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Cameron J, Sutherland N, Han HC, Raman J, Lim H. Ventricular arrhythmias and sudden cardiac death caused by mitral valve prolapse: should we operate and when? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Several autopsy and observational studies have investigated the link between mitral valve prolapse (MVP) and sudden cardiac death (SCD) due to the well accepted yet rare occurrence of complex ventricular arrhythmia (VA) in this cohort. Few studies however have investigated whether arrhythmia burden and more importantly SCD are reduced following surgical correction of MVP.
Purpose
To investigate the impact of mitral valve surgery (MVS) (replacement or repair) on VA and SCD in patients with MVP.
Methods
A systematic review of the current literature was conducted using an electronic search of the PubMed database in October 2021. Studies were included if subjects had undergone mitral valve (MV) repair or replacement with documented rates of arrythmias/SCD pre- and post-intervention. Small patient numbers in individual reports precluded formal meta-analysis and results were reported on a per study basis.
Results
19 identified studies (10 cohort studies, nine case studies) comprised 1322 patients with a pooled mean age of 63.4 years and 38.9% were female. 748 of the 1322 patients underwent MVS: 263 MV repair, 18 MV replacement (one with leaflet and papillary muscle excision), two MV repair with Maze procedure, 177 percutaneous transcatheter MV repair, 45 annuloplasty with or without valve repair, and in 243 cases the surgical method was not specified.
Of the 10 included cohort studies, seven of the eight which investigated rates of VA post MVS concluded there was a significant reduction, while one reported the predisposition to arrythmia persisted after relieving the abnormal mechanical effects of non-ischaemic MR (75% due to MVP). One study reported a reduction in SCD post MVS. Each of the nine included case studies showed a reduction in VA post MVS. One study showed mitral annular disjunction (MAD) was independently associated with a higher risk of arrhythmic events, this link persisting with time dependent MVS although reduced compared to medical management.
Conclusions
The underlying mechanisms for VA and SCD associated with MVP are not completely understood, and guidelines for the surgical correction of MVP based on arrhythmic and SCD risk are lacking. This systematic review illustrates a possible reduction in VA following MVS. Further identification of patients at risk of SCD, and potential use of risk stratification algorithms, would allow for consideration of earlier management and appropriate use of implantable cardioverter-defibrillators (ICD) placement / MVS with an expected survival benefit.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Cameron
- Austin Hospital, Cardiology , Melbourne , Australia
| | - N Sutherland
- Northern Health, Cardiology , Melbourne , Australia
| | - H C Han
- Austin Hospital, Cardiology , Melbourne , Australia
| | - J Raman
- University of Melbourne, Medicine , Melbourne , Australia
| | - H Lim
- University of Melbourne, Medicine , Melbourne , Australia
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Chen H, Coias J, Raman J, Adams-Huet B, Neeland I, Chong B. 664 Metabolic syndrome in black patients with cutaneous lupus erythematosus – a pilot study. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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3
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Tchegnon E, Liao C, Ghotbi E, Saeid A, Raman J, Le L. 136 Physiological function of Krox20 (Egr2) in epithelial stem cells. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Raman J, Hu R, Bellomo R, Nguyen P, Venkatesh S. M16 Artificial Intelligence in Building Predictive Models of Acute Kidney Injury After Cardiac Surgery. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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5
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Brooke BD, Raman J, Frean J, Rundle J, Maartens F, Misiani E, Mabuza A, Barnes KI, Moonasar DP, Dlamini Q, Charles S, Blumberg L. Implementing malaria control in South Africa, Eswatini and southern Mozambique during the COVID-19 pandemic. S Afr Med J 2020; 110:1072-1076. [PMID: 33403980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023] Open
Abstract
The COVID-19 pandemic has strained healthcare delivery systems in a number of southern African countries. Despite this, it is imperative that malaria control and elimination activities continue, especially to reduce as far as possible the number and rate of hospitalisations caused by malaria. The implementation of enhanced malaria control/elimination activities in the context of COVID-19 requires measures to protect healthcare workers and the communities they serve. The aim of this review is therefore to present innovative ideas for the timely implementation of malaria control without increasing the risk of COVID-19 to healthcare workers and communities. Specific recommendations for parasite and vector surveillance, diagnosis, case management, mosquito vector control and community outreach and sensitisation are given.
