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At least 253 records · Page 14Linked to original sources
PubMed1988

Spectrum of exercise intolerance in 45 patients with Ebstein's anomaly and observations on exercise tolerance in 11 patients after surgical repair.

To determine the effects of definitive operation for Ebstein's anomaly on rest and exercise cardiorespiratory function, cycle exercise studies were performed on 38 patients with Ebstein's anomaly before definitive operation and on 11 patients after operation. An atrial septal defect was present in 29 of the 38 preoperative patients and in none of the postoperative patients. Seven of the postoperative patients had tricuspid valvuloplasty and four had valve replacement. Exercise tolerance, as defined by maximal oxygen uptake, was significantly greater in patients after operation for Ebstein's anomaly than in the preoperative patients. However, exercise tolerance for preoperative patients without an atrial septal defect was similar to that for postoperative patients. Tricuspid valve repair or replacement appeared to affect favorably cardiac output response to exercise. Rest systemic arterial oxygen saturation increased from 88 to 95% and exercise saturation from 77 to 93% after operation. Rest ventilatory equivalent for oxygen decreased from 48 +/- 13 preoperatively to 37 +/- 6 postoperatively, and exercise ventilatory equivalent for oxygen decreased from 53 +/- 23 preoperatively to 38 +/- 6 postoperatively. Definitive operation (tricuspid valvuloplasty or replacement and atrial septal defect closure) for Ebstein's anomaly results in significant improvement of exercise tolerance, normalization of systemic arterial oxygen saturation and reduction of excess ventilation at rest and during exercise.

Adolescent↗
PubMed1991

Diastolic function in valvular heart disease.

Diastolic dysfunction in patients with valvular heart disease is characterized by an impaired isovolumic relaxation, a normal or even enhanced early diastolic filling rate and an increased myocardial stiffness. These abnormalities do not depend on coexisting systolic dysfunction but are often combined. Several mechanisms are responsible for the occurrence of diastolic dysfunction, such as increased wall stress, altered myocardial structure, subendocardial hypoperfusion and/or diastolic calcium overload. Postoperative regression of myocardial hypertrophy is beneficial in regard to wall stress, subendocardial hypoperfusion and calcium overload but diastolic dysfunction might become worse after valve replacement due to a relative increase in interstitial fibrosis consequent to the decrease in myocyte mass (= myocardial remodeling). Persisting diastolic dysfunction with a substantial rise in left ventricular filling pressure can be observed during dynamic exercise in postoperative patients with preoperative severe pressure overload hypertrophy. Thus, diastolic dysfunction can be present as a primary derangement of cardiac function and can be unmasked as an abnormal response of diastolic filling pressure during exercise.

Cardiomegaly↗
PubMed1980

Improvement in left ventricular function after myocardial revascularization: assessment by first-pass rest and exercise nuclear angiography.

Thirty-six patients with coronary artery disease were studied by first-pass radionuclide angiography to assess the effects of myocardial revascularization on exercise-induced myocardial ischemia. The radionuclide studies were performed in the 30 degree right anterior ablique position, at rest and during exercise, 1 to 3 days preoperatively and 10 to 14 days postoperatively. The mean population age was 53 years; the mean number of grafts placed was 4.0 per patient. Fifteen normal male volunteers were tested by rest and exercise radionuclide angiography to serve as normal control subjects. In all exercise radionuclide studies, progressive upright bicycle exercise was performed to symptoms of fatigue, dyspnea, or chest pain. The parameters of ejection fraction (EF), end-diastolic volume (EDV), and regional wall motion (RWM) were determined. Twenty-nine of the 36 patients had postoperative coronary arteriography that was correlated with radionuclide determinations. The results showed that in the normal subjects with maximal exercise the mean EF rose, the mean EDV increased 19%, and there was no exercise-induced regional wall motion dysfunction (ERWMD). In the patients with coronary artery disease prior to operation, the mean EF fell significantly, the mean EDV rose 24%, and 26 of 36 patients had ERWMD. After operation, the mean EF of the group rose, the EDV increased only 15%, and only two of 36 patients continued to show ERWMD. Of the eight patients who demonstrated on abnormal response postoperatively, seven had what was considered to be inadequate revascularization, and in one there was no explanation. The data demonstrate that myocardial revascularization does improve ventricular function by abolishing exercise-induced evidence of ischemia (decreased EF, increased EDV, and ERWMD) as assessed by radionuclide angiography. Failure to abolish the exercise-induced functional instability suggests incomplete revascularization.

