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Burn S, Schilling R, Kaye GC. Cardiac syncope due to transient coronary artery occlusion: the role of percutaneous angioplasty. Postgrad Med J 1998; 74:361-2. [PMID: 9799893 PMCID: PMC2360952 DOI: 10.1136/pgmj.74.872.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A case of cardiac syncope is presented, associated with single vessel coronary disease. The mechanism of the syncope would appear to be a ventricular arrhythmia with transmural myocardial ischaemia due to transient occlusion of the diseased coronary artery. The symptoms and electrocardiographic abnormalities were reproduced and subsequently abolished by percutaneous coronary angioplasty.
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Affiliation(s)
- S Burn
- Department of Cardiology, Hull Royal Infirmary, North Humberside, UK
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Surgical management of post–myocardial infarction ventricular tachyarrhythmia by myocardial debulking, septal isolation, and myocardial revascularization. J Thorac Cardiovasc Surg 1986. [DOI: 10.1016/s0022-5223(19)35875-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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3
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Miller JM, Josephson ME. Malignant ventricular arrhythmias early after myocardial infarction: brighter prospects. J Am Coll Cardiol 1985; 6:769-71. [PMID: 4031291 DOI: 10.1016/s0735-1097(85)80480-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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4
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Molajo AO, Summers GD, Bennett DH. Effect of percutaneous transluminal coronary angioplasty on arrhythmias complicating angina. Heart 1985; 54:375-7. [PMID: 2932132 PMCID: PMC481913 DOI: 10.1136/hrt.54.4.375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Four patients who had stenosis of a single major coronary artery which was treated by percutaneous transluminal coronary angioplasty are described. Three had exercise induced myocardial ischaemia complicated by ventricular tachycardia, fibrillation, and sinus bradycardia, respectively. Asystole developed in a fourth patient who had spontaneous chest pain. After successful percutaneous transluminal coronary angioplasty these arrhythmias did not recur spontaneously or on treadmill exercise testing. Percutaneous coronary angioplasty can be effective in preventing arrhythmias complicating acute myocardial ischaemia secondary to stenosis of a single major coronary artery.
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Miller JM, Marchlinski FE, Harken AH, Hargrove WC, Josephson ME. Subendocardial resection for sustained ventricular tachycardia in the early period after acute myocardial infarction. Am J Cardiol 1985; 55:980-4. [PMID: 3872591 DOI: 10.1016/0002-9149(85)90730-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
One hundred nineteen patients with drug-refractory ventricular tachycardia (VT) underwent mapping-guided subendocardial resection for control of their arrhythmias from 3 weeks to 10 years after acute myocardial infarction (AMI). Patients were separated into 2 groups: those treated early (within 4 months, group I) and those treated later (after 1 year, group II) after AMI. There were 32 patients in group I and 72 patients in group II. Both groups of patients had similar clinical, angiographic and hemodynamic characteristics. Patients in group I had VT with a shorter mean cycle length than patients in group II (322 +/- 71 vs 349 +/- 88 ms, p less than 0.05). The groups did not differ with respect to operative mortality (12% vs 7%), late mortality (31% vs 33%, mean follow-up 23 months), or frequency with which subendocardial resection without any adjunctive therapy prevented postoperative spontaneous or inducible VT (21% vs 34%). Group I was further separated into patients who underwent subendocardial resection within 1 month of AMI (n = 7) and those who underwent subendocardial resection with 2 months of AMI (n = 14). Although patients in group I were characterized by having more spontaneous morphologically distinct tachycardias, their operative mortality, total mortality and surgical success rates were comparable to those of patients in group II.(ABSTRACT TRUNCATED AT 250 WORDS)
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Garan H, Ruskin JN, DiMarco JP, McGovern B, Levine FH, Buckley MJ. Refractory ventricular tachycardia complicating recovery from acute myocardial infarction: treatment with map-guided infarctectomy. Am Heart J 1984; 107:571-7. [PMID: 6695702 DOI: 10.1016/0002-8703(84)90101-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
All cardiac arrhythmias are either automatic or reentrant. Automatic arrhythmias occur in the periinfarction or perioperative period. Chronic, recurrent arrhythmias are typically reentrant. By definition, reentrant arrhythmias are inducible with programmed electrical stimulation. When a malignant cardiac arrhythmia is identified, the patient is taken to the electrophysiologic laboratory for study. Reentrant ventricular tachyarrhythmias are induced with programmed electrical stimulation. Pharmacologic suppression is guided by electrophysiologic testing. When antiarrhythmic suppression fails, surgical intervention may be an effective alternative. Endocardial catheter mapping before surgery may serve as an important guide to the surgeon. Myocardial mapping is clinically valuable only when all antiarrhythmic therapy has failed, and the patient is considered to be a candidate for surgical intervention. When surgical intervention is planned, we consider preoperative catheter mapping desirable and intraoperative electrophysiologic localization mandatory.
