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Biomedical subjects

S J Shubrooks

Publications and source records attributed to S J Shubrooks.

At least 37 records · Page 2Linked to original sources
PubMed1994

Similar results of percutaneous transluminal coronary angioplasty for women and men with postmyocardial infarction ischemia.

OBJECTIVES: The purpose of this study was to determine whether there are gender differences in the outcome of percutaneous transluminal coronary angioplasty performed for postmyocardial infarction ischemia. BACKGROUND: Although women have a higher mortality rate after myocardial infarction than that of men, they are less frequently referred for coronary angioplasty (and coronary artery bypass graft surgery) than are men, possibly because of expectations of a worse procedural outcome. METHODS: We analyzed the morbidity and mortality at coronary angioplasty and during a mean follow-up period of 34.4 months for women and 34.2 months for men in 505 consecutive patients (164 women and 341 men) with postmyocardial infarction ischemia between 1981 and 1989. RESULTS: Compared with men, women had similar procedural success rates (89.6% and 91.2%, respectively), need for coronary artery bypass surgery (3.7% and 2.6%) and mortality rates at coronary angioplasty (0.6% and 0.9%). During the follow-up period, there were no significant gender differences in the requirement for coronary artery bypass surgery (3.6% and 4%), repeat angioplasty (18.7% and 17.3%), reinfarction (5.8% and 6%) and death (3.6% and 3.7%) or the combined end points of all four events (26.6% and 26.6%). Women had significantly more recurrent angina than did men (54% vs. 42.5%, p < 0.01), even though the extent of coronary artery disease and frequency of incomplete revascularization were similar in men and women. CONCLUSIONS: The procedural outcome of coronary angioplasty for postmyocardial infarction ischemia is similar in women and men. Long-term follow-up is also similar except that women experience an increased incidence of recurrent angina, an outcome also reported after bypass surgery. Therefore, concerns over the safety of coronary angioplasty in women should not adversely influence decisions concerning referral of women for coronary angioplasty after myocardial infarction complicated by ischemia.

Adult↗
PubMed1993

The use of transesophageal echocardiography to avoid left atrial thrombus during percutaneous mitral valvuloplasty.

During mitral balloon valvuloplasty, transesophageal echocardiography (TEE) has been employed for the accurate placement of the transseptal needle, guide wires, and balloon catheters and to provide an immediate evaluation of the results of the procedure. We describe a case demonstrating that TEE can be used to avoid a left atrial appendage thrombus during the placement of wires and catheters. With TEE guidance, we feel left atrial appendage thrombi are no longer an absolute contraindication to percutaneous mitral valvuloplasty.

Aged↗
PubMed1992

Improved support for right coronary artery angioplasty with a new guiding catheter.

Inadequate guiding catheter support is a frequent cause for failure in right coronary angioplasty (PTCA). A new guiding catheter designed to provide easy placement in the right coronary and improved stability and backup support is described. Use of this catheter for PTCA of right coronary lesions, the majority of which were considered technically difficult to dilate, in 100 patients resulted in successful dilatations in 88% of patients. Failures were due to inability to seat the guide adequately in 8 patients with narrow aortic roots or unusual coronary origins and to inability to cross a lesion in 4 patients despite good support. In 4 patients successful dilatation was achieved after failure using another presently available guide.

Angioplasty, Balloon, Coronary↗
PubMed1978

Spontaneous near closure of coronary artery fistula.

An asymptomatic 14-year-old male was found at cardiac catheterization to have a coronary artery fistula involving a vessel originating from the left main coronary artery and terminating in the right heart. Chest X-ray and electrocardiogram were within normal limits and shunt flow was too small to be detected by oximetry although a large vessel was seen angiographically. One year later, the previously loud continuous murmur had disappeared and repeat catheterization demonstrated near closure of the fistula. This is the first report documenting the spontaneous closure of a coronary artery fistula.

Adolescent↗
PubMed1977

Mitral valve prolapse with atrioventricular and sinoatrial node abnormalities of long duration.

A 20-hear-old patient with mitral valve prolapse and minimal mitral regurgitation associated with intermittent marked sinus bradycardia and sinus arrhythmia, and atrioventricular block, proximal to the bundle of His, varying from first-degree to high-grade, is described. Both the murmur and the atrioventricular block had been documented since the age of eight years, and probably since the first year of life, and has shown no subsequent progression. The patient's symptoms of chest pain and severe lightheadedness and near syncope have been shown by telemetry electrocardiogrphic monitoring to be unrelated to changes in cardiac rhythm.

Adult↗
PubMed1977

Mitral valve prolapse in rheumatic mitral stenosis.

Four adult women with histories of rheumatic fever and clinical findings of mitral stenosis and regurgitation had echocardiograms demonstrating moderately severe mitral stenosis (EF slope less than 20 mm/sec, mean left atrial size 3.0 cm/m2, mean anterior mitral leaflet excursion 25 mm) as well as typical mitral valve prolapse. Three patients underwent cardiac catheterization which confirmed the presence of mitral stenosis, as well as systolic prolapse and excessive scalloping of the mitral valve with no visible mitral calcium and no coronary artery disease. One patient had associated mild aortic stenosis and regurgitation. Two patients underwent mitral valve surgery which revealed anterior and posterior commissural fusion consistent with rheumatic disease and intact chordal apparatus. Both leaflets were large and the anterior leaflets were redundant. There were no vegetations. Pathology revealed myxomatous degeneration of the valve leaflets. In the absence of heavy calcification and thickening, the presence of mitral stenosis with commisural fusion does not exclude the possibility of a redundant mitral valve. When these entities coexist, systolic clicks may be absent.

