Nevin M. Katz

Severe aortic regurgitation from systemic hypertension (without aortic dissection) requiring aortic valve replacement: Analysis of four patients

Clinical and morphologic observations are described in four patients who had severe aortic regurgitation from severe systemic hypertension unassociated with aortic dissection; each patient underwent aortic valve replacement. Although aortic regurgitation of minimal or mild degree is well recognized to occur in patients with systemic hypertension, severe degrees of aortic regurgitation are rare in such patients; aortic valve replacement in such patients has not previously been reported. Why these four patient had such severe aortic regurgitation was not determined. Although systemic hypertension is rarely a cause, it nevertheless must be added to the list of causes of severe pure aortic regurgitation.

Desmopressin acetate in cardiac surgery: A double-blind, randomized study

Use of desmopressin acetate (DDAVP) for patients having cardiac surgery is controversial. We did a double-blind, randomized study of 83 patients having cardiac operations at Georgetown University Hospital. The effect of DDAVP on bleeding as compared to placebo was evaluated by blood loss, replacement volume, and laboratory tests. There were no significant differences in baseline and intraoperative data between the DDAVP (n = 40) and placebo (n = 43) groups. Total drainage for the first 24 postoperative hours was 1,214 mL ( ± 78) for the DDAVP group and 1,386 mL ( ± 116) for the placebo group (not significant). There were no significant differences in replacement therapy. In this study, administration of DDAVP did not decrease bleeding.

Changing practice of coronary bypass surgery and its impact on early risk and long-term survival.

Over the past 20 years, a steady evolution in cardiac surgical techniques for coronary bypass graft (CABG) surgery has occurred. Recent reports are refining our knowledge of early and late survival after CABG surgery. Studies have documented the changing importance of well-recognized risk factors. New models that take into account multiple factors and that predict early risk of CABG surgery with good reliability have been developed. Long-term survival has been related to factors such as age, gender, diabetes mellitus, race, smoking history, left ventricular function, estrogen treatment in women, and serum lipids. Several recent studies provide insight into decision making regarding CABG versus catheter interventions for both primary and secondary revascularization. Data concerning new techniques, such as minimally invasive surgery, document promising results but also the anticipated learning curve of new procedures. Overall, favorable short-term and long-term survival results after CABG surgery continue to be reported despite an increasing elderly and complex patient group undergoing cardiovascular surgical procedures.

Predictors of length of hospitalization after cardiac surgery

The cardiac surgical data base at Georgetown University Hospital was reviewed for patients operated on between January 1, 1980, and September 30, 1986, to determine predictors of length of postoperative hospitalization. Mortality among the 1,919 operations was 115 (6%). In the study group of 1,804 operations resulting in survival for at least 30 days, the following factors were analyzed: type of operation, age, sex, New York Heart Association (NYHA) Functional Class, urgency of operation, preoperative myocardial infarction (MI), weight, body surface area, hypertension, diabetes mellitus, previous cardiac operation, smoking history, and family history of cardiac disease. The overall mean length of hospitalization was 10.7 +/- 5.6 days. The analyses indicated that valve operation, age less than 30 and greater than 60 years, female sex, NYHA Class IV, urgent operation, preoperative MI 1 to 4 weeks before operation, and diabetes mellitus requiring medical treatment prolonged hospitalization, but generally by only 2 days. Major prolongation of hospitalization was associated with age in the 20- to 30-year and 80- to 90-year brackets. Unexpectedly, heavy body weight and smoking were not predictive.

Hepatoma presenting as a right atrial mass

pericarditis as the first manifestation of AIDS in the course of a disseminated tuberculosis. Even with the serious immunosuppressed state of these patients, the standard treatment is usually successful and at this moment (11 months from the begining of the treatment) there is no evidence of tuberculosis in our patient. We have recently described 12 patients with tuberculosis and infection by human immunodeficiency virus; among them only two patients showed a typical pattern of a reactivation disease; the remaining patients showed an atypical pattern.6 Cardiac manifestations in AIDS are very unu5ud and limited to nonbacterial thrombotic endocarditis, focal metastatic involvement by Kaposi’s sarcoma, or congestive cardiomyopathy probably of viral origin.6 Cardiologists should be aware that AIDS may start with cardiac involvement within the context of a systemic disease.