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Affiliation(s)
- B D Brooke
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Wits Research Institute for Malaria, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Al Hussein Al Awamlh B, Shoag J, Posada L, Ma X, Raman J, Shariat S, Scherr D. Implications of inadvertent radical nephrectomy instead of nephroureterectomy in the treatment of upper tract urothelial carcinoma. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32767-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Khene Z, Peyronnet B, Bernhard J, Kocher N, Vaessen C, Doumerc N, Pradere B, Seisen T, Beauval J, Verhoest G, Mathieu R, Roumiguie M, De La Taille A, Bruyere F, Roupret M, Méjean A, Raman J, Bensalah K. Développement et validation d’un nomogramme pour prédire les complications majeures après néphrectomie partielle robot-assistée. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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8
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Khene Z, Peyronnet B, Robert C, Mathieu R, Verhoest G, Vincendeau S, Manunta A, Rioux-Leclercq N, Raman J, Bensalah K. RENAL nephrometry score vs Mayo Adhesive Probability Score : une étude internationale multicentrique. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Tuanquin L, McDermott D, Mackley H, Holder S, Wagner H, Rosenberg J, Drabick J, Kaag M, Joshi M, Raman J, Merrill S. The Outcomes of Adjuvant Radiation Therapy in Postcystectomy Muscle-Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Delibasic M, Dobrilovic N, Raman J, Mohamedali B. Education Status as a Predictor of Outcomes in Orthotopic Heart Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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11
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Benton A, Sobowale O, Lin Y, Raman J, Harkins G. 10: Surgical approaches to the management of bladder and ureteral endometriosis. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sobowale O, Riley K, Raman J, Harkins G. A Multi-Disciplinary Approach for the Surgical Management of Bladder Endometriosis. J Minim Invasive Gynecol 2015; 22:S130-S131. [DOI: 10.1016/j.jmig.2015.08.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Delibasic M, Mohamedali B, Dobrilovic N, Raman J. Depression as a Predictor of Compliance and Morbidities After Orthotopic Heart Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lehmann S, Wong MS, Zehr K, DeGuzman BJ, Garrett HE, Mochalski M, MacMahon H, Raman J, Mohr FW. Wire fixation versus rigid titanium plate after sternotomy – Results of a randomized, prospective, multi-center trial. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Maputla NW, Dempster ER, Raman J, Ferguson JWH. Strong hybrid viability between two widely divergent chromosomal forms of the pouched mouse. J Zool (1987) 2011. [DOI: 10.1111/j.1469-7998.2011.00825.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Koyner J, Trevino S, Konczal D, Worcester E, Raman J, Jeevanandam V, Murray P. 9 URINARY CYSTATIN C IN PATIENTS WITH ACUTE KIDNEY INJURY FOLLOWING CARDIAC SURGERY.: Table 1. J Investig Med 2007. [DOI: 10.1136/jim-55-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Koyner J, Trevino S, Konczal D, Worcester E, Raman J, Jeevanandam V, Murray P. Urinary Cystatin C in Patients with Acute Kidney Injury following Cardiac Surgery. J Investig Med 2007. [DOI: 10.1177/108155890705500209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | - J. Raman
- University of Chicago, Chicago, IL
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Krug L, Pass H, Rusch V, Kindler H, Sugarbaker D, Rosenzweig K, Friedberg J, Raman J, Ye Z, Obasaju C, Vogelzang N. 174 Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin (PC) followed by extrapleural pneumonectomy (EPP) and radiation (RT) for malignant pleural mesothelioma (MPM). Lung Cancer 2006. [DOI: 10.1016/s0169-5002(07)70250-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kim A, Russell H, Raman J, Gupta M, Tian X, Lang R, Miller J. Cardiomyopathy Results in Dysregulation of Endocardial Thrombomodulin and An Altered Protein C Activation Pathway. J Investig Med 2006. [DOI: 10.1177/108155890605402s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- A.Y. Kim
- The University of Chicago, Chicago, IL
| | | | - J. Raman
- The University of Chicago, Chicago, IL
| | - M. Gupta
- The University of Chicago, Chicago, IL
| | - X. Tian
- The University of Chicago, Chicago, IL
| | - R.M. Lang
- The University of Chicago, Chicago, IL
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Kim AY, Russell HM, Raman J, Gupta M, Tian X, Lang RM, Miller JL. 26 CARDIOMYOPATHY RESULTS IN DYSREGULATION OF ENDOCARDIAL THROMBOMODULIN AND AN ALTERED PROTEIN C ACTIVATION PATHWAY. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0015.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Bolotin G, Raman J, Thomas N, Jeevanandam V. Salvage ventricular assistance for patients undergoing cardiopulmonary resuscitation: Long term results. J Heart Lung Transplant 2005. [DOI: 10.1016/j.healun.2004.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Agarwal J, Raman J, Jeevanandum V, Anderson A, Kim A, Song D. Prophylactic sternal plating in the cardiac transplant population. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jeevanandam V, Mather P, Russell H, Furokawa S, Raman J. Prophylactic suture annuloplasty of the tricuspid valve during orthotopic heart transplantation (OHT) - intermediate results of a randomized clinical trial. J Heart Lung Transplant 2004. [DOI: 10.1016/j.healun.2003.11.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Durairaj M, Buxton B, Shah P, Gordon I, Fuller J, Rosalion A, Raman J, Seevanayagam S. Patency of radial artery: Angiographic study of 286 grafts in symptomatic patients operated between 1995–2002. Indian J Thorac Cardiovasc Surg 2004. [DOI: 10.1007/s12055-004-0290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Raman J, Shah P, Hare D, Buxton B, Mather P, Furokawa S, Jeevanandam V. Long-term outcome of coronary artery surgery for ischemic cardiomyopathy - a multi-institutional experience. J Heart Lung Transplant 2003. [DOI: 10.1016/s1053-2498(02)00788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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28
