Don W. Chapman

The influence of residual disease after coronary bypass on the 5-year survival rate of 1274 men with coronary artery disease.

To determine the independent influence of the extent and site of residual disease on late survival, we analyzed the fate of 1448 consecutive patients who had coronary artery bypass surgery during 1968-1974. There were 1274 males, mean age 53.4 ± 8 years (range 24-75 years). Females were excluded from further analysis. Two hundred twenty-six patients (17.7%) had one-vessel disease, 492 (38.6%) had two-vessel disease, 408 (32.0%) had three-vessel disease and 148 (11.6%) had left main stenosis. Survival was determined at a follow-up of at least 5 years. Survival data were analyzed by Kaplan-Meier survival curves for the patients with two- and three-vessel disease according to the extent of residual disease. For patients with two-vessel disease and good ventricular function, survival was similar at 5 years, 89.1 % and 87.7% for no and one residual lesion; for those with two-vessel disease and poor ventricular function, 5-year survival was 84.5% and 52.6% for no and one residual lesion; for those with three-vessel disease and good ventricular function, it was 92.0 %, 83.4%, and 75.0% for no, one and two residual lesions, respectively. With poor ventricular function, the corresponding results were 83.1%, 72.5% and 23.1%. The Cox multivariate analysis technique was used to analyze the influence of age at operation, number of vessels diseased preoperatively, preoperative left ventricular function, period of surgery, and the number and site of residual lesions after operation. Residual disease, age at operation and left ventricular function were the most important variables affecting survival of patients with two- and three-vessel disease. Residual lesions of the left anterior descending or circumflex coronary arteries were the most important predictors of survival; residual lesions of the right coronary artery exerted a lesser influence. The results of this study suggest that the greatest benefit in terms of improved survival may come from the first two to three grafts placed.

Primary Pulmonary Hypertension Review of Literature and Results of Cardiac Catheterization in Ten Patients

A brief historical review of primary pulmonary arteriosclerosis and hypertension has been given. Ten additional cases with detailed laboratory, roentgenographic, electrocardiographic, cardiac catheterization, and angiocardiographic studies are presented. The findings on 4 necropsied cases are also included. Progressive exertional shortness of breath, syncope, left chest pain, right ventricular hypertrophy, and pulmonary arterial dilatation, combined with high right ventricular and pulmonary arterial pressure and normal pulmonary capillary pressure in the absence of pulmonary disease, should be extremely suggestive of primary pulmonary hypertension. An unrelenting downhill course of right ventricular failure is usually seen.

Some Pharmacological Properties of Three New Mercurial Diuretics.

Summary The compounds, 3–chloromer–curi–2–methoxypropylurea (1347Ex), 3–car–boxymethylmercaptomercuri − 2 – methoxypro–pylurea (1353 Ex), and. 3 – (α–carboxye thylmer–captomercuri) − 2 –methoxypropylurea (1431–Ex), had 3 or 4 times the diuretic potency of meralluride in the dog. Twenty–four and 48 hour mercury excretion rates were comparable to that of meralluride at the same dosage level. Chronic toxicity studies indicated no essential difference between meralluride and the other compounds, if the greater diuretic potency of the new compounds was considered and the dosage adjusted accordingly. Large amounts of 1353Ex and 1431 Ex were infused intravenously without disturbing cardiac function, but the acute cardiac toxicity of 1347Ex, although greater than the other 2 compounds, appeared to be less than meralluride.

Ventricular aneurysm. Fourteen cases subjected to cardiac bypass repair using the pump oxygenator.

Abstract Ventricular aneurysm is a frequent late complication of extensive myocardial infarction. Although cardiac rupture is rare, serious and frequently incapacitating symptoms result from the impairment of cardiac function produced by the noncontractile, expansile aneurysm. Embolism from mural thrombi may also produce disastrous complications. Fourteen patients with aneurysm of the left ventricle following myocardial infarction have been treated by surgical excision of the aneurysm utilizing an extracorporeal pump oxygenator for temporary cardiopulmonary bypass, with three deaths. Cardiac catheterization studies performed prior to surgery in twelve of these patients revealed a reduction in cardiac output and significant pulmonary hypertension. After operation cardiac function improved and the eleven survivors received clinical benefits. The optimum time for surgical intervention following myocardial infarction is probably governed by the pathologic state of the diseased myocardium. At 3 months fibrous tissue develops at the margin of the aneurysm and firm repair of the ventricle after aneurysmectomy is facilitated. Surgical excision and ventricular repair is a feasible and rational surgical treatment for ventricular aneurysm following myocardial infarction when the lesion is of sufficient size to cause impairment of cardiac function.

Neurofibroma; A gastroscopic report

At the time of the gastroscopic examination, the patient had a severe secondary anemia causing an extreme pallor of the gastric mucosa. This extreme pallor was responsible for both the poor visualization and the difficulty encountered in differentiating between a malignant and benign lesion. The ulcerated area was not seen through the gastroscope as it was situated on the distal part of the mass below the greatest diameter of the tumor. Since it is our policy to have all suspicious lesions removed, this was carried out. It is interesting to speculate on the possibility that if we had examined this woman after she had had the transfusions, would the more normal color of the mucosa have enabled us to differentiate between a benign and malignant lesion?

The exercise electrocardiogram: An aid in the diagnosis of arteriosclerotic heart disease in persons exhibiting abnormally large Q3 waves

Abstract Twenty persons with the single electrocardiographic abnormality of a large Q wave in lead III were studied by the exercise electrocardiogram. In five persons who had a previous myocardial infarction the exercise electrocardiogram was positive and remained so through a minimum period of one year after recovery. In the others who had no clinical evidence of previous infarction the exercise electrocardiogram was negative or unaltered. The significance of these results is discussed in relation to the diagnosis of arteriosclerotic heart disease.

Observations on two patients with paroxysmal ventricular tachycardia treated by the intravenous administration of quinidine lactate

Abstract Two cases of ventricular tachycardia treated by the intravenous administration of quinidine lactate are reported. The possible etiological factors, diagnostic difficulties, and electrocardiographic findings in ventricular tachycardia are presented. The oral and intravenous administration of quinidine are discussed, also.

Blood Flow Determinations and Cardiodynamic Effects of a Venous Shunt in Pulmonary Hypertension.

Conclusion 1. In acute experiments producing increased pulmonary vascular pressure in dogs, the capacity of a pulmonary vein-azygous vein shunt was found to be up to 8% of the total cardiac output. 2. There was no consistent evidence that the presence of the shunt produced or added to the strain on the right ventricle or interfered with the filling pressure of the left ventricle.

Acute myocardial infarction: Decision making in the first critical hours

Decisions about early management of acute myocardial infarction require great care and astuteness, since the threat of sudden death is the greatest during the first few hours after onset of infarction. General measures of acute care include relief of pain and management of arrhythmia. Drug therapy with beta-adrenergic blocking agents or vasodilators may also be indicated. Other measures that may be considered (some of which are controversial) include hemodynamic monitoring, mechanical circulatory assistance, ambulatory electrocardiographic monitoring, exercise testing, modification of risk factors, and coronary angiography. Intracoronary administration of streptokinase, which is still investigational, has shown marked preservation of myocardial tissue in some cases.

Reconstitution of Coronary Blood Flow Using Autogenous Vein Bypass Grafts.

Excerpt Our groups extensive successful use of autogenous vein grafts in bypass and reconstruction of small arterial vessels in extremities prompted use of similar bypass grafts in the coronary ci...