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Holman WL, Ikeshita M, Douglas JM, Smith PK, Lofland GK, Cox JL. Ventricular cryosurgery: short-term effects on intramural electrophysiology. Ann Thorac Surg 1983; 35:386-93. [PMID: 6838265 DOI: 10.1016/s0003-4975(10)61589-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The acute effects of cryothermia on regional electrophysiology were examined in order to devise a means of localizing and monitoring the intramural progression of ventricular cryolesions during a two-minute period of cryothermia application. Intramural unipolar electrograms were recorded from multipoint plunge electrodes placed in the left ventricle in 15 dogs. Epicardial, intramural, and endocardial applications of cryothermia were then employed, and changes in the unipolar peak-to-peak amplitude (UPPA) of electrograms were recorded. The location and depth of the ultimate permanent cryolesion could be predicted by noting locations of those electrograms demonstrating a decrease in the UPPA to less than 30% of the control values. Such electrophysiological monitoring of the region of myocardium undergoing cryothermic ablation provides a means of limiting the ultimate cryolesion to the desired location and depth within the ventricular wall. This allows precise placement of cryolesions in specific areas of the left ventricle for the treatment of ventricular tachyarrhythmias by selectively ablating arrhythmogenic ventricular myocardium without inducing injury in surrounding nonarrhythmogenic myocardium.
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Ostermeyer J, Breithardt G, Kolvenbach R, Borggrefe M, Seipel L, Schulte HD, Bircks W, Kirklin JW. The surgical treatment of ventricular tachycardias. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)38960-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Moran JM, Kehoe RF, Loeb JM, Lichtenthal PR, Sanders JH, Michaelis LL. Extended endocardial resection for the treatment of ventricular tachycardia and ventricular fibrillation. Ann Thorac Surg 1982; 34:538-52. [PMID: 7138122 DOI: 10.1016/s0003-4975(10)63001-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A total of 40 patients with drug-refractory, life-threatening cardiac rhythm disturbances--ventricular tachycardia in 23 patients and ventricular fibrillation in 17 patients--underwent extended endocardial resection (EER) of scar tissue. Scarring was due to myocardial infarction in 38 patients, to previous congenital heart operation in 1 patient, and to sarcoidosis of the heart in 1. The EER procedure was directed by epicardial and endocardial mapping data whenever possible, and was usually combined with revascularization, aneurysmectomy, or, in 5 patients, mitral valve replacement. Operative mortality was 10%, incident to poor preoperative ventricular function and hemorrhage secondary to previous cardiac surgical procedures. Thirty-three of the 36 survivors (92%) are free of arrhythmia at follow-up periods ranging from 3 to 36 months (mean, 12.5 months); the arrhythmia in the remaining 3 patients is now drug controlled. Thirty-three patients had postoperative electrophysiological studies, and in 30 (91%), the arrhythmia was no longer inducible. The results of surgical treatment for ventricular tachycardia and ventricular fibrillation were similar. The results also proved satisfactory whether the EER procedure was directed by visual observation or mapping.