Adult↗
PubMed1986

Rupture of abdominal aortic aneurysm during exercise. Gated blood pool studies.

There is a high prevalence of associated coronary artery disease in patients with abdominal aortic aneurysms. Exercise nuclear ventriculography is often used preoperatively to evaluate these patients. A patient who had a rupture of an abdominal aneurysm during exercise ventriculography is described. An instantaneous diagnosis of the acutely ruptured aneurysm was confirmed by blood pool scanning of the abdomen.

Aged↗
PubMed2000

Influence of valve replacement on plasma endothelin-1 level in mitral stenosis.

BACKGROUND AND AIM OF THE STUDY: The rise of pressure in the pulmonary circulation during the course of mitral stenosis leads to pathomorphological changes and a reduction in vascular compliance. Endothelial dysfunction is also promoted, with increased expression of endothelin. This aim of this study was to evaluate whether the increase in endothelin-1 levels in pulmonary hypertension due to advanced mitral stenosis is reversible after valve replacement. METHODS: Thirty-nine patients with isolated, longlasting post-rheumatic mitral stenosis were enrolled. During preoperative Swan-Ganz catheterization blood samples were withdrawn from the pulmonary artery and capillaries for measurement of endothelin-1 (ET-1). Similar examinations were performed six months after mitral valve replacement. Hemodynamic parameters were measured also during 25-W exercise effort. RESULTS: The mean preoperative hemodynamic parameters of the pulmonary circulation were moderately increased. Mean plasma levels of ET-1 were about three-fold higher than normal. Capillary levels of ET-1 were significantly higher than those in the pulmonary artery (1.78+/-1.22 versus 1.03+/-1.16 pg/ml, p <0.05). There was no significant correlation between ET-1 level and any hemodynamic or clinical parameters, except NYHA functional class. After surgery, pulmonary capillary levels of ET-1 fell significantly, but were still high (1.78+/-1.22 versus 1.41+/-1.00 pg/ml); ET-1 levels in the pulmonary artery were unchanged. Patients with persistently high ET-1 levels had significantly worse exercise hemodynamic parameters, especially of pulmonary arterial compliance. CONCLUSION: In patients with long-lasting, severe mitral stenosis, ET-1 levels remained increased and the ET-1 concentration gradient across the pulmonary circulation persisted for six months after valve replacement. High ET-1 capillary levels are correlated with poor exercise tolerance and poor exercise compliance of the pulmonary vessels.

Endothelin-1↗
PubMedDate not supplied

Cardiopulmonary performance during exercise in patients with repaired tetralogy of Fallot with absent pulmonary valve.

In patients with tetralogy of Fallot and absent pulmonary valve, the dilated pulmonary arteries sometimes result in bronchial compression and pulmonary symptoms due to airway obstruction, recurrent pulmonary infection, and development of bronchiectasis. After complete intracardiac repair, residual pulmonary disease may be expected to result in impaired cardiopulmonary performance during exercise. To assess this hypothesis, nine patients with tetralogy of Fallot and absent pulmonary valve underwent exercise testing and were compared to 38 patients with tetralogy of Fallot repaired using a transannular patch. All patients were exercised to maximum volition using a 1 minute incremental treadmill protocol with monitoring of pulmonary functions and expired gases. Maximal heart rate, maximal oxygen consumption, oxygen consumption at anaerobic threshold, and maximal respiratory exchange ratio were similar for the two groups. There was no significant difference for ventilation and gas exchange parameters at rest or at maximal exercise, and values for both groups were below the predicted normal for healthy subjects. Breathing reserve, however, did tend to be somewhat lower in the group with tetralogy of Fallot with absent pulmonary valve. In summary, despite significant preoperative symptoms, cardiopulmonary performance during exercise in patients with tetralogy of Fallot and absent pulmonary valve is similar to patients with tetralogy of Fallot repaired with a transannular patch.

Adolescent↗
PubMed1997

Pulmonary rehabilitation exercise program for high-risk thoracic surgical patients.

