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S Wilansky

Publications and source records attributed to S Wilansky.

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

Left ventricular outflow tract obstruction and hemolytic anemia after mitral valve repair with a Duran ring.

We report a case of mitral valve repair with a Duran ring that was complicated by left ventricular outflow tract obstruction, mitral regurgitation, and hemolytic anemia. A 59-year-old man with severe mitral valve regurgitation underwent mitral valve repair, including a Duran ring annuloplasty. Postoperatively, left ventricular outflow tract obstruction developed and echocardiography revealed severe systolic anterior motion of the mitral valve. The patient then underwent mitral valve replacement with a 29-mm St. Jude valve.

Adult↗
PubMed1994

Echocardiographic evaluation of anuloplasty rings. Comparison of continuity equation and pressure half-time methods.

This study was undertaken to compare pressure half-time and continuity equation methods in the postoperative evaluation of anuloplasty rings. We performed 2-dimensional echocardiography and Doppler studies in 39 patients who had undergone valve repair for mitral regurgitation. In patients with a pressure half-time of 110 msec or more (9/39), there was no significant difference in calculated valve area between the 2 methods (p = 0.696). A significant difference was shown between the 2 methods (p < 0.001) in patients with a half-time less than 110 msec (30/39). When patients were classified according to the type of ring they had received, no significant difference was noted between the 2 groups with regard to peak and mean mitral gradients. In patients placed in subgroups according to half-times of less than 110 msec and half-times of 110 msec or more, no difference was noted between groups in terms of mean mitral gradient, presence of mitral regurgitation, left atrial size, left ventricular function, or heart rate. The continuity equation appears to provide much more homogeneous results in the calculation of valve area in patients who have undergone valvular repair for mitral valve regurgitation.

Adolescent↗
PubMed1994

Dobutamine stress echocardiography in clinical practice with a review of the recent literature.

Stress echocardiography has been developed in recent years as an effective noninvasive test for the detection and assessment of coronary artery disease. This method combines exercise with 2-dimensional echocardiography, which can assess regional and global left ventricular function during stress. Dobutamine infusion, a pharmacologic means of producing cardiovascular stress, appears to be an excellent alternative to exercise in echocardiographic studies. Currently, it is reserved for patients who cannot exercise at a meaningful level because of advanced age, physical deconditioning, or other factors. This review evaluates the current clinical application of dobutamine stress echocardiography and compares its efficacy with that of exercise echocardiography and nuclear perfusion imaging.

Contraindications↗
PubMed1993

A cost-effective Dacron annuloplasty ring.

Annuloplasty rings fashioned from Dacron tube grafts have been used in mitral valve operations at the Texas Heart Institute for the past 3 years. This technique has been applied in 70 consecutive patients, with excellent clinical and echocardiographic results. We have found that annuloplasty rings constructed from transverse sections of knitted Dacron offer the same advantages as other flexible rings at a greatly reduced cost.

Humans↗
PubMed1993

Pheochromocytoma-induced myocardial infarction in pregnancy. A case report and literature review.

We present the case of a 30-year-old woman, 33 weeks pregnant, whose pregnancy was complicated with the rare condition of pheochromocytoma-induced myocardial infarction. Alpha- and beta-adrenergic blockade was instituted immediately for control of hypertension and arrhythmias. Two weeks after myocardial infarction, fetal maturity was documented, and the patient underwent cesarean section delivery of a 6-lb, 6-oz baby girl. The delivery was followed immediately by excision of a 7- x 6- x 4.5-cm tumor, which was confirmed to be a pheochromocytoma by histologic examination. Her post-operative course was uneventful. Our case study and a review of the literature show that the key to successful fetal and maternal outcome is early diagnosis, which can be confirmed by 24-hour urine testing of catecholamine and metanephrine levels. If the tumor is diagnosed before 20 weeks' gestation, we recommend immediate surgical removal of the tumor and continuation of the pregnancy to term. The management of the patient who presents between 20 and 24 weeks' gestation will depend on the uterine size in terms of tumor access. After 24 weeks, the pregnancy should be carried to term, at which time delivery by cesarean section will be followed by tumor excision. Postoperative care should include appropriate cardiovascular investigation and ongoing serial measurements of urinary catecholamines.