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Raman J, Gupta M, Gupta M, Jeevanandam V. Increased expression of single-strand DNA-binding proteins represses alpha-myosin heavy chain (MHC) gene expression in heart failure. J Heart Lung Transplant 2003. [DOI: 10.1016/s1053-2498(02)00776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Fluid overload is common before, during and after cardiac surgery. The fluid associated with cardiopulmonary bypass (CPB) and cardioplegia is a particularly important source of such fluid overload. In addition, renal dysfunction, which is common in these patients, participates in the pathogenesis of a positive sodium and water balance. Such fluid overload is physiologically undesirable and participates in the pathogenesis of several clinically important complications. Fluid overload can be partly prevented with the use of diuretics. However, in many patients, diuretics do not achieve sufficient sodium and water diuresis. In these patients, the application of hemofiltration (HF) during CPB and also immediately after CPB is an effective and safe approach to the maintenance of fluid homeostasis. If acute renal failure occurs, early intervention with HF may even improve survival.
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Affiliation(s)
- R Bellomo
- Department of Intensive Care, Austin and Repatriation Medical Centre, Heidelberg, Vic., Australia.
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Raman J, Dixit A, Storer M, Hare D, Buxton BF. Geometric endo-ventricular patch repair of inferior left ventricular scars improves mitral regurgitation and clinical outcome. Ann Thorac Surg 2001; 72:S1055-8. [PMID: 11565726 DOI: 10.1016/s0003-4975(01)02939-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The surgical reconstruction of inferior left ventricular (LV) aneurysms and scars has been considered a difficult procedure and there has been little material published about this treatment option. In this study we report on our experience with reconstruction of the inferior wall and compare it to the outcome of anterior LV reconstructions. METHODS Seventeen patients (group 1) underwent geometric endo-ventricular patch repair (GER) of inferior LV aneurysms and dyskinetic scars between January 1998 and December 2000. In addition to poor LV function, 5 of these patients had severe mitral valve regurgitation (MR), 8 had moderate MR, and 4 had mild MR preoperatively. These patients also underwent coronary artery bypass graft surgery or valve surgery. The perioperative course, survival, and clinical status were evaluated in this group and was compared to those of 86 patients (group 2) undergoing anterior GER during the same period. RESULTS There was 1 early death in group 1 (5.8%) and 6 in group 2 (7%) (p = ns). At the conclusion of the operative procedure, all patients in group 1 were weaned off cardiopulmonary bypass with trivial to mild MR. There was 1 late death in group 1 (6.2%) and 2 in group 2 (2.8%) (p = ns). Eleven patients (73%) in group 1 were in New York Heart Association class 1 compared to 60 in group 2 (77%) (p = ns). Follow-up echocardiography showed that 80% of patients in group 1 had trivial MR. CONCLUSIONS The surgical reconstruction of inferior LV aneurysms and scars can be performed safely with the expectation of a reasonable early outcome similar to that achieved with anterior LV scars. When used in this setting GER improves MR, reducing the likelihood of heart failure decompensation.
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Affiliation(s)
- J Raman
- Department of Cardiac Surgery, Austin & Repatriation Medical Centre, Melbourne, Victoria, Australia.
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Abstract
BACKGROUND AND OBJECTIVE Laser tissue-welding has been used for anastomosis of carotid arteries. During welding, thermal injury sustained by the vessel walls should be minimized to prevent thrombosis. Two different types of lasers were used and effects on tissue damage were studied in vitro and in vivo. STUDY DESIGN/MATERIALS AND METHODS End-to-end anastomosis of dog carotid arteries (n = 10) was performed by using a human albumin solder (HAS) in conjunction with Nd:YAG or diode lasers (lambda = 1.32 microm and 1.9 microm, respectively). The arteries were evaluated for patency and evidence of histologic injury after 21 days. Another group of arteries was laser soldered in vitro to measure the intimal and adventitial temperatures by using thermocouples. RESULTS The arteries repaired with the diode laser sustained significantly less thermal damage than those repaired with Nd:YAG laser, both in vitro and in vivo. In particular, the intimal temperature was significantly lower (P < 0.05) for the diode than for the Nd:YAG repairs (approximately 35 degrees C and approximately 50 degrees C, respectively). In the latter group, the patency rate was 75%, but thrombosis occurred in 75% of the specimens at 21 days. All diode anastomoses were patent and thrombosis developed in only 17% of the arteries. CONCLUSION Use of the diode laser and albumin solders may provide a means to successfully repair carotid arteries with minimal thermal damage.
