Biomedical subjects
Publications and source records attributed to T J Reeves.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Sixty-two patients with isolated aortic valvular stenosis were analyzed by a series of common noninvasive procedures and by cardiac catheterization. The data from 50 of these were evaluated in a retrospective fashion by multiple regression methods to determine significant objectively obtained predictors of aortic-left ventricular gradient and valvular area. Formulae were derived from these analyses and an additional 12 patients were then studied prospectively to evaluate the validity of the predictive formulae. Forty-three of 50 patients (86 per cent) were correctly identified as to a gradient of greater or less than 50 mm. Hg in the initial group, and all those in the prospectively studied sample were correctly classified. Thiry-five of 43 patients (82 per cent) of those with valve area data in the first application were correctly classified as to valve area or greater or less than 0.8 cm.2, and all patients in the prospectively studied group were appropriately identified as to the same area. The combined application of the observations of calcification of the aortic valve, shudder waves on the anacrotic limb, prolonged time to peak of the percussion wave and alteration of the dicrotic notch of the carotid pulse tracing, left ventricular hypertrophy by electrocardiogram, and the altered duration of ventricular ejection time were reliable predictors of elevated aortic-left ventricular gradient and decreased aortic valvular size.
The diagnosis of perioperative myocardial infarction (POMI) in patients undergoing coronary artery bypass is uncertain because the criteria of infarction are unclear. Fifty patients who underwent coronary artery bypass were evaluated preoperatively and postoperatively with serial ECGs, creatine phosphokinase (CPK), isoenzyme determinations, and technetium pyrophosphate myocardial scans. Clinical evaluation correlated with exercise testing and postoperative angiography supported the diagnosis in questionable cases. Thirty-five patients (70%) had no evidence of POMI by any criteria, and 2 patients (4%) had unequivocal evidence of infarction by all criteria. Our studies indicate the complexities of diagnosing POMI. We believe that the serially recorded ECG is the most useful diagnostic technique. CPK isoenzyme determinations may be useful but are difficult to interpret in the operative setting. Preoperative cardiac scans are necessary so as to avoid a high incidence of false-positive scans postoperatively. In doubtful cases, postoperative coronary arteriography and left ventricular angiography may provide the most definitive information.
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Hemodynamic and metabolic responses to pacing from either the coronary sinus or right atrium were evaluated in 41 patients with chest pain and normal coronary arteriograms. A group of patients (group II) with angina, lactate production, or significant ST segment depression had a significantly higher mean pulmonary capillary pressure on peak pacing or angina than did a group of patients considered to have a normal pacing response (group I). In 6 of 9 group II patients, the left ventricular end-diastolic pressure either rose abnormally with pacing or was greater than 14 mm Hg immediately after pacing and resembled that of a group of patients with coronary artery disease; Patients with a prolapsing mitral valve (group III) also had a significantly higher pulmonary capillary pressure on peak pacing as compared to those of group I, although abnormal left ventricular pressure responses occurred in only 2 of 9 of these patients. The stroke index was significantly lower in group III on peak pacing while group II was no different from group I. Lactate production occurred in 6 of 9 group II patients. However, only 1 of 6 patients with a prolapsing mitral valve who were studied for lactate production was found to produce lactate, suggesting a different mechanism for their pain.
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