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Ungerleider RM, Holman WL, Stanley III TE, Lofland GK, Mark Williams J, Ideker RE, Smith PK, Quick G, Cox JL. Encircling endocardial ventriculotomy for refractory ischemic ventricular tachycardia. J Thorac Cardiovasc Surg 1982. [DOI: 10.1016/s0022-5223(19)37179-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Boineau JP, Cox JL. Rationale for a direct surgical approach to control ventricular arrhythmias: relation of specific intraoperative techniques to mechanism and location of arrhythmic circuit. Am J Cardiol 1982; 49:381-96. [PMID: 7036704 DOI: 10.1016/0002-9149(82)90516-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Cohn LH. Surgical management of acute and chronic cardiac mechanical complications due to myocardial infarction. Am Heart J 1981; 102:1049-60. [PMID: 7032267 DOI: 10.1016/0002-8703(81)90489-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Recurrent ventricular tachycardia is a well-recognized complication of ischemic heart disease. Coronary bypass operation with or without aneurysmectomy has been disappointing as therapy for these arrhythmias. With the advent of programmed electrical stimulation, it has become possible to distinguish automatic and reentrant ventricular tachyarrhythmias. The latter have recently proved amenable to operative intervention. This review examines the pathophysiology and diagnosis of ventricular tachycardia using programmed electrical stimulation. Surgical therapy with resection, revascularization, autonomic modulation, thermal ablation, cardiac pacing, reentrant circuit interruption, and endocardial excision is explored. Operation for cardiac arrhythmias is on a firm electrophysiological foundation. Surgical treatment of refractory ventricular tachyarrhythmias is now rational, recommended, and rewarding.
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Harken AH, Horowitz LN, Josephson ME, Harken DE. Comparison of standard aneurysmectomy and aneurysmectomy with directed endocardial resection for the treatment of recurrent sustained ventricular tachycardia. J Thorac Cardiovasc Surg 1980. [DOI: 10.1016/s0022-5223(19)37739-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Horowitz LN, Harken AH, Kastor JA, Josephson ME. Ventricular resection guided by epicardial and endocardial mapping for treatment of recurrent ventricular tachycardia. N Engl J Med 1980; 302:589-93. [PMID: 7351905 DOI: 10.1056/nejm198003133021101] [Citation(s) in RCA: 238] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Recurrent, medically refractory ventricular tachycardia is usually associated with ventricular aneurysms after myocardial infarction, but aneurysmectomy alone has not been consistently effective in abolishing this dangerous arrhythmia. Therefore, we have used endocardial and epicardial mapping during induced ventricular tachycardia in 30 consecutive patients to identify the probable site where arrhythmia originated in the endocardial tissue. Complete resection of the site was possible in 27 patients, and partial resection in three. In addition aneurysmectomy was performed in 27 patients, and coronary-bypass grafting in 21. There were two operative and three late nonarrhythmic deaths. None of the 25 surviving patients have had ventricular tachycardia during follow-up of four to 28 months; three patients, who had incomplete resections, have required antiarrhythmic drugs. We conclude that surgical therapy of recurrent ventricular tachycardia can be improved through identification of the endocardial origin of the arrhythmia followed by appropriately guided resection.