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Affiliation(s)
- A Lauto
- Center for Pediatric Urology and Minimal Invasive Urologic Surgery, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York 10021, USA.
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Haim A, Downs CT, Raman J. Effects of adrenergic blockade on the daily rhythms of body temperature and oxygen consumption of the black-tailed tree rat (Thallomys nigricauda) maintained under different photoperiods. J Therm Biol 2001; 26:171-177. [PMID: 11240222 DOI: 10.1016/s0306-4565(00)00039-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
(1) Measurements of VO(2) and T(b) daily rhythms in T. nigricauda were conducted. (2) Three different effects on VO(2) and T(b) were assessed: alpha and beta blockade, time of the day, and photoperiod regime. (3) Results show that in T. nigricauda, the response of T(b) and VO(2) differs significantly under the different photoperiod regimes. Rats acclimated to 16L:8D increased T(b) values as a response to beta blockade, while alpha blockade caused a decrease in T(b). (4) VO(2) values of T. nigricauda acclimated to 11.5L:12.5D responded differently to alpha and beta blockade. It can be assumed that the thermoregulatory responses with beta blockade are through a decrease in heat production, rather than through heat dissipation. However, in the case of alpha blockade, it may be assumed that heat dissipation, through vasodilation, is the cause for the decrease in T(b) values.
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Affiliation(s)
- A Haim
- School of Education Oranim, University of Haifa, P.O. Kiryat, Tivon, Israel
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Nakanishi K, Raman J, Hata M, Buxton B. [Early outcome with the Alfieri mitral valve repair]. J Cardiol 2001; 37:263-6. [PMID: 11392895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVES Mitral regurgitation in cases of prolapse of the anterior leaflet, posterior leaflet with calcified annulus, or prolapse of both leaflets is thought to be difficult to repair. The Alfieri repair has been developed to address these conditions. METHODS Seven patients (four men and three women, mean age 71 +/- 9 years) underwent the Alfieri repair for mitral regurgitation at Austin and Repatriation Medical Centre between January 1999 and December 1999. The mechanism of mitral regurgitation was prolapse of the posterior leaflet with calcified annulus in one patient, prolapse of the anterior leaflet in two, and prolapse of both leaflets in four. Mitral regurgitation before operation was severe in all patients. The Cosgrove ring was used in all patients. Four patients underwent combined operation, coronary artery bypass surgery in three and tricuspid annuloplasty in one. RESULTS There was no hospital death. Two patients had postoperative complications, transient ischemic attack in one patient and rapid atrial fibrillation in one. The mean hospital stay was 11.3 +/- 8.7 days. Mitral regurgitation after operation was mild in five patients and trivial in two. Mean pressure gradient of the transmitral valve was 4.0 +/- 1.4 mmHg. CONCLUSIONS The Alfieri mitral valve repair is a simple and satisfactory technique to repair mitral regurgitation in selected patients. Long-term follow-up is required to evaluate the durability of this technique.
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Affiliation(s)
- K Nakanishi
- Department of Cardiac Surgery, Austin and Repatriation Medical Centre, Melbourne, Australia
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Bent P, Tan HK, Bellomo R, Buckmaster J, Doolan L, Hart G, Silvester W, Gutteridge G, Matalanis G, Raman J, Rosalion A, Buxton BF. Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. Ann Thorac Surg 2001; 71:832-7. [PMID: 11269461 DOI: 10.1016/s0003-4975(00)02177-9] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. METHODS Medical record analysis with collection of demographic, clinical, and outcome information was used. RESULTS Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). CONCLUSIONS Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
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Affiliation(s)
- P Bent
- Department of Intensive Care, Austin & Repatriation Medical Centre, Heidelberg, Melbourne, Victoria, Australia
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Abstract
Patterns of daily torpor were measured in response to photoperiod and food restriction at a constant temperature (18 degrees C) in two species of elephant shrew (Macroscelidea), Elephantulus rozeti (from Morocco) and Elephantulus myurus (from southern Africa). Body temperature was monitored continuously for ca. 3 months using temperature-sensitive telemeters. Under short photoperiods (8:16 L:D), both species entered spontaneous torpor on an ad libitum diet, but showed a higher frequency of induced torpor when food was restricted. Under long photoperiods (16:8 L:D), E. myurus could be induced to enter daily 'summer' torpor. A total of 378 torpor bouts were measured, none of which were longer in duration than 18 h. Under short photoperiods, arousal from torpor was associated with the onset of the photoperiod, whereas the time of entry was variable throughout the scotophase. However, E. myurus tended to phase shift torpor from the photophase to the scotophase under long photoperiods, despite displaying weak circadian amplitudes of body temperature indicative of a photophase rest phase. Both species lacked well-defined circadian amplitudes of body temperature, a pattern thought to be associated with polyphasic activity cycles characteristic of several Elephantuluis species. It was concluded that these and other patterns of torpor shown by Elephantulus show similarities with other small Afrotropical insectivores inhabiting semi-arid habitats or unpredictable environments.
