Robert J. Adolph

Cardiac Prognosis in Noncardiac Geriatric Surgery

Predictors of perioperative complications, including cardiac death, ventricular tachycardia or fibrillation, and heart failure or myocardial infarction, were assessed in an initial study of 100 patients aged 65 years or older scheduled for elective abdominal or noncardiac thoracic surgery. Preoperative history, results of physical examination, chest roentgenogram, electrocardiogram, laboratory data, Dripps (American Society of Anesthesiologists) class, and Goldman cardiac risk index were compared with rest and exercise radionuclide ventriculograms. Thirteen patients had perioperative cardiac complications, and 6 died. Multivariate analysis showed that an inability to do 2 minutes of bicycle exercise in the supine position to raise the heart rate above 99 beats/min (sensitivity 85%, specificity 64%) gave predictive information not available from clinical or radionuclide data. On prospective testing involving 55 additional geriatric patients, inability to exercise was the only independent predictor of perioperative complications (p less than 0.05). Data from rest and exercise radionuclide ventriculography added little information for predicting perioperative cardiac risk.

Calcium emboli to the retinal artery in calcific aortic stenosis

It is generally appreciated in the cardiovascular literature that calcium emboli to a central retinal artery or its branches may be the presenting feature of otherwise uncomplicated calcific aortic stenosis. The ophthalmologic literature provides good evidence for this point. Over a 7-month period, four such cases have come to our attention. Other potential sources of emboli were excluded by standard noninvasive and invasive diagnostic techniques, and two patients underwent successful aortic valve replacement. Previous studies of calcific aortic stenosis have demonstrated postmortem histologic evidence of calcium emboli to various organs, for example, heart, kidney, or brain. Since these emboli are small, their occurrence is clinically silent. The retinal circulation is unique in that its occlusion by a calcium microembolus results in loss of vision, and this symptom may be a clue to the presence of calcific aortic stenosis.

Myocardial perfusion imaging with 99mTc-DMPE in man

Technetium-99m DMPE (99mTc-DMPE) is a newly synthesized myocardial perfusion imaging agent that shows intense myocardial accumulation in the dog. In the present study, dosimetry and potential clinical usefulness of this agent were assessed in four human subjects. Absorbed radiation doses were low, with the highest doses consisting of 200 mrad/mCi (54 μGy/MBq) to the gallbladder and 160 mrad/mCi (43 μGy/MBq) to the liver. No evidence of clinical toxicity was found. Technetium-99m DMPE did image the myocardium, but the ratio of target to nontarget activity was less favorable than that observed in the dog. Intense hepatic 99mTc-DMPE activity interfered with clinical imaging of the cardiac apex in two of the four subjects. We conclude that the prototype radiopharmaceutical, 99mTc-DMPE, is capable of myocardial perfusion imaging in man but the planar myocardial images produced are of inferior quality compared with 201Tl myocardial images. Further work is justified to develop related compounds to overcome the clinical limitations described.

Myocardial scintigraphy with 99mTc-tris-DMPE in man

Cardiac scintigraphy was performed in six patients with a documented previous myocardial infarction, in one patient with mitral regurgitation, and in four healthy volunteers following administration of 99mTc-tris-DMPE. An intense early blood pool phase permitted gated blood pool scintigraphy and left ventricular ejection fraction calculation. A myocardial phase 12–14 h later permitted myocardial perfusion imaging. The rest myocardial perfusion image quality with 99mTc-tris-DMPE appeared to be superior to the resting image quality obtained with 99mTc-dichloro-DMPE but was inferior to the resting image quality obtained with 201Tl.

Persistent atrial mechanical dysfunction after spontaneous conversion of chronic atrial fibrillation to sinus rhythm

creased. Fourteen months after initial examination, the patient underwent mitral valve repair. Intraoperatively the valve leaflets were noted to be pliable, with thickening along the leading edge of the posterior leaflet. The chordae to the posterior leaflet were thickened and foreshortened, and the chordae to the anterior leaflet were mildly thickened. The valve was repaired by dividing the papillary muscle heads to allow release of the posterior chordal apparatus and placement of a 30 mm Carpentier annuloplasty. After repair, transesophageal echocardiography revealed a small, eccentric regurgitant jet at the coaptation point of the anterior and posterior leaflets; the jet was graded as mild. The postoperative course was uncomplicated, and the patient has done well since hospital discharge.

A 12-lead patient cable for electrocardiographic exercise testing

Abstract A simple electrocardiographic cable for use with exercise testing has been developed which has proved to have many advantages over commercially available cables used with standard single-channel recorders. It can be adapted easily for multiple channel equipment.