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Treatment of early postinfarction ventricular aneurysm by intra-aortic balloon pumping and surgery. J Thorac Cardiovasc Surg 1979. [DOI: 10.1016/s0022-5223(19)38111-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Horowitz LN, Josephson ME, Farshidi A, Spielman SR, Michelson EL, Greenspan AM. Recurrent sustained ventricular tachycardia 3. Role of the electrophysiologic study in selection of antiarrhythmic regimens. Circulation 1978; 58:986-97. [PMID: 709782 DOI: 10.1161/01.cir.58.6.986] [Citation(s) in RCA: 543] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Twenty patients with recurrent sustained ventricular tachycardia (VT) underwent serial electrophysiological studies (EPS) 1) to determine the predictive value of the EPS in the selection of antiarrhythmic therapy, and 2) to establish the therapeutic efficacy of available antiarrhythmic agents. In each patient VT could be reproducibly initiated by programmed stimulation. After control EPS, the effects of several drugs (lidocaine, procainamide, quinidine, disopyramide and diphenylhydantoin) on the ability to initiate VT were assessed. An oral regimen was chosen on the basis of acute EPS and its effectiveness was evaluated by repeat EPS in 24--72 hours. Blood levels achieved acutely were used as guidelines to chronic therapy. In 14 patients the initiation of VT was prevented by the acute administration of one or more agents. In 13 of these patients, a chronic oral regimen based on these results prevented recurrence of VT with a three- to 27-month follow-up. In the remaining patient, oral therapy could not achieve blood levels of procainamide shown to be effective intravenously, and VT recurred. In six patients no single drug or drug combination was effective during acute EPS, and VT recurred in all while on therapy with the agent shown to make initiation of VT most difficult. Procainamide prevented VT in nine patients; quinidine in three patients; lidocaine in three patients; diphenylhydantoin in two patients; and disopyramide in one patient. The mean duration of EPS studies was 4.5 days. This study suggests that serial EPS provides rapid identification of successful antiarrhythmic therapy and can predict in which patients conventional therapy would be ineffective, thereby identifying patients requiring more aggressive modes of therapy.
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Austen WG, McEnany MT. The role of surgery in the treatment of patients with complications of acute myocardial infarction. World J Surg 1978; 2:709-16. [PMID: 726472 DOI: 10.1007/bf01556513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
A variety of surgical interventions have evolved for the treatment of intractable or life-threatening arrhythmias unresponsive to conventional pharmacologic or pacemaker therapy. Supraventricular arrhythmias associated with rapid ventricular responses can be indirectly treated with ablation of the atrioventricular conduction system and insertion of a pacemaker. Ventricular tachyarrhythmias have previously been treated with sympathectomy, resection of tissue or revascularization. More recent approaches include the simple ventriculotomy, encircling endocardial ventriculotomy, cryosurgical ablation and insertion of the automatic implantable defibrillator. Refinement of methods to localize more precisely the origin of ventricular arrhythmias may allow design of more direct surgical procedures. The surgical treatment of arrhythmias related to the preexcitation syndromes remains the model of electrophysiologic surgery. It is now feasible to divide accessory pathways with a high degree of success and at low risk in selected patients.
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Abstract
During the forty-month period ending July, 1976, intraaortic balloon counterpulsation was used as an adjunct to medical or surgical therapy in 273 patients. Thirty-seven developed complications. Limb ischemia occurred in 16; it resolved in 12, resulted in gangrene of the toes in 1 and leg gangrene in 2, and was the casue of death in 1 patient. Aortic dissection was confirmed in 7 patients and strongly suspected in another 4. Eight of the 11 patients with dissection underwent cardiac procedures with heparinization at two days to three months after balloon insertion with no untoward effects. Septicemia developed in 2 patients, 1 of whom died of cardiogenic shock. Localized groin sepsis occurred in 8 patients, 2 of whom required removal of infected Dacron graft material. Awareness of the complications of balloon insertion, proper attention to details of balloon management at the time of insertion and removal, and continuous monitoring through a central-lumen balloon should decrease the incidence of complications.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 27-1977. N Engl J Med 1977; 297:37-45. [PMID: 301246 DOI: 10.1056/nejm197707072970107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ramanathan KB, Bodenheimer MM, Banka VS, Helfant RH. Electrophysiologic effects of partial coronary occlusion and reperfusion. Am J Cardiol 1977; 40:50-4. [PMID: 879012 DOI: 10.1016/0002-9149(77)90099-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Yashar J, Yashar JJ, Witoszka M, Kitzes DL, Simeone FA. The treatment of patients with recurrent ventricular fibrillation. Am J Surg 1977; 133:453-57. [PMID: 300571 DOI: 10.1016/0002-9610(77)90130-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
During the four year period from 1972 to 1975, eleven patients, eight with recurrent and three with first attacks of ventricular fibrillation, underwent aortocoronary bypass graft and/or resection of ventricular aneurysm. All patients had old myocardial infarction from seven weeks to six years. Left ventricular angiography demonstrated discrete aneurysm of the anterior wall of the left ventricle in nine of the patients and akinesis or hypokinesis of the anterior and posterior wall of the left ventricle in the remaining two. Coronary angiography was carried out in ten patients and revealed significant disease of the left anterior descending and right coronary arteries in ten and nine patients, respectively. There was no operative mortality, and there were two late deaths. Eight patients have improved significantly and have had no further sign of ventricular irritability. The present study indicates that aortocoronary bypass graft and/or resection of ventricular aneurysm is an effective method of therapy for patients with repeacted ventricular fibrillation who have ventricular aneurysm and ischemic heart disease.