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Affiliation(s)
- B G Lovegrove
- School of Botany and Zoology, University of Natal, Scottsville, South Africa.
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Abstract
The physiological parameters of heterothermy (e.g. minimum body temperature and oxygen consumption, percentage metabolic reduction, and bout length) were measured in two species of Elephantulus elephant shrews (Elephantulus myurus and Elephantulus rozeti; Macroscelidea) as a function of ambient temperature. Both species displayed deep torpor whereby the body temperatures of ca. 5 degrees C and oxygen consumption as low as 2% of basal metabolic rate were attained. Torpor bout length (n = 57 bouts) never exceeded 24 h. These data are characteristic of both hibernation (minimum body temperature and metabolism) and daily torpor (bout length), and argue that these two physiological responses may not necessarily have separate evolutionary origins.
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Affiliation(s)
- B G Lovegrove
- School of Botany and Zoology, University of Natal, Scottsville, South Africa.
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Morton J, Raman J, Byrne M, Power J, Kalman J. Electrical remodeling of the atrium in an anatomic model of atrial flutter. Relationship between substrate and triggers for conversion to atrial fibrillation. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.06103.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Raman J, Seevanayagam S, Power J, Hare D, Buxton B, Alferness C. Ventricular containment as an adjunctive procedure in ischaemic cardiomyopathy — results of the phase I study. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.07467.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Power J, Raman J, Byrne M, Alferness C. Passive ventricular constraint performed in advanced heart failure prevents mortality in an experimental model of progressive, malignant dilated cardiomyopathy. Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- J. Power
- Baker Medical Research Institute; Melbourne Australia
| | - J. Raman
- Baker Medical Research Institute; Melbourne Australia
| | - M. Byrne
- Baker Medical Research Institute; Melbourne Australia
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Power JM, Raman J, Dornom A, Farish SJ, Burrell LM, Tonkin AM, Buxton B, Alferness CA. Passive ventricular constraint amends the course of heart failure: a study in an ovine model of dilated cardiomyopathy. Cardiovasc Res 1999; 44:549-55. [PMID: 10690287 DOI: 10.1016/s0008-6363(99)00255-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Dilated cardiomyopathy (DCM) is associated with a progressive deterioration in cardiac function. We hypothesised that some of the deleterious effects of DCM could be reduced by mechanically limiting the degree of cardiac dilatation. METHODS A Transonic 20A cardiac output (CO) flow-probe was implanted in the pulmonary artery of 12 adult (52 +/- 4 kg) sheep. Early heart failure was created by rapid right ventricular (RV) pacing for 21 days at a rate which resulted in an initial 10% decrease in CO (to a maximum of 190 bpm). A custom polyester jacket (Acorn Cardiovascular, St Paul, MN) was then placed, via a partial lower sternotomy, on the ventricular epicardium of all sheep. Animals were randomised either to jacket retention (wrap) or removal (sham). Pacing was recommenced at a higher rate (that initiated a further 10% decrease in CO) for 28 days. Haemodynamic and echocardiographic parameters were determined at baseline, implant and at termination. RESULTS At termination, the left ventricular fractional shortening was significantly higher (p = 0.03), the degree of mitral valve regurgitation lower (scaled 0-3) (p = 0.03) and the left ventricular long axis area smaller (p = 0.02) in the wrap animals compared with sham. CONCLUSIONS In this model of heart failure, ventricular constraint with a polyester jacket diminished the deterioration in cardiac function associated with progressive dilated cardiomyopathy. These results suggest that maintainance of a more normal cardiac size and shape may be beneficial in patients with dilated cardiomyopathy.
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Affiliation(s)
- J M Power
- Department of Medicine, University of Melbourne, Australia.
