Charles S. Wilson

Aortic Stenosis and Mucopolysaccharidosis

A 43-year-old man had severe aortic stenosis and Maroteaux-Lamy syndrome (mucopolysaccharidosis, type VI). Aortic-valve replacement gave a good long-term result. Information was obtained indicating that his two brothers had also had mucopolysaccharidosis and aortic stenosis and that both had died of cardiac disease. This paper reviews the literature on cardiac involvement in mucopolysaccharidosis.

Bilateral arteriosclerotic coronary arterial aneurysms successfully treated with saphenous vein bypass grafting

A man with ischemic heart disease was discovered to have bilateral coronary arterial aneurysms that were sucessfully treated with saphenous vein grafting. Preoperative coronary arteriograms revealed a tight luminal stenosis at the proximal end of the large aneurysm in the left anterior descending artery, suggesting poststenotic dilatation as an etiologic or contributing factor. The right coronary artery was totally occluded proximally, but was noted to be aneurysmal at operation. This is the 14th published case of nonfistulous coronary arterial aneurysm diagnosed in vivo, and the first associated with proximal luminal stenosis.

Correlation between segmental early relaxation of the left ventricular wall and coronary occlusive disease.

Fifty of 305 patients studied angiographically had segmental early relaxation phenomenon (SERP) of the anterolateral or apical left ventricular wall. Fourteen of the 50 patients had cardiac abnormality other than, or in addition to, coronary occlusive disease. Of the remaining 36 patients, 35 had significant lesions in the left anterior descending artery (LAD) and one had occlusion of the proximal left circumflex artery. SERP was noted in 35 (37.2 per cent) of 94 patients with LAD disease who did not have severe anteroapical contraction abnormality. SERP was found in none of 49 patients who had neither significant coronary occlusive disease nor other cardiac abnormality. Eight patients were restudied after bypass grafting of the LAD. Three patients with patent grafts no longer demonstrated SERP. Five had persistent SERP, but four of these had occluded LAD grafts or nongrafted disease in other vessels supplying the anterolateral wall. Myocardial ischemia appears to be one cause, but probably not the only cause, of SERP.

Acquired Aortic Stenosis in Systemic Lupus Erythematosus

Two patients with systemic lupus erythematosus had aortic valvular stenosis resulting from massive thrombotic deposits on the valve. This condition has not been described previously, but a similar process has been reported to have caused mitral stenosis in a patient.

Mid-diastolic aortic valve opening in severe acute aortic regurgitation.

SUMMARYA case of severe acute aortic regurgitation is reported. Echocardiographic findings included mid-diastolic opening of the aortic valve, premature closure of the mitral valve, diastolic shuddering of the anterior mitral leaflet, probable prodemonstration of the flail aortic cusp in the left ventricular outflow tract, and increased left atrial and left ventricular dimensions. Correlation with hemodynamic, angiographic and surgical evidence is made.

Bilateral nonfistulous congenital coronary arterial aneurysms

A 15 year old boy collapsed and died after participating in a basketball game. Autopsy revealed bilateral congenital coronary arterial aneurysms. The diagnosis was made post mortem but, retrospectively, might have been suspected during life, even before angiography. The clues to the correct diagnosis were chest pain, a systolic and diastolic murmur and a mass on the right heart border in the chest roentgenogram.

Paramedics as decision makers on the activation of the catheterization laboratory in the presence of acute ST-elevation myocardial infarction

MATERIALS AND METHODS To minimize delays in time to reperfusion in an urban-suburban North Carolina County, Guilford County Emergency Medical Services (EMS) and Moses Cone Hospital, Greensboro, NC, have collaborated to use the acquisition of 12-lead electrocardiographs and their paramedic interpretation to initiate the catheterization laboratory team and cardiologist; independent of over read by a physician. The study population of 91 patients was divided into the catheterization laboratory activation by EMS and catheterization laboratory activation by the emergency department physician (ED-MD) groups, and also by EMS and self-transported groups. RESULTS The EMS group had shorter median time intervals from hospital door to percutaneous coronary intervention (PCI) with balloon inflation than those patients who self-transported to the hospital. Also, patients who were treated during the EMS activation of the catheterization laboratory phase had shorter median hospital door to PCI times than those who were treated during ED-MD activation of the catheterization laboratory. CONCLUSION The time from hospital arrival to PCI with balloon inflation was significantly shorter during the period in which EMS activated the catheterization laboratory than during the period the laboratory was activated by hospital staff. Thus, paramedics with quality electrocardiogram interpretation training and education can identify patients with acute ST-elevation myocardial infarction and properly activate the catheterization laboratory.

Membranous subaortic stenosis complicated by aneurysm of the membranous septum and mitral valve prolapse

The clinical, echocardiographic, and catheterization findings in a patient with discrete subaortic stenosis, aneurysm of the membranous interventricular septum, and mitral valve prolapse are presented. Echocardiography showed a subaortic membrane, abnormal aortic valve motion, accentuated systolic anterior motion of the membranous interventricular septum, and prolapsing mitral leaflets. Cardiac catheterization confirmed the diagnoses. The possible functional interrelationship of these lesions is discussed.

Percutaneous extraction of a fractured, exposed atrial “J” lead retention wire

The recent identification of fracturing of the retention wire in the Telectronics atrial lead, models 329-701 and 330-801, and the report of death due to cardiac tamponade caused by aortic puncture resulting from protrusion of the retention wire, necessitates fluoroscopic screening of these patients and the explantation of all leads identified to have the component failure. We present in this paper a percutaneous alternative to lead explantation in patients with protrusion of the retention wire through the polyurethane insulation and with an otherwise properly functioning atrial lead.

Results of Elective Aortocoronary Saphenous Vein Graft Surgery in a Community Hospital

In a community hospital setting, without academic affiliation or house staff coverage, 145 patients had elective saphenous vein graft surgery between January 1970 and January 1973. Patients with good left ventricular function, with or without associated procedures, had an operative mortality of 2.4%. The surgical mortality of patients who had associated procedures was 9.5%. The overall operative mortality was 6.2% with an immediate postoperative myocardial infarction rate of 17%. Results in 38 patients with pre-infarction angina were no different from the group as a whole. The risk of surgery is best categorized by a combination of angiographic severity of coronary artery disease plus severity of left ventricular dysfunction estimated by left ventriculogram.