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Dubost C, Deloche A, Carpentier A, Relland J, Sellier P, Vial F, Piwnica A, Fabiani JN. Emergency myocardial revascularization. Postgrad Med J 1976; 52:743-8. [PMID: 1087725 PMCID: PMC2496435 DOI: 10.1136/pgmj.52.614.743] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
From 1969 to 1975, 175 patients with acute coronary insufficiency underwent emergency saphenous vein aorto-coronary bypass grafting (SVBG). The patients were divided into two groups: group I, unstable angina (165 patients) and group II, acute evolving myocardial infarction (ten patients). In group I, the hospital mortality was 8-4%, the incidence of post-operative myocardial infarction was 10-3%. Long-term follow-up was obtained for an average of 25 months, functional improvement was definite in the majority of the patients and actuarial survival curves show 87% patients alive at the end of 48 months. In group II, the hospital mortality was 30%; seven of ten patients had good results.
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Gunstensen J, Goldman BS, Scully HE, Huckell VF, Adelman AG. Evolving indications for preoperative intraaortic balloon pump assistance. Ann Thorac Surg 1976; 22:535-45. [PMID: 999379 DOI: 10.1016/s0003-4975(10)64472-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Over a two-year period about 1,000 operations were performed with cardiopulmonary bypass. Intraaortic balloon pump assistance (IABP) was employed on 150 occasions, and a review of these has permitted clarification of the indications for its use. Sixty patients had IABP for carcinogenic shock either after infarction or cardiotomy, and 37 (62%) survived. Preoperative IABP in 90 high-risk patients resulted in survival for 79 (88%). The indications for prophylactic IABP included: (1) relief of severe pain, which occurred in 42 patients with acute coronary insufficiency, (2) improvement in the coronary perfusion pressure, which was accomplished in 20 patients with significant left main coronary artery occlusion or its equivalent, and (3) protection of left ventricular function, which war carried out in 28 patients with an LV ejection fraction of less than 0.40. The significance of the preoperative endocardial viability ratio (EVR) in relation to prophylactic IABP was also assessed: an EVR below 0.70 appears to be an indication for preoperative IABP.