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Ruengsakulrach P, Sinclair R, Komeda M, Raman J, Gordon I, Buxton B. Comparative histopathology of radial artery versus internal thoracic artery and risk factors for development of intimal hyperplasia and atherosclerosis. Circulation 1999; 100:II139-44. [PMID: 10567293 DOI: 10.1161/01.cir.100.suppl_2.ii-139] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In this study, we examined the comparative histopathology, morphometry, and risk factors for the development of intimal hyperplasia and atherosclerosis in the radial artery (RA) and the internal thoracic artery (ITA). METHODS AND RESULTS Paired specimens of RAs and ITAs, obtained from 150 patients who underwent CABG, were evaluated with histopathology; 110 pairs of arteries were suitable for morphometric analysis. The severity of disease was evaluated on the basis of percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio. Risk factors were determined with stepwise linear regression. Intimal hyperplasia was seen in 141 RAs (94%) and 103 ITAs (69%) (P<0.001). Atherosclerosis was seen in 5% of RAs and 0.7% of ITAs (P=0.04). Medial calcification was found only in RAs (20 of 150, 13.3%) (P<0.001). Morphometric analysis showed that compared with ITAs, RAs had a significantly higher intimal area, medial area, percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio (all P<0.001) Factors found to be significant (P<0.05) predictors of the 3 severity indices of intimal hyperplasia, including atherosclerosis, in RAs were peripheral vascular disease, smoking, age, and diabetes. Risk factors for intimal hyperplasia in ITAs were age and smoking. CONCLUSIONS The RA is more likely to have atherosclerosis, intimal hyperplasia, and medial calcification than the ITA. Morphometric analysis indices showed marked differences between the RA and the ITA. Care should be taken when selecting the RA as a conduit in CABG, particularly in patients who are elderly, diabetic, smoke, or have peripheral vascular disease.
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Affiliation(s)
- P Ruengsakulrach
- Department of Cardiac Surgery, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
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Power JM, Beacom GA, Alferness CA, Raman J, Farish SJ, Tonkin AM. Effects of left atrial dilatation on the endocardial atrial defibrillation threshold: a study in an ovine model of pacing induced dilated cardiomyopathy. Pacing Clin Electrophysiol 1998; 21:1595-600. [PMID: 9725159 DOI: 10.1111/j.1540-8159.1998.tb00248.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Left atrial (LA) dilation is a common finding in patients with chronic atrial fibrillation (AF). Progressive dilatation may alter the atrial defibrillation threshold (ADFT). In our study, epicardial electrodes were implanted on the LA free wall and right ventricular apex of eight adult sheep. Large surface area, coiled endocardial electrodes were positioned in the coronary sinus and right atrium (RA). LA dilatation was induced by rapid ventricular pacing (190 beats/min) for 6 weeks and echocardiographically assessed weekly along with the ADFT (under propofol anesthesia). LA effective refractory period (ERP) was measured every 2-3 days using a standard extra stimulus technique and 400 ms drive. The AF cycle length (AFCL) was assessed from LA electrograms. During the 6 weeks of pacing the mean LA area increased from 6.1 +/- 1.5 to 21.3 +/- 2.4 cm2. There were no significant changes in the mean ADFT (122 +/- 15 V), circuit impedance (46 +/- 5 omega), or LA AFCL (136 +/- 23 ms). There was a significant increase in the mean LA ERP (106 +/- 10 ms at day 0, and 120 +/- 13 ms at day 42 of pacing). In this study, using chronically implanted defibrillation leads, the minimal energy requirements for successful AF were not significantly altered by ongoing left atrial dilatation. This finding is a further endorsement of the efficiency of the coronary sinus/RA shock vector. Furthermore, the apparent stability of the AF present may be a further indication of a link between the type of AF and the ADFT.
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Affiliation(s)
- J M Power
- Department of Cardiology, Austin and Repatriation Medical Centre, Heidelberg, Australia
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Palleroni AV, Specian A, Aglione A, Dvorozniak MT, Raman J. A second-generation enzyme immunoassay for detection of antibodies to IFN-alpha. J Interferon Cytokine Res 1998; 18:357-60. [PMID: 9660241 DOI: 10.1089/jir.1998.18.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have developed a solid-phase enzyme-linked immunoassay (EIA) for detecting antibodies to interferon-alpha2 (IFN-alpha2) in serum or plasma. In this assay, based on the sandwich principle, the capture antigen, IFN-alpha2, is covalently bound to the wells in 96-well plates. This novel procedure offers considerable advantages over the antigen binding by passive adsorption used in most previous EIA. Specific antibodies present in clinical specimens bind to the anchored antigen and are detected by adding peroxidase-labeled IFN-alpha2 and a peroxidase substrate mixture. The resultant color is a function of the concentration of antibody in the sample. The assay has proved to be convenient, precise, and reproducible and can detect as little as 1-5 ng/ml of specific antibody IgG.
