephrine were compared to results obtained by altering heart rate, it was found that increasing inotropic state by these pharmacologic agents is more costly in terms of myocardial energy demands than when inotropic state is enhanced by increasing heart rate.

Animals↗
PubMed1978

Dithiothreitol-induced alterations of blood pressure, vascular reactivity and aortic microsomal calcium uptake in spontaneously hypertensive rats.

Dithiothreitol, a potent sulfhydryl reducing agent, depressed systolic blood pressure to a greater extent in genetically hypertensive rats (SHR) than in normotensive Wistar-Kyoto rats (WKY). Dithiothreitol depressed the contractile response to norepinephrine and potassium chloride of isolated aortic strips from both SHR and WKY. Dithio-bis-2-nitrobenzoid acid, a sulfhydryl oxidizing agent, restored the responsiveness of rat aortic strips to these contractile agents. Microsomes isolated from rat aortae sequester calcium in the presence of ATP. This activity, generally referred to as calcium-pump activity, has been postulated to function in smooth muscle relaxation, and is significantly depressed in aortic microsomes of the SHR. Dithiothreitol (10 mM) greatly increased and dithio-bis-2-nitrobenzoic acid (100 micrometer) decreased the ATP-dependent calcium pump activity of microsomes isolated from both SHR and WKY aortae. These observations indicate that sulfhydryl groups may influence systems involved in vascular reactivity and blood pressure regulation.

Animals↗
PubMed1977

Right and left heart size and function in infants with symptomatic coarctation.

Right and left heart volumes, ejection fractions and ventricular outputs were determined from biplane cineangiocardiograms in infants with symptomatic coarctation of the aorta and correlated with clinical and hemodynamic alterations. Patients were divided into two age groups: group 1, aged 3.5 to 14 days and group 2, 5 weeks to 7 1/2 months. Infants in group 1 had severe depressions of left ventricular ejection fraction and output associated with normal left ventricular size. The massive cardiomegaly in these infants results from right heart enlargement secondary to left-to-right atrial shunting, and pulmonary hypertensive right heart failure, and possibly a more distensible right than left ventricle. Infants in group 2 also have right, and to a lesser degree, left heart enlargement. Group 2 patients differ from group 1 infants in having less impairment of left heart pump function and significant left ventricular myocardial hypertrophy. Echocardiographic measurements of left ventricular pump function are normal or increased in postoperative patients. Thus alterations of left ventricular function in infants with symptomatic coarctation appear to be largely afterload related and do not indicate permanent impairment of left ventricular contractile function.

Age Factors↗
PubMed1977

Dose-response relation of diazoxide in children with hypertension.

Diazoxide was administered to sixteen pediatric patients (ages 10 months to 13 years) with secondary forms of hypertension. Admission BP was 178+/-8/130+/-5 mm Hg (mean +/- SEM). Diazoxide was administered rapidly intravenously in doses ranging from 2 to 7.5 mg/kg. A significant (P less than 0.001), linear log dose-response relation was obtained which showed that a 3 mg/kg dose of diazoxide lowered diastolic BP by an average of 30 mm Hg. In five patients reduction of idastolic BP by a single injection of diazoxide was no different than when the same total dose was given as two or three small injections repeated at fifteen to twenty minute intervals. It is concluded that 1) many hypertensive children respons significantly to doses of diazoxide smaller than the usually recommended 5 mg/kg; 2) diazoxide has a significant dose-response relation in hypertensive pediatric patients; and 3) the desired blood pressure response in hypertensive children can be titrated using repeated small injections of diazoxide.

Adolescent↗
PubMed1976

Left heart volume characteristics following ventricular septal defect closure in infancy.

Left ventricular and left atrial volume, left ventricular ejection fraction, and left ventricular muscle mass were determined preoperatively and postoperatively in 13 patients who underwent surgical closure of ventricular septal defects in the first two years of life. Left ventricular end-diastolic volume and systolic output averaged 255 +/- 19% (+/- SEM) and 240 +/- 19% of normal, respectively, before operation but fell to within normal limits postoperatively. Left ventricular ejection fraction was normal preoperatively (100 +/- 4% of normal) and remained so after correction (106 +/- 3%, NS). Left ventricular mass was mildly elevated at the preoperative catheterization (271 +/- 21%) and decreased significantly following repair (P less than 0.001). However, the postoperative left atrial volume (147 +/- 14%) remained abnormal (P greater than 0.05). These data suggest that when early surgical closure of a ventricular septal defect is necessary because of failure of medical management, good results with regard to postoperative left ventricular size and function can be expected.

Cardiac Catheterization↗
PubMed1976

Right ventricular volume characteristics before and after palliative and reparative operation in tetralogy of Fallot.

Right heart volume data were obtained in 63 patients with tetralogy of Fallot. The patients were divided into three groups: 1) preoperative tetralogy (N=34); 2) post shunt procedure (N=14); 3A) post repair without outflow patch (N=10); 3B) post repair with an outflow patch (N=8). In Group 1 right ventricular end-diastolic volume (RVEDV), RV ejection fraction (EF), and RV systolic output (SO) were all mildly depressed. In post shunt patients, RVEDV was normal but RVEF remained depressed. RVEDV and RVSO increased following a shunt procedure, and these variables were larger in patients with a large versus a small shunt. In Group 3A RVEDV, RVEF, and RVSO were normal. In contrast in patients in Group 3B, RVEDV was increased averaging 177 +/- 15% of normal RVEF was depressed averaging 0.45 +/- 0.04, and RVSO was normal. RV size and pump function are abnormal in patients whose operation requires an outflow tract patch and the factors which may contribute to these abnormalities include a higher RV peak pressure, pulmonary incompetence, and a larger noncontractile outflow tract. Longitudinal studies relating these variables to clinical performance and exercise testing will be important in assessment of the importance of these abnormalities.