Preoperative assessment of the patient with moderate to severe COPD continues to be a difficult task. Pulmonary function tests cannot be the only deciding factor. Exercise testing is supported in the literature to improve the sensitivity and specificity in predicting perioperative morbidity and mortality rates. The presence of comorbid disease, especially COPD, increases the chances of postoperative pulmonary complications. Pulmonary rehabilitation in the nonsurgical COPD patient has been proven to be beneficial in improved exercise capacity and quality of life. The question which remains to be answered is whether a short-term, intense, and focused preoperative program in surgical candidates with resectable NSCLC and preexisting pulmonary dysfunction can influence outcome.

Carcinoma, Non-Small-Cell Lung↗
PubMed1996

Pharmacological stress testing with technetium-99m single-photon emission computerized tomography imaging in the preoperative assessment of patients undergoing noncardiac surgery.

Pharmacological stress testing with Tc-99m sestamibi is being used extensively for the diagnosis of coronary disease. Although there are no randomized and prospective studies using this technique for preoperative evaluation of patients undergoing noncardiac surgery, there are several studies that indicate that it is equivalent to exercise perfusion imaging and can be used for evaluating the prognosis of patients with coronary artery disease (CAD). This review will discuss these studies.

Coronary Disease↗
PubMed2026

Effectiveness of exercise-based prehabilitation on pre and postoperative outcomes of patients undergoing cardiac surgery-An umbrella review of systematic reviews.

AIMS: Individuals undergoing cardiac surgery are becoming older, frailer, and less mobile. Prehabilitation has shown to improve postoperative outcomes by optimizing preoperative physical function. This umbrella review aims to pool the systematic reviews assessing the effectiveness of exercise-based prehabilitation in cardiac surgery. METHODS AND RESULTS: The review followed the PRIOR checklist. PubMed, Embase, CINAHL, Cochrane library, Scopus, Web of science, ProQuest NAHD, ProQuest HMC, Open Grey and MedNar were searched using relevant keywords from inception to 16th December, 2024. Two reviewers screened and extracted data from the included reviews and assessed primary study overlap with the corrected covered area. Methodological quality of the reviews was evaluated with the A MeaSurement Tool to Assess systematic Reviews-2 scale. Certainty of evidence was assessed using a previously developed criteria for overview of reviews. Six systematic reviews with 30 unique trials and 6705 participants were included. The interventions assessed included breathing exercises, inspiratory muscle training, and exercise training. Prehabilitation reduced length of hospital stay, postoperative pulmonary complications, and clinically improved functional capacity with a very low to moderate certainty of evidence. However, there was uncertainty regarding the effects pertaining to adverse events and quality of life. The methodological quality of all reviews was critically low. The primary trials scored poorly in the domains of selection and detection bias. CONCLUSION: Exercise-based prehabilitation might reduce length of hospital stay and postoperative complications, and improve functional capacity. However, the quality of evidence is poor, and individual discretion is required before implementing them into practice. REGISTRATION: PROSPERO: CRD42023480100.

Humans↗
PubMed1980

Bullous emphysema. Progressive incremental exercise testing to evaluate candidates for bullectomy.

Various tests of both function and anatomy have been used in patients being considered for surgical resection of giant pulmonary bullae. A young patient had an excellent response to removal of a large bulla in the right lung. In addition to roentgenographic evaluation, ventilation perfusion scanning, and routine preoperative pulmonary function studies, we performed progressive incremental exercise testing to determine both preoperative and postoperative ventilatory and cardiac measurements. We feel that progressive incremental exercise pulmonary function adds another dimension to the selection and follow-up of patients being considered for operative bullectomy.

Adult↗
PubMed2001

Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus.