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Affiliation(s)
- A V Palleroni
- Roche Research Center, Hoffmann-La Roche, Inc, Nutley, NJ 07110, USA.
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Lovegrove BG, Raman J. Torpor patterns in the pouched mouse (Saccostomus campestris; Rodentia): a model animal for unpredictable environments. J Comp Physiol B 1998; 168:303-12. [PMID: 9646507 DOI: 10.1007/s003600050150] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patterns of spontaneous and induced daily torpor were measured in the Afrotropical pouched mouse (77-115 g), Saccostomus campestris, in response to photoperiod, temperature, and food deprivation, using temperature telemetry. Photoperiod had no influence on the incidence, depth, or duration of daily torpor in either males and females. Although the testis size index decreased in response to food deprivation and photoperiod by a maximum of 24%, full testis regression did not occur. Torpor bout duration was, on average, 5.3 h, independent of photoperiod and ambient temperature. Males did not enter torpor in response to food deprivation but did in response to low ambient temperature, though significantly less frequently than females. At normothermia, the body temperatures (daily minimum, mean, maximum) of males were significantly lower than those of females. Minimum body temperatures of both males and females during torpor did not fall below 20 degrees C at an ambient temperature of 15 degrees C. The patterns of torpor measured here differ from those observed in species from strongly seasonal environments. They suggest adaptation to an environment rendered unpredictable by the El Niño Southern Oscillations. As an aseasonal, opportunistic breeder capable of year-round adaptive hypothermia, the pouched mouse represents an excellent model animal for research on physiological and behavioral adaptations to unpredictable environments.
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Affiliation(s)
- B G Lovegrove
- Department of Zoology and Entomology, University of Natal, Scottsville, South Africa.
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Power JM, Beacom GA, Alferness CA, Raman J, Wijffels M, Farish SJ, Burrell LM, Tonkin AM. Susceptibility to atrial fibrillation: a study in an ovine model of pacing-induced early heart failure. J Cardiovasc Electrophysiol 1998; 9:423-35. [PMID: 9581958 DOI: 10.1111/j.1540-8167.1998.tb00930.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The development of susceptibility to atrial fibrillation (AF) is a common consequence of many forms of cardiovascular disease, especially heart failure. In this study we used a sheep model of pacing-induced stable early heart failure to describe, quantify, and relate the level of susceptibility to AF to changes in structural and electrophysiologic parameters. METHODS AND RESULTS Epicardial electrodes were implanted on the atria and right ventricles of nine sheep. The AF threshold, atrial vulnerability period, atrial effective refractory period (ERP), and interatrial conduction time were examined during control and over a 6-week period of ventricular pacing at 190 beats/min. Left atrial (LA) area and left ventricular (LV) fractional shortening were monitored using echocardiography. There were significant increases in LA susceptibility to AF (P < 0.0003), LA area (P < 0.0002), and LA ERP400 (P < 0.0002). Rate of increase in LA area was related positively to AF susceptibility (P = 0.02) and inversely to LA ERP400 (P = 0.002). LV fractional shortening decreased to approximately 50% of control value (P < 0.00001). No changes were observed in right atrial electrophysiology. CONCLUSION In this study, susceptibility (the ability of an extrastimulus to induce AF) was rigorously measured within a predetermined format. Significant relationships were found to exist between susceptibility, certain of the observed changes in atrial electrophysiology and structure.
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Affiliation(s)
- J M Power
- Department of Medicine, University of Melbourne, Heidelberg, Australia.
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Komeda M, Buxton B, Raman J, Mullaly L, Hare D. Allen test — new value of the “old” Test. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chan RK, Raman J, Lee KJ, Rosalion A, Hicks RJ, Pornvilawan S, Sia BS, Horowitz JD, Tonkin AM, Buxton BF. Prediction of outcome after revascularization in patients with poor left ventricular function. Ann Thorac Surg 1996; 61:1428-34. [PMID: 8633954 DOI: 10.1016/0003-4975(96)00089-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients with poor left ventricular function, the determinants of outcome after revascularization are unknown. METHODS We studied prospectively 57 patients with stable coronary artery disease and poor left ventricular function (left ventricular ejection fraction, 0.28 +/- 0.04) who underwent coronary artery bypass grafting. Clinical variables were assessed as predictors of outcome in all patients, and preoperative stress thallium-201 scintigraphic data were analysed in 37 patients. RESULTS The operative mortality was 1.7%. At 12 months after operation, 46 of the 49 survivors were angina-free and 35 had fewer heart failure symptoms, but postoperative left ventricular ejection fraction (0.30 +/- 0.09) did not change significantly. Eighteen survivors had left ventricular ejection fraction improved by 0.05 or more (0.30 +/- 0.03 preoperatively, 0.40 +/- 0.05 postoperatively; p = 0.0001). The adjusted odds ratio of large reversible thallium-201 defects in predicting such outcome was 15 (95% confidence interval, 1.6 to 140), whereas other clinical variables had no predictive value. The transplantation-free 5-year survival was 73%. CONCLUSIONS In patients with poor left ventricular function, surgical revascularization can be performed safely, with good symptomatic relief and long-term survival. One-year survival and improvement in left ventricular function is better in patients with large reversible defects on preoperative stress thallium-201 scintigraphy.