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Buckberg GD, Olinger GN, Mulder DG, Maloney JV. Depressed postoperative cardiac performance. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)39646-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Williams E, Tyers G, Carter S, Williams D. Ventricular Arrhythmias following Mitral Valve Replacement. Chest 1975. [DOI: 10.1378/chest.68.5.641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Levites R, Banka VS, Helfant RH. Electrophysiologic effects of coronary occlusion and reperfusion. Observations of dispersion of refractoriness and ventricular automaticity. Circulation 1975; 52:760-5. [PMID: 1175258 DOI: 10.1161/01.cir.52.5.760] [Citation(s) in RCA: 102] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
UNLABELLED In order to determine the electrophysiological changes that occur during coronary occlusion and following reperfusion, 19 mongrel dogs were studied. Refractory periods were determined by the extrastimulus method in nonischemic and ischemic zones prior to and after variable periods of left anterior descending artery occlusion and reperfusion. After 15-30 minutes of occlusion, refractory periods in the nonischemic zones remained unchanged while in the ischemic zone they shortened by 17%, resulting in a dispersion of refractoriness. Within three minutes of reperfusion, arrhythmias appeared together with a marked directional change of refractory periods to a prolongation by 34% (P less than 0.001) in the ischemic zone and by 3% (P less than 0.02) in the nonischemic zone. Refractory periods returned to baseline values after 60 minutes of reperfusion. After 60-90 minutes of occlusion, refractory periods in the nonischemic zones were unchanged whereas in the ischemic zone they demonstrated a decrease by 28% (P less than 0.01), again resulting in a dispersion of refractoriness. Within five minutes of reperfusion, refractory periods in the ischemic zone prolonged by 44% (P less than 0.001). Similar but smaller directional changes were also seen in nonischemic zones. Concomitant with the observed prolongation in refractory periods frequent ventricular ectopic activity was again documented. In addition, refractory periods did not return to control values after periods of observation up to 120 minutes in this group. In seven dogs, complete heart block was induced to ascertain the rate of idioventricular pacemaker and the effect of ventricular overdrive on the escape interval. Control ventricular rates (53.3 +/- 5.7 beats/min) remained unchanged (52.3 +/- 5.6) following coronary occlusion, but decreased to 48.0 +/- 4.4 (P less than 0.05) during reperfusion. Mean control escape intervals (1.8 +/- 0.2 sec) did not change after occlusion (1.7 +/- 0.2 sec) but prolonged to 2.1 +/- 0.2 sec (P less than 0.05) following reperfusion. IN CONCLUSION 1) sudden prolongation in refractory periods following reperfusion leads to an overshoot resulting in a dispersion of refractoriness temporally related to the onset of ventricular arrhythmias and 2) re-entry, and not enhanced automaticity, appears to be the mechanism for postperfusion arrhythmias.
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Wittig JH, Boineau JP. Surgical treatment of ventricular arrhythmias using epicardial, transmural, and endocardial mapping. Ann Thorac Surg 1975; 20:117-26. [PMID: 51609 DOI: 10.1016/s0003-4975(10)63864-7] [Citation(s) in RCA: 123] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In 3 patients with ischemic coronary disease or primary myocardiopathy who were unresponsive to conventional and experimental antiarrhythmia therapy, surgical treatment of intractable ventricular tachycardia was performed using epicardial, transmural, and endocardial mapping techniques. An experimental canine model of acute and chronic myocardial ischemia with recurrent ventricular tachycardia was developed to refine the mapping technique for clinical use. In patients and animals alike, atrial overdrive pause pacing, premature ventricular pacing, or both were used to bring outa repeatable pattern of tachycardia. Mapping techniques distinguished the irritable focus so that surgical excision of the site of earliest activation could be performed. In addition, the mapping techniques were used in the validation following excision. The limitations of epicardial mapping alone in locating all areas of premature focus are discussed, and the need for mapping in ventricular aneurysm is demonstrated.
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Mundth ED, Gold HK, Leinbach RC. Surgery in the Treatment of Coronary Artery Disease. Postgrad Med 1975; 57:68-72. [PMID: 27410508 DOI: 10.1080/00325481.1975.11714032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - H K Gold
- a Massachusetts General Hospital Boston
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36
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Cohen LS, Ross AM. Long-Term Management of Complicated Myocardial Infarction. Postgrad Med 1975; 57:17-21. [DOI: 10.1080/00325481.1975.11714026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sehapayak GK, Watson JT, Curry GC, Londe SP, Mullins CB, Willerson JT, Sugg WL. Late development of intractable ventricular tachycardia after acute myocardial infarction. J Thorac Cardiovasc Surg 1974. [DOI: 10.1016/s0022-5223(19)41754-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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