Blood Pressure↗
PubMed1976

Spontaneous resolution of massive congenital tricuspid insufficiency.

Four cases of congenital tricuspid insufficiency (CTI) are presented in whom spontaneous improvement occured. There was no evidence of Ebstein's disease in three of the four. All presented with similar clinical and laboratory findings including massive cardiomegaly, mild to moderate congestive heart failure, and moderate to severe desaturation. Catheterization data demonstrated severe TI and right-to-left atrial shunting. During the period of follow-up, up to 3.5 years, all symptoms have spontaneously disappeared. Clinical and angiocardiographic evidence for minimal residual TI have remained. Right atrial and right ventricular volume measurements were markedly abnormal initially and returned to normal or near normal. These measurements may be a useful method for quantitating the severity of tricuspid insufficiency. The course of the three infants with massive CTI (without Ebstein's disease) differs from previous reports and may be important both in formulating future management plans and in defining the etiology of the disorder.

Angiocardiography↗
PubMed1976

Right ventricular volume characteristics in ventricular septal defect.

Right and left ventricular volume characteristics were determined from biplane cineangiocardiography in 37 patients with isolated ventricular septal defects. Patients were divided into three categories as determined by the degree of left-to-right shunt: small shunt-less than 35% of pulmonary blood flow (N=9); moderate shunt-35-49% (N=8), and large shunt-greater than 50% (N=20). Right ventricular (RV) end-diastolic volume was increased above normal in 15 of 20 studies performed in patients with large left-to-right shunts and averaged 159 +/- 10% of normal (P less than 0.001). In contrast, only one of the patients in the small shunt group and only half of the patients in the moderate shunt group showed increases in RV end-diastolic volume. The increase in RV volume was proportional to the corresponding increase in left ventricular end-diastolic volume, with the right ventricle ranging from 48 to 116% of LV end-diastolic volume (average 83%). Right ventricular ejection fraction was normal in all patient groups. Right ventricular outpur was increased commensurate with the increases in the RV end-diastolic volume. These data indicate that substantial augmentation in RV end-diastolic volume does occur in patients with isolated ventricular septal defects and large left-to-right shunts. These data can be explained by the significant diastolic and "isovolumic" shunting from left ventricle to right ventricle which occurs in these patients.

Cardiac Output↗
PubMed1975

Right heart volume characteristics in transposition of the great arteries.

Right and left heart volume data were obtained during 44 cardiac catheterizations in 24 patients with complete transposition of the great arteries (TGA) prior to "corrective surgery." Patients were divided into three hemodynamic groups: I)TGA with intact ventricular septum, N = 23 studies in 13 patients, ages 1 day-22 months; II)TGA with ventricular septal defect (VSD), N = 12 studies in six patients, ages 7 days-15 months; III)TGA with VSD plus pulmonary stenosis, N = 9 studies in five patients, ages 5 days-5.6 years. In group I, right ventricular end-diastolic volume (RVEDV) averaged 170 plus or minus 52% of normal (P smaller than 0.001), RV ejection fraction (EF) was 0.48 plus or minus 0.09, 74% of normal (P smaller than 0.001), and RV systolic output (SO) was 123 plus or minus 34% (NS). In group II, RVEDV was 163 plus or minus 25% of normal (P smaller than 0.001), RVEF 0.59 plus or minus 0.08, 91% of normal (NS), and RVSO was 158 plus or minus 52% (P smaller than 0.02). In group III, RVEDV averaged 124 plus or minus 26% of normal (P smaller than 0.04), RVEF 0.58 plus or minus 0.15, 89% of normal (NS), and RVSO 125 plus or minus 57% (NS). Right atrial maximal volume was increased in 21 or 22 studies and averaged 185 plus or minus 47% of normal (P smaller than 0.001). RVEDV was greater than left ventricular end-diastolic volume in all but one patient in group I, but RVEDV/LVEDV was smaller than 1.00 in four VSD patients with very large pulmonary flows. A majority of patients with TGA without VSD have abnormal right heart function as indicated by an increased RVEDV and a low ejection fraction. Longitudinal studies of right ventricular performance in these patients continue to be important in assessment of current methods of therapy.

Angiocardiography↗
PubMed1975

Abnormalities of right ventricular function following Mustard's operation for transposition of the great arteries.

Postoperative data were obtained at cardiac catheterization in twelve patients studied 6-29 months following Mustard's operation for transposition of the great arteries (TGA) to assess the incidence and severity of abnormalities of right ventricular (RV) function. Age at operation was 5-13 months in seven patients (infant group) and 19-25 months in the remaining five patients. RV end-diastolic volume (EDV) decreased in all patients following surgery and averaged 123% of normal in the postoperative group (NS). RV ejection fraction (EF) was depressed postoperatively averaging 0.45 (69% of normal (P less than 0.001) as was RV systolic output (78% of normal, P less than 0.01). LVEDV averaged 65% of normal (P less than 0.001), LVEF 0.67 (103% of normal, NS), and LV systolic output 67% of normal (P less than 0.001) following operation. Left atrial (systemic venous) volume was decreased in all postoperative patients averaging only 39% of normal (P less than 0.001). A high incidence (greater than 50%) of partial baffle obstruction was found and LV systolic output showed a significant negative correlation with baffle gradients. The low output postoperatively may be related to decreased LV filling pressure, a small LV reservoir, and thus a small atrial "booster pump." Pressure-velocity indices of RV contractile function in four patients showed a poor correlation with pump function. Long-term follow-up will be required to determine the clinical significance of the abnormalities of venous return and ventricular function.

Cardiac Output↗