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Affiliation(s)
- R K Chan
- Department of Cardiac Surgery, Austin and Repatriation Medical Center, Melbourne, Australia
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Raman J, Apte DV, Dawson MJ, Bobowski SJ, Trupin SR. Biochemical evaluation of endometrial biopsies by magnetic resonance spectroscopy--preliminary data. Am J Obstet Gynecol 1990; 162:1511-5; discussion 1515-7. [PMID: 2360585 DOI: 10.1016/0002-9378(90)90914-s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Biochemical study of tissue biopsy samples by magnetic resonance spectroscopy involves relatively small capital and running costs and could become a routine diagnostic or screening procedure if its utility were to be adequately demonstrated. We have demonstrated feasibility of evaluation of endometrial biopsy samples by magnetic resonance previous to histopathologic examination. Preliminary comparisons of magnetic resonance spectra with histopathologic evaluation indicates that in at least some instances, magnetic resonance may be the more sensitive indicator of disease.
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Affiliation(s)
- J Raman
- Department of Physiology and Biophysics, University of Illinois, Urbana-Champaign
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Abstract
Rehydrated freeze-dried microarterial allografts were implanted to bridge arterial defects using New Zealand White rabbits as the experimental model. Segments of artery from the rabbit ear and thigh were harvested and preserved for a minimum of 2 weeks after freeze-drying. These allografts, approximately 1 mm in diameter and ranging from 1.5 to 2.5 cm in length, were rehydrated and then implanted in low-pressure and high-pressure arterial systems. Poor patency was noted in low-pressure systems in both allografts and autografts, tested in 12 rabbits. In the high-pressure arterial systems, allografts that were freeze-dried and reconstituted failed in a group of 10 rabbits with an 8-week patency rate of 30 percent. Gamma irradiation in an effort to reduce infection and antigenicity of grafts after freeze-drying was associated with a patency rate of 10 percent at 8 weeks in this system in another group of 10 rabbits. Postoperative cyclosporin A therapy was associated with a patency rate of 22.2 percent in the high-pressure arterial system in a 9-rabbit group. Control autografts in this system in a group of 10 rabbits showed a 100 percent patency at 8 weeks. Microarterial grafts depend on perfusion pressure of the vascular bed for long-term patency. Rehydrated freeze-dried microarterial allografts do not seem to function well in lengths of 1 to 2.5 cm when implanted in a high-pressure arterial system. Freeze-dried arterial allografts are probably not antigenic.
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Affiliation(s)
- J Raman
- Department of Surgery, St Vincent's Hospital
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50
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Saldanha RF, Raman J, Batreddi RV, Chang VP. Coronary artery surgery in Asian patients. J Cardiovasc Surg (Torino) 1990; 31:26-30. [PMID: 2324179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We studied retrospectively, 412 consecutive Asian patients undergoing coronary artery bypass grafting between January 1st, 1982 and June 30th, 1987. The mean age was 55 +/- 9 years at operation with a 70.5% male predominance. Patients of Chinese origin accounted for 60.9%, Indonesian for 26.4%, Indian 9.9% and Malaysian 2.6%. Chronic stable angina was the most consistent presenting symptom in 71% and 49% had at least one myocardial infarction in the past. Fifty percent were hypertensive and 26% diabetic. Left main stem coronary artery obstruction was evident in 21.6% and the coronary arteries diffusely diseased in 53%. An average of 3.8 +/- 0.4 grafts were performed per patient using reversed saphenous vein, and endarterectomies were necessitated in 27.1%. The small calibre of coronary arteries in Asian patients was reflected by 54% of grafted vessels having a luminal diameter of 1.5 mm. The early mortality rate and the peri-operative myocardial infarction rate was 1.2% in each instance. A mean follow-up of 30 months revealed a late mortality of 1.9% and 76% of patients were in NYHA Functional Class I. This study suggests that despite a high incidence of hypertension, diabetes and diffuse coronary artery disease Asian patients tolerate coronary artery bypass graft surgery well and obtain significant benefit from it.
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Affiliation(s)
- R F Saldanha
- Cardiothoracic Surgical Unit, St. Vincent's Hospital, Sydney, NSW, Australia
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