Aged↗
PubMed1975

The significance of bundle branch block during acute myocardial infarction.

Analysis of the course of 71 patients with acute myocardial infarction complicated by bundle branch block (BBB) confirms a high incidence of atrioventricular (A-V) block (42 per cent) and severe pump failure (35 per cent) in these patients. Hospital mortality was not correlated with BBB per se, but rather with the associated development of second or third degree A-V block (57 per cent with A-V block vs. 12 per cent without A-V block; p less than .0005) or severe pump failure (35 per cent with vs. 11 per cent without severe pump failure; p less than .001). However, late mortality was high and not significantly different among those surviving hospitalization whether transient A-V block was present or absent. Eight of 11 late deaths were sudden. Temporary pacing could not be shown to alter hospital survival statistically, but made the onset of complete heart block a hemodynamically smooth and clinically undetectable event in several patients who later survived. The place of permanent pacing in these patients cannot be clearly determined on the basis of this study or in the available literature. More data obtained either by pooling the experience of several centers or from a prospective randomized study are needed to determine the indications for permanent pacemakers.

Adult↗
PubMed1975

Variant angina pectoris: Clinical and anatomic spectrum and results of coronary bypass surgery.

Twenty patients are described with the variant angina syndrome (recurrent angina at rest with S-T segment elevations occurring only during pain and no evolution of infarction). In contrast to patients previously reported on, all but one had progressive unstable angina before hospitalization. Angina was frequently associated with arrhythmias, including ventricular fibrillation (2 instances), ventricular tachycardia (4), frequent ventricular premature beats (5), atrioventricular block (4), sinus bradycardia (2), sinoatrial exit block (1) and supraventricular tachycardia (1). Seventeen patients had significant proximal stenosis of one or more coronary arteries with good distal vessels. Bypass surgery in 15 of these patients resulted in one noncardiac postoperative death, one perioperative infarction and relief of pain in all 14 survivors. After a 17 month mean follow-up period (range 4 to 38 months), all survivors are pain-free. Three patients had no significant coronary disease; one of these became asymptomatic with medical therapy, one continues to have angina and one died suddenly. Patients with normal coronary arteries could not be distinguished clinically or by electrocardiogram from those with severe obstructive lesions. This experience suggests that all patients with the variant angina syndrome should be studied by coronary angiography, and that most patients with significant fixed coronary lesions will do well after coronary bypass surgery.

Adult↗
PubMed1975

Left ventricular wall motion response to intravenous propranolol.

The effects of intravenous propranolol on left ventricular wall motion and hemodynamics were studied in 16 patients, 12 with significant coronary artery disease and four with chest pain but no coronary disease. Eight patients received 0.10 mg/kg and eight received 0.15 mg/kg of propranolol intravenously. All underwent atrial pacing at a constant rate. Left ventricular angiograms were performed before and 20 minutes after propranolol. At both doses, propranolol caused no significant change in left ventricular systolic or diastolic pressures, either before or immediately following ventriculography. Cardiac index fell significantly (3.4 plus or minus 0.2 [SEM] to 2.6 plus or minus 0.1 L/min/m-2) with the higher dose only. Of the ten patients with coronary artery disease and adequate ventriculograms, one patient had a normal left ventricle, two had regional hypokinesis, only three had areas of hypokinesis and akinesis, two had dyskinetic and akinetic areas, and two had areas of hypokinesis, akinesis and dyskinesis. No changes in regional contractility occurred with propranolol except for a minimal increase in hypokinesis in one patient at each dosage and equivocal development of a new area of slight hypokinesis in one patient and minimal apex of dyskinesis in another at the higher dosage. Of the four patients without coronary artery disease, two were affected by propranolol, one with initial regional akinesis and dyskinesis had slight worsening with propranolol and one with regional hypokinesis developed a definite new area of hypokinesis. Therefore, propranolol, even in large intravenous doses, resulted in no significant change in left ventricular wall motion in patients with coronary artery disease.

1-Propanol↗
PubMed1975

Coronary hemodynamics during positive (+G-z) acceleration.

Left circumflex (LC) and left anterior descending (LAD) coronary flows, coronary perfusion pressure (P-ca), and arterial O-2 content (Cao-2) were determined in five dogs, lightly anesthetized with chloralose, during exposures to +2.0 and +3.0 G-Z stress; and for three of these dogs at +3.5-G-Z. At +2.0 G-Z, except for one dog with the most marked decrease in P-ca, KC and LAD flows increased above control by 15 s and thereafter gradually returned toward control; coronary resistances were significantly below control at 15 and 30 s (p smaller then 0.05). At +3.0 G-Z, LC and LAD flows were significantly greater than control (p smaller 0.05) from 30 to 60 s, while resistances were below control (p smaller than 0.05). At +3.5 G-Z, LC flow was maintained above control by a much reduced resistance, with P-ca below control; LAD flow increased in one dog, remained unchanged in one, and decreased slightly in one, although resistance always decreased. Cao-2 did not change significantly at any +G-Z level, and myocardial O-2 transport paralleled the changes in coronary flow.

Acceleration↗