http://repub.eur.nl/res/aut/13171/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/5292/ 1984-01-01T00:00:00Z Six cases of acute myocardial infarction with blood in the pericardial sac are described. In one case rapid death followed myocardial rupture leaving no time for the possibility of intervention. Of two other cases acute symptoms developing after myocardial rupture, one was operated on promptly and the other, whose condition improved on pericardiocentesis, after a delay of a few hours. Both are now long term survivors A fourth patient probably had two episodes of rupture which apparently sealed off. He underwent cardiac catheterization, but no epicardial leak was found. Subsequently at operation a sealed myocardial rupture was detected and sutured over. The fifth patient suffered a silent myocardial rupture. A false aneurysm was diagnosed four months later and he withstood successful surgery. In the sixth patient, the course was similar to that of case 1, namely rapid death with a clinical picture suggestive of tamponade. Postmortem examination showed a covert rupture with some evidence of attempts to plug the opening. The purpose of this report is to emphasize the varying course which myocardial rupture can take. http://repub.eur.nl/res/pub/4085/ 1983-01-01T00:00:00Z To determine whether a ventricular (LV) end-systolic dimension (ESD) greater than or equal to 55 mm and LV left fractional shortening less than 25% are risk factors for aortic valve replacement (AVR) in patients with aortic insufficiency, we analyzed the clinical course and M-mode echocardiograms in 47 consecutive patients who underwent AVR for isolated symptomatic AI. Group 1 patients (n = 27) had a preoperative ESD less than 55 mm (mean 44 mm, range 30-52 mm) and group 2 patients (n = 20) had a preoperative ESD greater than or equal to 55 mm (mean 62 mm, range 55-85 mm). One patient in group 1 and 10 patients in group 2 had left ventricular fractional shortening less than 25%. There were no perioperative or postoperative deaths during an average follow-up of 41 months (range 6-76 months). Five patients had perioperative myocardial infarctions (MIs), three in group 1 and two in group 2. Since myocardial protection with cold potassium cardioplegia was instituted, no patient has suffered a perioperative MI. The average preoperative New York Heart Association functional classification was 2.3 (group 1) and 2.6 (group 2). Postoperatively, it was 1.2 in group 1 and 1.1 in group 2. Thirty-three patients (20 in group 1 and 13 in group 2) had echocardiograms at least 1 year after AVR. Of these, LV-end diastolic dimension decreased fro 67 +/- 6 to 53 +/- 6 mm (mean +/- SD) in group 1 (p less than 0.001) and from 79 +/- 3 to 55 +/- 6 mm in group 2 (p less than 0.001). The LVESD also decreased, but this is difficult to interpret because of frequent postoperative abnormal interventricular septal motion. The LV cross-sectional area, an index of LV mass, decreased in group 1 from 25 +/- 5 to 20 +/- 5 cm2 (p lss than 0.001) and in group 2 from 32 +/- 9 to 20 +/- 5 cm2 (p less than 0.001). Postoperative end-diastolic dimension and cross-sectional area were not significantly different between the two groups. We concluded that in aortic insufficiency, a preoperative ESD greater than or equal to 55 mm does not preclude successful AVR, as judged by long-term survival, symptomatic relief, and normalization of LV dimensions assessed by echocardiography. http://repub.eur.nl/res/pub/4015/ 1979-01-01T00:00:00Z Extent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was manifest in 16 regions (a 12% incidence) during the follow-up period, and six of these showed spontaneous remission. All cases of PSE were in the region of the left anterior descending artery. Correlation between graft flow measured during operation and regional shortening during the postoperative period revealed that the development of PSE could not be predicted from the hemodynamic measurements. In the majority of cases postoperative myocardial infarction could also be excluded as an explanation. At 1 year after operation most grafts were patent in PSE regions but collaterals, apparent preoperatively, could not be visualized. Excluding PSE, shortening fraction (ratio of shortening to maximum marker separation) for all graft regions at 1 week was 9.8%; 1 month, 12.8%; 3 months, 13.3%; and six months, 13.9%. Average graft flow was 56 ml. per minute and average reactive hyperemia was 25% with 37% of grafts showing no response. For those regions that did not develop PSE there was a positive correlation between shortening fraction and flow that became significant (null hypothesis: r = 0) when reactive hyperemia exceeded 20%. Correlation was greatest at 1 week and 1 month, but became nonsignificant at 6 months. These results are consistent with a simple interpretation of reactive hyperemia: Graft-reactive hyperemia is related to the dependence of viable tissue on the functioning of the graft.