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Biomedical subjects

R E Matisonn

Publications and source records attributed to R E Matisonn.

15 recordsLinked to original sources
PubMed1981

Penetrating thoracic trauma producing cardiac shunts.

The English literature contains 101 reported cases of cardiac fistula following penetrating thoracic trauma. We describe an additional 10 cases seen during a 7 year period. Six patients had ventricular septal defects, another a ventricular septal defect together with a ventriculo-atrial defect, two patients had aorta--right ventricular fistulous and the final patient, a right coronary artery--right atrial fistula. This series demonstrates several interesting features. First, the mode of clinical presentation in four of the 10 patients was remarkable, because despite severe cardiac injury they initially had neither symptoms nor signs of cardiac decompensation. Second, only two of the seven patients hospitalized immediately after the injury presented with cardiac murmurs suggestive of cardiac fistula formation, whereas the remaining five exhibited cardiac murmurs 1 to 21 days after initial cardiovascular examination. Third, concomitant traumatic valvular lesions occurred frequently (five of 10 cases) but usually were not clinically detectable because of the similarity and dominance of the fistulous murmur. Fourth, it was confirmed that the type of cardiac fistula occurring most commonly following penetrating cardiac trauma was a ventricular septal defect and that conservative management of small ventricular septal defects is compatible with a prolonged asymptomatic course. Finally, attention is drawn to the frequent association of aortic incompetence with aorta--right heart fistulas and the tendency for these fistulas to produce congestive cardiac failure.

Adolescent↗
PubMed1978

Prostaglandin E1 in infants with pulmonary atresia.

Infants with pulmonary atresia are frequently dependent upon the patency of the ductus arteriosus for adequate pulmonary blood flow. Endogenous production of a dilator prostaglandin probably maintains patency of the ductus in utero. Infusion of prostaglandin E1 (PGE1) 0,1 microgram/kg/min was used in 6 infants with pulmonary atresia to increase pulmonary blood flow and systemic oxygenation. The infusion improved the clinical condition of the infants and diminished the degree of central cyanosis. In 3 cases serial measurement of systemic arterial oxygen tension showed a sustained increase. There were no deleterious side-effects. During cardiac catheterization and preparation for operation, PGE1 provides a valuable means of maintaining pulmonary blood flow in infants with pulmonary atresia and a ductus arteriosus.

Ductus Arteriosus, Patent↗
PubMed1978

Myocardial infarction in the black population of South Africa: coronary arteriographic findings.

Thirteen Black patients who had classic electrocardiographic evidence of myocardial infarction supported by changes in serum enzymes were investigated by coronary arteriography. Ten of these had occlusive atherosclerosis and in none of these did the associated risk factors such as hypertension or diabetes appear to be operative, and most were manual laborers. Their mean serum cholesterol measurement was found to be 222 mg. per cent, a value which is found in 25 per cent of the urban Black population. In the remaining three patients, the coronary arteries were found to be angiographically normal and two of these were associated with the billowing mitral leaflet syndrome; it is postulated that their myocardial infarction was a result of coronary spasm, or a consequence of fibrin emboli emanating from the redundant mitral leaflets. Based on statistics from our major referring hospital, it is estimated that the prevalence rate from myocardial infarction among general admissions to a medical ward is less than 0.05 per cent, a figure lower than previously reported by clinico-electrocardiographic studies. It would appear that the prevalence of this disease has not increased over the last two decades and the immunity of the Black population is unexplained.

Adult↗
PubMed1978

Non-invasive observations on initial low frequency vibrations of the first heart sound--correlation with the 'presystolic' murmur in mitral stenosis.

The initial low frequency component of the first heart sound, 'M', has been studied in normal subjects, and in patients with vario-s prosthetic mitral valves and with mitral stenosis, using simultaneous low frequency phonocardiography, echocardiography, and apex cardiography. The techniques showed 'M' to have a constant morphology in preisovolumic systole. In mitral stenosis, 'M' and the preisovolumic 'presystolic' murmur appear to be the same phonocardiographic phenomenon. While 'M' was present in sinus rhythm, augmentation of this normal vibration occurred particularly during the short cycles of atrial fibrillation. Leaflet coaption and movement of the ventricular wall as detected echocardiographically do not appear to play a role in its pathogenesis but the sound could emanate from the ventricular wall as it tautens and decreases its compliance at the onset of systole.

Echocardiography↗
PubMed1978

Valve replacement for rheumatic aortic incompetence in adolescents.

The timing of valve replacement in patients with rheumatic aortic regurgitation is assessed by balancing the mortality and complications associated with the operation and the prosthetic valves against the natural history of the lesion. The time course without surgery is determined by the severity of the volume overload and the gradual deterioration of myocardial function. We wished to obtain information both on the haemodynamic recovery achieved after aortic valve replacement in young patients and also on the risks of operation in this group. Twenty patients, in whom the aortic valve was replaced at a mean age of 15 years, were reviewed. An improvement in symptoms and in the cardiothoracic ratio on the chest radiograph occurred in every case, and the voltage measurements suggestive of left ventricular hypertrophy on electrocardiogram diminished in all but two. The left ventricular end-diastolic pressure decreased in the 11 patients who were recatheterised after operation. The ejection fraction improved in three patients and stayed the same in three others. While there were no operative deaths in our series the incidence of serious morbidity, in terms of myocardial damage at or after operation, was disappointingly high. Early valve replacement to preserve myocardial function is especially attractive in young patients but cannot be advised if the insertion of the prosthetic valve is associated with appreciable myocardial damage.

Adolescent↗
PubMed1977

Complete heart block in a case of idiopathic hypertrophic subaortic stenosis: noninvasive correlates with the timing of atrial systole.

