George J. Taylor

Holt-Oram syndrome

The autosomal dominant association of upper extremity skeletal defects with congenital heart disease is known as the Holt-Oram syndrome. We reviewed our experience with 39 affected patients of whom 15 were considered new mutations. Wide varieties of skeletal defects and congenital heart disease were observed, and the severity of skeletal involvement did not parallel that of cardiac disease. These patients demonstrate four previously unemphasized points: (1) There is a striking asymmetry of skeletal involvement, with the left side more severely affected. (2) Patients with skeletal defects alone can transmit both skeletal and cardiac defects to their children. (3) Hypoplastic peripheral vessels may be an associated abnormality and can result in difficulty with cardiac catheterization. (4) Electrocardiographic changes of terminal conduction delay in the right anterior chest leads were nor uniformly present in patients with otherwise typical secundum atrial septal defects.

Prognostic cardiac catheterization variables in survivors of acute myocardial infarction: A five year prospective study

The prognostic variables from predischarge coronary angiography and left ventriculography in survivors of acute myocardial infarction during the years 1974 to 1978 were evaluated in 143 patients (less than or equal to 66 years of age) with documented myocardial infarction who were then followed up prospectively for 5 years. One half of the study population had triple vessel coronary disease (greater than or equal to 50% stenosis). However, only 7% of patients had severely depressed left ventricular function with an ejection fraction less than or equal to 29%. Evaluation of the contribution of many clinical and angiographic variables to a first cardiac event (death, nonfatal reinfarction or coronary artery bypass surgery) was considered with Kaplan-Meier actuarial curves and multivariate Coxs hazard function analysis. A risk segment was defined as an area of contracting myocardium supplied by a coronary artery with a greater than 50% stenosis. Multivariate analysis demonstrated that right plus left anterior descending coronary artery stenoses (p less than 0.01), ejection fraction (p less than 0.01) and the presence of risk segments (p less than 0.05) were significant predictors of outcome. Furthermore, on separate multivariate analyses, the angiographic variables added significantly to the clinical variables to predict cardiac events over 5 years of follow-up. Therefore, in survivors of acute myocardial infarction who undergo cardiac catheterization, additive prognostic information is obtained that can be used to stratify risk over 5 years.

Comparative cost of myocardial revascularization: Percutaneous transluminal angioplasty and coronary artery bypass surgery

A consecutive series of 78 patients having percutaneous transluminal coronary angioplasty for single vessel coronary artery disease and 85 patients having single vessel coronary artery bypass graft surgery were followed up prospectively for 1 year. Days in hospital and angiographic and revascularization procedures were counted in the two groups of patients and total cost of care for 12 months was calculated using current billing levels. Angioplasty was initially successful in 74% of patients; because of initial failure in 26% and late restenosis in 18%, bypass surgery was ultimately needed in 23 of 78 patients having coronary angioplasty. Nevertheless, total cost of care per patient was 43% lower for those having angioplasty as an initial procedure for single vessel coronary artery disease.

Recurrent cardiac tamponade and large pericardial effusions: Management with an indwelling pericardial catheter

A new technique, using an atraumatic indwelling catheter, has been developed for short-term management of large or rapidly reaccumulating pericardial effusions. This technique (1) permits continuous pericardial fluid drainage, obviating repeated aspirations; (2) provides a convenient route for intrapericardial instillation of chemotherapeutic agents; and (3) enables one to await the results of diagnostic studies without subjecting a patient to thoracotomy. Experience in three patients suggests that in some cases the use of this catheter may eliminate the need for surgery; in others, it may serve as a valuable temporary measure to achieve stabilization of the patients condition.

Comparison of Regional Wall Motion Determined by Two-Dimensional Echocardiography, Radionuclide Angiography, and Left Ventriculography

Considerable recent interest has been focused on the use of noninvasive methods for assessing left ventricular wall motion. Two-dimensional echocardiography (2DE) and gated radionuclide angiography (RNA) have been shown to accurately assess left ventricular segmental wall motion [1, 2, 3, 4]. The current investigation compared both noninvasive techniques with contrast left ventriculography (LVG) in the same patients. When significant discrepancies existed between techniques, coronary artery and valvular anatomy were examined to determine the basis of the discrepancy.

The Primary Care Physician And Thrombolytic Therapy For Acute Myocardial Infarction: Comparison Of Intravenous Streptokinase In Community Hospitals And The Tertiary Referral Center

From September 1982 through December 1987, 1012 patients were treated with intravenous streptokinase within 6 hours of acute myocardial infarction. Most of them (816/1012, 81 percent) were treated in community hospitals by primary care physicians. The remaining 196 (19 percent) were treated in the referral center, usually by a cardiologist. Cardiac catheterization within 2 days showed an open infarct artery in 87 percent of the community hospital and 83 percent of the referral center patients (P = NS). Predischarge ejection fraction was similar for community hospital and referral center patients (49 percent ± 14 percent versus 51 percent ± 14 percent, respectively), and there was a similar rate of bleeding complications (10 percent versus 13 percent, respectively). We conclude that primary physicians can use intravenous streptokinase effectively and safely in the treatment of patients in community hospitals.