Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Dec 1993
Echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch.
This study was designed to identify preoperative echocardiographic predictors of left ventricular outflow tract obstruction after repair of interrupted aortic arch and ventricular septal defect closure. ⋯ The preoperatively measured cross-sectional area of the left ventricular outflow tract is significantly smaller in patients with interrupted aortic arch who develop subaortic obstruction postoperatively, with a left ventricular outflow tract area < or = 0.7 cm2/m2 being a sensitive predictor. Aortic arch anatomy (i.e., type of interrupted aortic arch and presence of aberrant right subclavian artery) is also predictive of postoperative left ventricular outflow tract obstruction, possibly by influencing the volume of blood flow across the left ventricular outflow tract. These data should enable preoperative identification of infants who may require surgical relief of subaortic stenosis.
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J. Am. Coll. Cardiol. · Nov 1993
Changes in left and right atrial size after cardioversion of atrial fibrillation: role of mitral valve disease.
The aim of this study was to examine the effect of cardioversion on left and right atrial volume in patients with chronic atrial fibrillation and to determine the influence of mitral valve disease on atrial size. ⋯ Restoration of sinus rhythm reverts the process of left and right atrial enlargement in patients with chronic atrial fibrillation and mitral valve disease. Therefore, cardioversion may reduce the incidence of thromboembolic complications and prevent the arrhythmia from becoming refractory to medical therapy.
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J. Am. Coll. Cardiol. · Nov 1993
Case ReportsExercise hemodynamics during long-term implantation of a left ventricular assist device in patients awaiting heart transplantation.
The goal of this study was to assess patients with end-stage heart disease after implantation of a left ventricular assist device at rest and during exercise compatible with activities of daily life. ⋯ Significant work loads compatible with activities of daily life and adequate exercise hemodynamics were demonstrated by these patients while awaiting heart transplantation. Definitive conclusions regarding the use of this device must be viewed as preliminary because only three patients were involved in this study and the failure rate may be as high as 71% (95% confidence interval of left ventricular assist device success as a bridge to transplantation 29.3% to 100%). Final conclusions regarding the safety and efficacy of the left ventricular assist device as a possible long-term circulatory support device must await results of larger multicenter trials in progress.
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J. Am. Coll. Cardiol. · Nov 1993
Beta-endorphins during coronary angioplasty in patients with silent or symptomatic myocardial ischemia.
The aims of this study were to correlate beta-endorphin plasma levels and anginal pain in patients with ischemia induced by percutaneous transluminal coronary angioplasty and to detect eventual endorphin variations during balloon occlusion. ⋯ Methodologic variables and the severity of coronary artery disease did not influence the presence of symptoms during angioplasty-induced ischemia. Beta-endorphin plasma levels were higher and more stable in patients with silent ischemia during angioplasty, suggesting that opiate levels and their variation during ischemia are associated with individual attitude toward anginal pain.
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J. Am. Coll. Cardiol. · Nov 1993
Comparative StudyCoronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional state.
The present study evaluated our experience with coronary artery bypass grafting in patients with severe left ventricular dysfunction. ⋯ In patients with coronary artery disease and advanced ventricular dysfunction: 1) coronary artery bypass grafting can be performed relatively safely, 2) good medium-term survival is attained, 3) improvement in left ventricular function can be documented objectively after bypass grafting, 4) quality of life is improved (as reflected by improvement in anginal and congestive heart failure status), and 5) the internal mammary artery can safely be used as a conduit. The use of coronary artery bypass grafting is encouraged for this group of patients and may provide a viable alternative to transplantation in selected patients.