A young man with IHSS who developed complete heart block was successfully treated with a permanent pacemaker. Echocardiography and other noninvasive techniques showed marked cycle-to-cycle variation in the evidence of subvalvular obstruction which decreased markedly when atrial systole preceded the ensuing paced complex by an appropriate interval. Because cycle length and therefore afterload were constant, it is concluded that diminished obstruction resulted from augmented ventricular end-diastolic volume produced by atrial contraction. The mitral valve echocardiogram showed unusual movements in diastole dependent upon the timing of atrial systole. Early reopening of the leaflets was a direct result of atrial contraction when the P waves were appropriately timed in presystole, whereas late reopening was passive and a result of ventricular filling in mid-diastole. Variations in intensity of the first heart sound correlated with the position of the mitral valve leaflets at the onset of ventricular systole.

Adult↗
PubMed1976

The ECG of constrictive pericarditis--pattern resembling right ventricular hypertrophy.

The ECG changes in 122 cases of constrictive pericarditis have been reviewed. Ninety-five per cent of tracings were typical and showed a normal QRS axis, low voltage, and generalized T wave flattening or inversion. The remaining six tracings showed evidence of right ventricular hypertrophy and half of these showed right axis deviation in addition. In only one could these findings be readily accounted for by the presence of severe fibrotic annular subpulmonic constriction; the remainder are unexplained and it is postulated that cardiac rotation and distrotion is causative since none of the other mechanisms of right axis deviation or right ventricular hypertrophy were operative.

Adult↗
PubMed1976

Successful electrical pacing for complete heart block complicating diphtheritic myocarditis.

A case of severe diphtheria complicated by myocarditis and neurorespiratory paralysis is reported. The myocarditis manifested with severe conduction disturbances including left bundle-branch block and high grade second degree atrioventricular block leading to Adams-Stokes attacks. Temporary transvenous electrical pacing for.3 days was successful in the management of this complication, but positive pressure ventilation was later required for respiratory paralysis. This case illustrates the potential value of electrical pacing in diphtheritic myocarditis. Sporadic cases of diphtheria still occur and the case fatality ratio remains at 10%, much of which is related to the occurrence of myocarditis.

Bundle-Branch Block↗
PubMed1976

Acute myocardial infarction with normal coronary arteries: a possible manifestation of the billowing mitral leaflet syndrome.

The findings in four young patients with the billowing mitral leaflet syndrome who presented with evidence of acute myocardial infarction are reported. Because technically adequate coronary arteriograms demonstrated patent vessels and the electrocardiograms initially showed pronounced elevation of the ST segments as occurs in Prinzmetal's angina, it is postulated that spasm of normal coronary arteries was the operative factor. Scrutiny of those cases of clinically apparent ischemic heart disease with normal coronary angiograms is suggested to establish whether there is in fact a causal relationship with the billowing mitral leaflet syndrome.

Adult↗
PubMed1976

Subpulmonic stenosis as a result of noncalcific constrictive pericarditis.

The clinical, electrocardiographic, and radiologic features in a patient with a pericardial band which produced an unusual form of infundibular pulmonary stenosis are presented. The findings are unique in that the band was not calcified and, therefore, not visualized roentgenographically and developed without a previous history of pericarditis or pericardial surgery. The diagnostic value of cineangiography is stressed and illustrated.

Adolescent↗
PubMed1976

Clinical experience with the Lillehei-Kaster cardiac valve prosthesis.

This paper reviews our experience with the Lillehei-Kaster pivoting disc prosthesis in 155 patients with aortic and mitral valve disease. We employed 189 valves during the period 1971 to 1974. The early surgical mortality rates for isolated mitral, isolated aortic, and combined mitral and aortic valve replacements were 9 per cent, 14 per cent, and 3 per cent, respectively. Postoperatively, there was no evidence of significant hemolysis, and the gradients across the prostheses were satisfactory. Clinical evaluation of prosthetic function was made difficult by the infrequency of an opening click and the common occurrence of mid-diastolic murmurs even with minimal gradients. The most disturbing complication, which has led to our abandoning use of this valve, was thrombosis, which occurred in at least 10 per cent of the mitral and 5 per cent of the aortic valves. The cause is thought to be late prosthetic disproportion as the heart shrinks in size.

Adolescent↗
PubMed1975

Pulmonary stenosis and impaired myocardial function.

Two young Black female patients with pulmonary valve stenosis and intact ventricular septa are presented in protracted congestive cardiac failure with severe tricuspid insufficiency and, in one, atrial fibrillation. Right ventricular systolic dysfunction was manifested by peak systolic pressures below systemic level, raised end-diastolic pressures and low cardiac output, but without right-to-left shunt. These findings are in strong contrast to those found in most patients with pulmonary stenosis of long standing, where persistent impairment of right ventricular function is diastolic with a high end-diastolic pressure and reversal of an interatrial shunt which result from poor right ventricular compliance. Evidence of left ventricular dysfunction was also present in both cases. Protracted heart failure in these patients is believed to have been the result of coincidental cardiomyopathy in a racial group highly predisposed to this disorder. A diagnostic appreciation of this phenomenon is important in the evaluation of heart disease in the Black, since cardiomyopathy may modify or even mask the features of the underlying disorder.

Adolescent↗
PubMed1975

Pulmonary edema following pulmonary valvulotomy.

A previously unreported combination of critical pulmonary valve stenosis and mitral stenosis is described. The initial clinical presentation was one of right ventricular failure that obscured the evidence of pulmonary venous hypertension. Following pulmonary valvulotomy, pulmonary edema ensued because of the increased pulmonary blood flow. The importance of urgent cardiac catheterization postoperatively following an operation that increases pulmonary blood flow is discussed.

Child↗