Determinants of Cardiac Failure after Coronary Bypass Surgery within 30 Days of Acute Myocardial Infarction

Timing of coronary artery bypass grafting after acute myocardial infarction (MI) is controversial, especially if myocardial function is depressed. Early coronary artery bypass grafting may result in reperfusion injury causing cardiac failure. Delay, however, may risk a second ischemic event. This study was performed to determine if four preoperative factors--time after MI, ejection fraction, ischemia (need for intravenous administration of nitroglycerin), and failure (need for inotropic support)--independently predict postoperative cardiac failure. Postoperative failure was defined as the need for inotropic support or intraaortic balloon pumping. The study group consisted of 145 patients who underwent isolated coronary artery bypass grafting between January, 1980, and July, 1985, within 4 weeks of an acute MI. Postoperatively 38 patients (26%) had cardiac failure. Five patients, all of whom had postoperative cardiac failure, died. Univariate and stepwise logistic regression analyses showed preoperative failure (p = .0001), ejection fraction less than 45% (p = .002), and preoperative ischemia (p = .02) were predictors of postoperative cardiac failure. Time after MI was not found to be an independent predictor (p = .96). We conclude that if ischemia or threatening coronary anatomy is present early after MI and clinical improvement is not occurring, operative intervention should be strongly considered at that time, as it does not appear that delay itself reduces the risk of cardiac failure and may risk a second ischemic event.

Myxoid variant of malignant fibrous histiocytoma of the heart

Malignant-fibrous histiocytoma (MFH), first described by O’Brien and Stout’ in 1964, has become a well-recognized entity.1,2 Rarely MFH primarily involves the heart.3r4 It tends to be an aggressive tumor and may be confused with left atria1 myxoma. A 49-year-old white woman was admitted with a 3-month history of intermittent episodes of sudden shortness of breath and crushing chest pressure. The patient had a regular heart rate and rhythm with a grade III/VI holosystolic

Isolated descending thoracic aortic aneurysm in Marfan's syndrome

Abstract Aneurysm of the ascending aorta due to cystic medial necrosis is usually the first aortic manifestation of Marfans syndrome. Aneurysm of the descending thoracic aorta in the patient with Marfans syndrome has been associated with ascending aortic and, often, abdominal aneurysmal disease. 1,2 We recently treated a woman with features characteristic of Marfans syndrome who had an isolated aneurysm of the descending thoracic aorta. To our knowledge, only 1 other such case has been reported previously. 3

Cardiac valve replacement for stenotic bicuspid aortic valve in husband and for purely regurgitant prolapsed mitral valve in wife

Abstract Congenital heart disease is recognized to occur in families, i.e., in a parent or grandparent and in 1 or more siblings. The occurrence of congenital heart disease in both husband and wife must indeed be rare, and even more so is the occurrence of cardiac valve replacement in both husband and wife. Such was the case, however, in 2 recently studied patients. Each had the most common congenital heart disease that occurs in their sex, namely, mitral valve prolapse in women and bicuspid aortic valve in men. 1

Venovenous Extracorporeal Membrane Oxygenation for Noncardiogenic Pulmonary Edema After Coronary Bypass Surgery

A 71-year-old woman with noncardiogenic acute pulmonary edema early after having a coronary operation was treated with venovenous extracorporeal membrane oxygenation for uncontrollable hypoxia. Adequate oxygenation was achieved, the rapid deterioration of her condition was reversed, and ventilatory settings could be moderated. Two and a half days later, the patient was weaned from the system. At the time of this writing, the patient was in her sixth postoperative month and doing well. Details of this fairly simple but powerful technique are described.