Adrenal Gland Neoplasms↗
PubMed1992

Prolapsing large aneurysm of the atrial septum simulating a right atrial mass.

An unusual case of a large, prolapsing atrial septal aneurysm in a patient with an otherwise normal heart is described. The aneurysm caused right atrial obstruction and resulted in a "tumor effect." The patient experienced debilitating symptoms for years before receiving an appropriate diagnosis and curative surgical treatment.

Blood Vessel Prosthesis↗
PubMed1991

Patent foramen ovale: a cause of hypoxemia in patients on left ventricular support.

We describe 2 patients who experienced right-to-left shunting during support with a left ventricular assist device as a result of patent foramen ovale. In the first patient, the patent foramen ovale was not found until autopsy. In the second patient, fluctuations in continuous mixed venous oxygen saturations caused us to suspect a patent foramen ovale, which was confirmed with transesophageal contrast echocardiography. We promptly repaired the defect and this patient survived. When patients on assist devices experience unexplained arterial hypoxemia, a patent foramen ovale should be considered. If a patent foramen ovale is found, surgical correction should be done early.

Adult↗
PubMed1991

Echocardiography in the assessment of complications of myocardial infarction.

The value of echocardiography as a tool for evaluating the prognosis of patients after myocardial infarction lies in its ability to define the region and extent of ischemic damage. Additionally, echocardiography is useful in assessing and predicting postinfarction complications. Wall motion abnormalities, pericardial effusion, left ventricular thrombi, and left ventricular aneurysms and pseudoaneurysms can be detected using echocardiography. The severity of mitral regurgitation and the location of interventricular septal rupture can also be assessed using echocardiography. This diagnostic tool can provide vital information regarding the appropriate clinical management of patients after myocardial infarction.

Journal Article↗
PubMed1990

Common sulfoglycolipid receptor for mycoplasmas involved in animal and human infertility.

Sulfoglycolipids are ubiquitous components of the male germ cell membrane. Sulfogalactoglycerolipid (SGG) is restricted to mammalian cells and has recently been implicated in sperm/egg interactions. Mycoplasma infections have been implicated in infertility in a variety of species, including humans. Four such species-specific mycoplasmas, Ureaplasma urealyticum and Mycoplasma hominis (humans), Mycoplasma pulmonis (rodents), and Ureaplasma diversum (cattle) are not shown to specifically recognize SGG and the sphingolipid counterpart, sulfogalactosyl ceramide. This glycolipid receptor binding may relate to the reproductive pathogenesis of these organisms.

Animals↗
PubMed1990

Transesophageal echocardiography in aortic dissection.

Aortic dissection is an emergent and potentially fatal condition requiring prompt and accurate diagnosis. In some patients, aortic dissection is abruptly painful at onset; in others, however, it has a chronic progression-with no apparent symptoms or with symptoms mimicking those of congestive heart failure. Transesophageal echocardiography, a promising new method for diagnosis of aortic dissection, has the advantages of being performed at the patient's bedside and providing results within 15 minutes. This method utilizes endoscopy and traditional noninvasive imaging techniques to provide a definitive picture of most segments of the aorta without the limitations associated with aortography and other invasive procedures. The technique of transesophageal echocardiography and its application in the diagnosis of aortic dissection are described in this report.

Journal Article↗
PubMed1989

Causal relation between the pressure gradient and left ventricular ejection time in hypertrophic cardiomyopathy.