OBJECTIVE: We evaluated the usefulness of analyzing expired gas during exercise testing for the prediction of postoperative cardiopulmonary complications in patients with esophageal carcinoma. BACKGROUND DATA: Radical esophagectomy with 3-field lymphadenectomy is performed in patients with thoracic esophageal carcinoma but has a high risk of postoperative complications. To reduce the surgical risk, we performed preoperative risk analysis using 8 factors. Although hospital mortality was decreased when this risk analysis was used, severe cardiopulmonary complications still occurred. METHODS: The study group consisted of 91 patients who had undergone curative esophagectomy with 3-field lymphadenectomy. The maximum oxygen uptake, anaerobic threshold, vital capacity, percent vital capacity, forced expiratory volume in 1 second, percent forced expiratory volume, V.(25)/HT, forced expired flow at 75% of forced vital capacity to height ratio (FEF(75%)/HT), forced expired flow at 50% to 75% of forced vital capacity ratio (FEF(50%)/FEF(75%)), percent diffusion capacity for carbon monoxide, and arterial oxygen tension were measured. Patients were divided into 2 groups on the basis of the presence or absence of postoperative cardiopulmonary complications. RESULTS: Only the maximum oxygen uptake was significantly different between the 2 groups. All patients were grouped according to the value of the maximum oxygen uptake, and the occurrence of postoperative cardiopulmonary complications was calculated for each group. A cardiopulmonary complication rate of 86% was found for patients with a maximum oxygen uptake of less than 699 mL. min(-1). m(-2); for those with a value of 700 to 799 mL. min(-1). m(-2), the complication rate was 44%. CONCLUSIONS: The maximum oxygen uptake obtained by expired gas analysis during exercise testing correlates with the postoperative cardiopulmonary complication rate. On the basis of these results, esophagectomy with 3-field lymphadenectomy can be safely performed in patients with a maximum oxygen uptake of at least 800 mL. min(-1). m(-2).

Adult↗
PubMed2003

A prospective evaluation of lung volume reduction surgery in 200 consecutive patients.

OBJECTIVES: Though numerous studies have demonstrated the short-term efficacy of lung volume reduction surgery (LVRS) in select patients with emphysema, the longer-term follow-up studies are just being reported. The primary objectives of this study were to assess long-term health-related quality of life, satisfaction, physiologic status, and survival of patients following LVRS. DESIGN: We used a prospective cohort study design to assess the first 200 patients undergoing bilateral LVRS (from 1993 to 1998), with follow-up through the year 2000. Each patient served as his own control, initially receiving optimal medical management including exercise rehabilitation before undergoing surgery. Preoperative postrehabilitation data were used as the baseline for comparisons with postoperative data. The primary end points were the effects of LVRS on dyspnea (modified Medical Research Council dyspnea sale), general health-related quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]), patient satisfaction, and survival. The secondary end points were the effects of LVRS on pulmonary function, exercise capacity, and supplemental oxygen requirements. SETTING: A tertiary care urban university-based referral center. PATIENTS: Eligibility requirements for LVRS included disabling dyspnea due to marked airflow obstruction, thoracic hyperinflation, and heterogeneously distributed emphysema that provided target areas for resection. Patients were assessed at 6 months, 3 years, and 5 years after surgery. INTERVENTIONS: Preoperative pulmonary rehabilitation and bilateral stapling LVRS. MEASUREMENTS AND RESULTS: The 200 patients accrued 735 person-years (mean +/- SD, 3.7 +/- 1.6 years; median, 4.0 years) of follow-up. Over the three follow-up periods, an average of > 90% of evaluable patients completed testing. Six months, 3 years, and 5 years after surgery, dyspnea scores were improved in 81%, 52%, and 40% of patients, respectively. Dyspnea scores were the same or improved in 96% (6 months), 82% (3 years), and 74% (5 years) of patients. Improvements in SF-36 physical functioning were demonstrated in 93% (6 months), 78% (3 years), and 69% (5 years) of patients. Good-to-excellent satisfaction with the outcomes was reported by 96% (6 months), 89% (3 years), and 77% (5 years) of patients. The FEV(1) was improved in 92% (6 months), 72% (3 years), and 58% (5 years) of patients. Changes in dyspnea and general health-related quality-of-life scores, and patient satisfaction scores were all significantly correlated with changes in FEV(1). Following surgery, the median length of hospital stay in survivors was 9 days. The 90-day postoperative mortality was 4.5%. Annual Kaplan-Meier survival through 5 years after surgery was 93%, 88%, 83%, 74%, and 63%, respectively. During follow-up, 15 patients underwent subsequent lung transplantation. CONCLUSIONS: In stringently selected patients, LVRS resulted in substantial beneficial effects over and above those achieved with optimized medical therapy. The duration of improvement was at least 5 years in the majority of survivors.

