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Biomedical subjects

R V Gibson

Publications and source records attributed to R V Gibson.

14 recordsLinked to original sources

Emergency transvenous ablation of atrioventricular conduction to control refractory atrial tachycardia.

Three patients were referred for urgent investigation and treatment of refractory arrhythmias. Each patient had failed to respond to antiarrhythmic drugs and in two patients direct current cardioversion was also unsuccessful. Transvenous ablation of atrioventricular conduction was therefore thought appropriate. With a temporary ventricular pacing system in situ, a second electrode was used to record His and atrial electrograms. A 270 watt-second shock was delivered through this lead when the His potential was maximized. The tachycardia was controlled in two patients and the procedure was without deleterious effects.

Bundle of His↗

Valve replacement without preoperative cardiac catheterization.

During the year 1978, the decision to perform cardiac catheterization in patients with valvular heart disease was delayed until clinical and noninvasive assessment have been completed. As a result, 184 patient underwent operation without invasive studies, and 59 had elective catheterization. Another 62 patients were referred during the same period for valve replacement after routine catheterization had been performed elsewhere. Age, sex distribution, symptoms, and cause of valve disease were similar in all three groups, although we managed emergencies and second operations more frequently without catheterization. In all patients, the preoperative diagnosis was confirmed, and no unexpected pathologic process was encountered. Operative mortality was the same in all three groups, and after two years of follow-up there was no difference in survival or symptoms. No uncorrected valve lesions became apparent in uncatheterized patients. We conclude that routine catheterization is unnecessary before valve replacement but can be reserved for specific indications in some patients.

Adolescent↗

Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism.

Massive pulmonary embolism was confirmed by pulmonary arteriography in 23 patients. All were seen between 2 and 48 hours after the onset of embolism and none had pre-existing cardiorespiratory disease. Fifteen were treated with streptokinase and eight with heparin. Factors which might influence prognosis and rate of resolution were similar in the patients in each group, and there was no significant difference between the groups in terms of pretreatment haemodynamic or arteriographic findings. Haemodynamic and arteriographic findings after treatment for 72 hours provided an objective measurement of resolution, which was significantly greater in the streptokinase-treated patients. There was no mortality in either group, but treatment had to be changed in two heparin-treated patients because of clinical deterioration. The principal complication of treatment, seen more often in the streptokinase-treated patients, was bleeding from cut-down or operation sites.

Acute Disease↗

Treatment of pulmonary embolism with streptokinase. A preliminary report.

Nine patients with arteriographically proved pulmonary embolism have been treated by a 36-hour infusion of streptokinase. Satisfactory haemodynamic and arteriographic resolution was obtained in four patients with acute massive pulmonary embolism and in two with recent minor embolism. Little or no haemodynamic or arteriographic improvement was obtained in three patients with pulmonary thromboembolic disease of longer duration.

Acute Disease↗