This study was designed to evaluate the relation between severity of obstruction to left ventricular outflow and left ventricular ejection time in hypertrophic obstructive cardiomyopathy. With dual catheters across the left ventricular outflow tract, the pressure gradient and corresponding left ventricular ejection time were measured in 10 patients as the pressure gradient was pharmacologically provoked or abolished, or both. The patients were studied during constant atrial pacing to avoid the potential errors introduced with heart rate correction equations. The pressure gradient was pharmacologically provoked or reduced over a range of greater than or equal to 62 mm Hg per patient. In each patient the left ventricular ejection time varied directly with the pressure gradient (mean r = 0.97, range 0.92 to 1.00). The change in magnitude of the pressure gradient varied directly with the corresponding change in the measured ejection time (mean r = 0.98, range 0.97 to 1.00). When the data from all 10 patients were pooled with use of Weissler's heart rate correction equation, the relation between the corrected left ventricular ejection time and the pressure gradient was still significant and linear (r = 0.86), but less so than in individual patients. This difference was the result of marked interpatient variability in the slope of this linear relation reflecting interpatient differences in other important factors, such as underlying myocardial contractility and stroke volume, that influence left ventricular ejection time. This study demonstrates a clear, direct and highly significant relation between the magnitude of the pressure gradient and the left ventricular ejection time in hypertrophic obstructive cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1989

Acute myocarditis presenting as asymmetric septal hypertrophy.

A 19-year-old male with myocarditis presented with the echocardiographic appearance of asymmetric septal hypertrophy. After six days of steroid therapy the septum and the posterior wall returned to normal thickness. This case suggests that a diagnosis of myocarditis should be considered in patients demonstrating asymmetric septal hypertrophy, particularly when there are associated left ventricular wall motion abnormalities.

Adult↗
PubMed1988

Doppler color-flow imaging assessment of shunt size in atrial septal defect.

Two-dimensional echocardiography and pulsed-Doppler studies have not proved to be reliable methods of assessing left-to-right shunt size in atrial septal defect. Doppler color-flow imaging displays the transatrial jet, providing a new dimension with the potential capability of quantifying left-to-right shunt size. Twenty-three patients with atrial septal defect were studied by color-flow imaging and cardiac catheterization. The defect size measured by two-dimensional echocardiography, the maximal color-flow jet width in the atrial septum, and the maximal color-flow jet area in the right atrium were correlated with cardiac catheterization-derived left-to-right shunt size. Correlation coefficients were 0.57 (p less than 0.01), 0.67 (p less than 0.001), and 0.65 (p less than 0.01), respectively. Atrial septal color-flow jet width distinguished patients with less than a 2:1 left-to-right shunt size ratio (eight patients, jet width less than 15 mm in in all) from patients with greater than a 2:1 left-to-right shunt size ratio (15 patients, jet width greater than 15 mm in all). These results indicate that Doppler color-flow imaging can distinguish left-to-right shunt size in atrial septal defect accurately enough to influence decisions with regard to subsequent patient management.

Adult↗
PubMed1988

Colour flow imaging in severe mitral and aortic regurgitation.

Several criteria have been proposed for the grading of severe aortic and mitral regurgitation by colour flow imaging. To evaluate the sensitivity of these criteria, colour flow imaging was performed in 21 patients with isolated severe mitral regurgitation and 11 patients with isolated severe aortic regurgitation prior to clinically indicated valvular surgery. In the colour flow imaging assessment of mitral regurgitation the criterion of the maximum distance of mitral regurgitant jet from mitral orifice greater than 4.5 cm was 95% sensitive (range 4.4 to 8.4 cm). Maximum ratio of mitral regurgitant jet area to left atrial area greater than 40% was 86% sensitive (range 32 to 84%) and maximum mitral regurgitant jet area greater than 6 cm2 was 100% sensitive (range 8.1 to 35.7 cm2) in the detection of severe mitral regurgitation. For aortic regurgitation, the criterion of height of regurgitant jet to height of left ventricular outflow tract greater than 65% in the parasternal long axis view was 100% sensitive (range 71 to 100%), whereas the ratio of area of regurgitant jet to area of left ventricular outflow tract greater than 60% in the short axis view was only 36% sensitive (range 8 to 74%) in the detection of severe aortic regurgitation requiring surgery. It is concluded that the most sensitive colour flow imaging criteria for severe mitral regurgitation is an absolute mitral jet area greater than 8 cm2; and for severe aortic regurgitation, ratio of height of regurgitant jet to height of left ventricular outflow tract greater than 65%.

Adult↗