Dyspnea↗
PubMed1984

Angina pectoris and blood lactate concentration during graded exercise.

Nineteen patients with angina pectoris referred for preoperative evaluation were studied by psychophysical scaling of the chest pain according to Borg and blood lactate determination at rest and during a graded exercise test. The exercise tests consisted of stepwise increments of 10 W every min. Anginal pain, systolic blood pressure, heart rate (HR), and blood lactate concentration were determined at the end of each work load. The exercise test was interrupted at a rated anginal pain level (RAP) of 5-6/9 ("strong"), and this load was referred to as Wmax. The patients were divided into three groups: A with a Wmax less than or equal to 74 W, B 75-124 W, and C greater than or equal to 125 W. At submaximal loads HR was almost identical at the same absolute work load in all three groups. The heart rate at Wmax varied, however, and averaged 98 (A), 118 (B), and 136 (C), respectively. Corresponding peak values for RAP were 3.8, 4.5, and 4.8. Blood lactate at rest ranged from 1.0-1.6 mmol X 1-1 and increased curvilinearly with intensity, which was also the case for RAP. RAP was almost linearly related to blood lactate in all three groups suggesting a causal relationship between these two parameters.

Aged↗
PubMed1995

Preoperative assessment of the patient with cardiac disease.

Assessment of the patient with cardiovascular disease is a challenging problem, especially for the subset of patients undergoing surgery. Perioperative cardiac morbidity affects more than 1.5 million people annually in the United States, and consumes more than +20 billion per year in health care resources. Solution of the problem initially had been addressed using routine historical and clinical evaluations and risk indices. More recently, nonroutine preoperative cardiovascular testing has been recommended, including exercise and Holter electrocardiography, radionuclide ventriculography, stress echocardiography, and dipyridamole thallium scintigraphy. Each of these tests has strengths and limitations that are addressed in this review. Paradigms for preoperative assessment of high-risk patients, based on the presence of coronary disease and the functional status of the patient, are presented and discussed. Diagnostic and therapeutic approaches for patients at high risk remain challenging; the mandate is for large-scale clinical trials to evaluate both the therapeutic and cost effectiveness of new preoperative assessment strategies.

Coronary Angiography↗
PubMed1981

Improvement in global and segmental left ventricular function after coronary bypass surgery.

Ventricular function was assessed at rest and during exercise by multiple gated cardiac blood pool scintigraphy before and after coronary artery bypass surgery in 21 patients. Resting left and right ventricular ejection fraction and segmental wall motion were unchanged by surgery. However, the postoperative exercise response of left ventricular ejection fraction (-1 +/- 12% vs 6 +/- 9%) and segmental wall motion score (medium -2.7 [range -8 to 2] vs -0.4 [range -6 to 2]) were significantly improved (p less than 0.05). The normal right ventricular ejection fraction exercise response was maintained after surgery. Previous myocardial infarction in 15 patients did not attenuate the observed improvement in ventricular function. In addition, normal postoperative left ventricular ejection fraction response to exercise was associated with symptomatic improvement. In three of six patients a normal preoperative left ventricular ejection fraction response to exercise was not maintained. Therefore, global and regional left ventricular reserve is improved by coronary bypass surgery and this improvement is not affected by previous myocardial infarction.

Adult↗
PubMed1976

[Function improvement in levography following aortocoronary bypass].

Actively contracting segments, preoperatively akinetic, were found in 8 of 63 patients, evaluated 6-12 months after aortocoronary surgery by coronary angiography. Ejection fraction was increased from 48.1% (S.D. 15.7) to 68.3% (S.D. 11.4). These patients are characterized by two simple clinical parameters: 1. All patients had angina pectoris at rest or at minimum exercise except for one; 2. preoperatively, there was a discrepancy between severe ventriculographic and discreet Ecg findings. These findings prove that myocardial function in coronary artery disease can be impaired at rest by ischemia, without clinical signs of coronary insufficiency, such as angina pectoris. Even severe impairment of left ventricular function is no contraindication for coronary artery surgery, if caused by reversible myocardial ischemia.

Adult↗