Rajindar Singh

Simultaneous determinations of cardiac output by thermal dilution, fiberoptic and dye-dilution methods.

Abstract A total of 225 simultaneous dye-dilution and thermal dilution and 176 dye-dilution and fiberoptic dilution cardiac output curves were obtained from 14 mongrel dogs at basal levels and after the injection of isoproterenol or angiotensin. The analog signal was digitized with an Ambilog 200 computer, and the data were analyzed with a Burroughs B5500 digital computer. Experience gained with this analysis has led to an on-line program for cardiac output determinations with digital readout using the Ambilog 200. Results indicate (1) that the fiberoptic technique is sufficiently accurate and desirable for acute studies but until the long-term risk of clot formation on the catheter tip is thoroughly evaluated, the use of this technique in chronic studies of patients under intensive care is questionable and (2) that thermal dilution cardiac output determinations correlate well with those of the other techniques studied and that the thermal method is uniquely attractive for use in the long-term monitoring of cardiac output necessary to the management of the critically ill patient.

Evaluation of myocardial contractility in man

Abstract In 53 patients studied at cardiac catheterization, the relationship between the maximal rate of rise of the left ventricular pressure and the integrated isovolumetric stress was observed to be an excellent index of contractility. A clearer separation of patients with evidence of myocardial disease was possible with this index than with other parameters assessed. The ejected fraction (fiber-shortening) was noticed to be an inverse function of the peak systolic tension (afterload) as expected from extensive experimental work. The highest reciprocity was observed in patients with myocardial disease, indicating the probable deleterious effect of an increasing peripheral resistance in this type of patient. End-diastolic stress was found to be significantly higher in patients with evidence of myocardial damage, due to a relatively thinner myocardial wall in this group.

Mitral stenosis associated with partial anomalous pulmonary venous return (with intact atrial septum). An unsolved question.

Abstract In a patient with severe mitral stenosis, intact atrial septum and venous drainage of the left lung into the left innominate vein, increased values for pulmonary capillary wedge pressure and flow in the abnormally draining left lung equaled those found in the normally draining right lung. The possible mechanisms for this discrepancy are discussed. Total surgical correction of these lesions was successful.

Acute dissecting aortic aneurysm resulting from retrograde brachial arterial catheterization. Successful operative intervention.

Abstract A case of type I aortic dissection occurring as a complication of retrograde catheterization of the right brachial artery is described. The problem was immediately identified and, after appropriate studies were performed, operative intervention was successfully carried out. Although this lesion is an extremely rare complication of the catheterization procedure, the possibility of its occurrence must be kept in mind. Prompt recognition, accurate diagnostic evaluation and immediate operation can result in a successful outcome.

Left ventricular ejection fraction and results of cardiac surgery.

The results of prosthetic valve replacement in 64 patients and coronary revascularization or aneurysmectomy in 58 patients were analyzed 1 year after the operation. 24 early and late deaths were found