J.O'Neal Humphries

Natural History of Ischemic Heart Disease in Relation to Arteriographic Findings A Twelve Year Study of 224 Patients

The severity of the atherosclerotic disease of the coronary arteries is demonstrated to be an important predictor of survival in a group of 224 patients followed from 5 to 12 years after coronary arteriography. The group consisted of young patients (average age 41.8 years) without hypertension or congestive heart failure, who were studied during the stable phase of their disease. The current status of 218 or 97% of this group of patients is known.

Prognosis of Surgically Corrected Coarctation of the Aorta A 20-Year Postoperative Appraisal

A long-term retrospective analysis of 248 patients, 11-25 years after surgical correction of coarctation of the aorta, revealed a high incidence of premature cardiovascular disease. Twelve percent of patients with follow-up have died. It is suggested that premature death in patients with adequate surgical repair may be related to the duration of preoperative hypertension. Fifty-nine patients were evaluated on a standard hospital protocol. Seventy-eight percent had evidence of cardiovascular disease and over 40% had no change or had increased blood pressure over the preoperative value.These data emphasize the importance of early diagnosis and treatment for patients with coarctation of the aorta as well as the need for close postoperative follow-up.

Unstable angina pectoris: Morbidity and mortality in 57 consecutive patients evaluated angiographically

Fifty-seven consecutive patients presenting with unstable angina pectoris or so-called pre-infarction angina were prospectively evaluated by clinical and angiographic studies. One patient died during angiography and another died of acute myocardial infarction 11/2 hours after cardiac catheterization. Forty-five patients had significant obstruction in two or three coronary arteries. The average left ventricular ejection fraction was 59 percent. Of 15 patients treated medically, 10 were potential candidates for surgery. One of these 10 died during hospitalization and 9 survived. The nine survivors were followed up for an average of 10 months; six reported symptomatic improvement, and one had an uncomplicated myocardial infarction 6 months after study. Aortocoronary saphenous vein bypass was performed in 40 patients, of whom 9 died during hospitalization and 31 survived operation. Of the 31 survivors, 1 had an uncomplicated myocardial infarction 9 months postoperatively; there were no late deaths in this group during a follow-up period averaging 16.7 months. Thirty of the 31 survivors reported marked symptomatic improvement, and 21 of these survivors were pain-free.

Coronary angiography and left ventriculography in survivors of transmural and nontransmural myocardial infarction

Recent studies have suggested a similar prognosis for patients with transmural myocardial infarction and nontransmural myocardial infarction despite a smaller infarct size in the latter patients estimated by creatine phosphokinase (CPK). Thirty-one patients with transmural myocardial infarction and 17 patients with nontransmural myocardial infarction as defined by electrocardiographic criteria underwent coronary angiography and left ventriculography from 10 to 24 days after they had an acute myocardial infarction. Forty-three of these 48 patients were asymptomatic following their myocardial infarction. When compared to patients with nontransmural myocardial infarction, those with transmural myocardial infarction had greater peak CPK levels, 1,090 +/- 210 versus 290 +/- 60 IU (p less than 0.01). There was no difference in prevalence of single, double or triple vessel coronary artery disease, mean number of coronary arteries 50 per cent narrowed (2.0 +/- 0.2 versus 2.0 +/- 0.2), near total or total occlusions, coronary score (Friesinger) (7.9 +/- 0.6 versus 8.2 +/- 0.7), left ventricular ejection fraction (48 +/- 2 versus 53 +/- 4), or per cent of akinetic-dyskinetic myocardial segments (66 of 242 [27 per cent] versus 32 of 132 [24 per cent]) between two groups. The similar extent of coronary artery narrowing and degree of left ventricular dysfunction may explain the similar prognosis for patients with transmural myocardial infarction and those with nontransmural myocardial infarction despite differences in enzymatically estimated acute infarct size.

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.

Giant right atrium in rheumatic mitral stenosis: Atrial enlargement restricted by mural calcification

Abstract Attention is called to the occurrence of a giant-sized right atrium and a nearly normal-sized left atrium in 3 adult patients with rheumatic mitral stenosis. In each patient the left atrial wall was calcified, probably the result of organization of intraatrial thrombus, and the calcific deposits prevented the left atrium from dilating. All patients also had tricuspid regurgitation, which certainly contributed to the development of enormous right atrial dilatation, although other undetermined factors were probably operative also.

Purulent pericarditis with asymmetric cardiac tamponade: A cause of death months after coronary artery bypass surgery

Summary This relatively young man with a host of medical problems including polycystic kidneys, chronic renal failure, long-standing hypertension, and premature atherosclerosis, died of cardiovascular disease; not, as might be expected, from his severe coronary artery disease but rather from purulent pericarditis. The latter was an unusual and unexpected consequence of the entire complex of his illnesses and because of its confinement to the posterior pericardium by postoperative adhesions produced an asymmetric cardiac tamponade.

Intrapericardial Cyst Formation in Constrictive Pericarditis Simulating Tricuspid Stenosis

Two cases of constrictive pericarditis with intrapericardial cyst formation are presented. In each, a tricuspid diastolic murmur was present, and confirmation of a tricuspid valve gradient was obtained at cardiac catheterization. Angiographic studies revealed that the tricuspid valves were distorted by the cysts. In both patients, surgical excision was successfully achieved.In case 1 a blood-containing cyst was found, the etiology of which is obscure. Case 2 was associated with rheumatoid arthritis, and the compression resulted from a chronic abscess that probably arose at a previous pericardiectomy.

Care of the patient undergoing valvular heart surgery

Summary Successful relief of stenosis or regurgitation of one or more heart valves by primary repair or replacement with a prosthesis may reverse the signs and symptoms of heart failure in most patients. Of the survivors of the operative and postoperative period, approximately four out of every five can be successfully rehabilitated and returned to a vocation.