Atrial fibrillation and the Wolff-Parkinson-White syndrome.
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Biomedical subjects
Publications and source records attributed to S D Clements.
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This report describes the features and the course of a patient on maintenance hemodialysis in whom infective endocarditis of the aortic valve ensued. The subsequent development of intractable congestive heart failure necessitated aortic valve replacement. Use of intraoperative hemodialysis, facilitating the intraoperative and postoperative management of the patient, is described. Following valve replacement the patient did well with no evidence of congestive heart failure.
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This report presents an echocardiographic study of a patient with fibrous ingrowth about the sewing ring and hinges of a Bjork-Shiley valve in the mitral position. The valve was obstructed and produced a distinct motion pattern. In addition to having a rounded diastolic motion, the disk excursion was decreased.
An echocardiographic correlate for a post-valvulotomy mid-systolic click is described. Simultaneous echocardiographic and phonocardiographic studies demonstrated that the click was temporally related to a sudden midsystolic posterior motion of part of the mitral valve apparatus. This temporal relationship suggests that the sudden change in position of portions of the mitral valve resulted in the loud midsystolic click. In our patient the sudden leaflet movement associated with the click was apparently a localized abnormality.
The value of coronary bypass surgery has been studied carefully during the last decade. Four methods, none perfect, have been used to compare the results of such surgery with the results of medical therapy. New data are likely to be merely supportive rather than the outcome of a definitive study with a new and a acceptable experimental design. It is therefore time to analyze the available data in light of the treacherousness of the disease and to determine if a clear trend is evident. There appears to be sufficient evidence to state that properly performed coronary bypass surgery will increase coronary blood flow and relieve angina pectoris in 90 percent of patients; total relief of angina can be expected in 60 percent and partial relief in 30 percent. Compared with modern medical therapy, properly performed coronary bypass surgery appears to prolong the life of patients who have obstruction of the left main coronary artery or triple or double vessel disease. There is not adequate evidence to state that the procedure will prolong the life of patients with single vessel obstruction. However, patients with single vessel obstruction and unacceptable angina pectoris should be considered for bypass surgery (especially patients with obstruction of the left anterior descending coronary artery). In practice, at Emory University Hospital, Atlanta, bypass surgery is recommended for young people with few symptoms if compelling obstructing lesions are present and in older patients only if their symptoms require it. Medical therapy is given before and after bypass surgery. When bypass surgery is performed in an excellent fashion (operative risk 1 percent) a great deal of "controversy" about this problem vanishes.
A patient had a ruptured ventricular septum due to an acute anterior myocardial infarction. An aortic balloon pump was inserted and a subsequent phonocardiographic study was made showing inflation and deflation sounds and the diastolic pulse wave generated. This study defines the extra sounds and pulses generated by such a device so that they may be better understood for clinical interpretation.
In a patient with myotonia dystrophica multiple ventricular arrhythmias and high degree atrioventricular block requiring a permanent pacemaker developed. Patients with skeletal muscle disease may present with disproportionately advanced manifestations of associated cardiac disease. Early recognition of potential serious underlying cardiac disease is important in patients with this condition.
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