American heart journal
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American heart journal · Nov 1994
Clinical TrialEncircling endocardial cryoablation for ventricular tachycardia after myocardial infarction: experience with 33 patients.
Encircling endocardial cryoablation, consisting of circumferential cryoablation of the infarct scar, can be curative in selected patients with ventricular tachycardia (VT). We describe our experience with and long-term outcome in 33 patients undergoing this procedure. The interval between myocardial infarction and the onset of tachycardia varied from 2 weeks to 22 years (mean 38 +/- 63 months and median 3 months). ⋯ The patient receiving amiodarone sustained a cardiac arrest subsequently and received an ICD implant. One patient with an ICD continued to receive appropriate shocks frequently and died 2 years after surgery. Nine patients had congestive heart failure postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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American heart journal · Nov 1994
Multicenter Study Clinical TrialInternational experience with secundum atrial septal defect occlusion by the buttoned device.
Several devices are available for transcatheter occlusion of atrial septal defect. This report describes the international experience with the buttoned device. During a 4.5-year period ending in February 1993, 180 transcatheter atrial septal defect occlusions were performed with the buttoned device. ⋯ Color Doppler studies revealed either complete disappearance of the previously demonstrated shunts or further diminution of their size. The results indicate that transcatheter occlusion of the atrial septal defects with buttoned devices is feasible, relatively safe, and effective, and it appears to be a viable alternative to surgery for some patients with secundum atrial septal defect. Complications are infrequent and should improve with experience.
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American heart journal · Nov 1994
Physical activity and mortality in women in the Framingham Heart Study.
Men who are more active live longer, but it is not clear if the same is true for women. We monitored 1404 women aged 50 to 74 who were free of cardiovascular disease. We assessed physical activity levels and ranked subjects into quartiles. ⋯ The relative risks were not changed by adjustment for cardiac risk factors, chronic obstructive pulmonary disease, or cancer or by excluding all subjects who died in the first 6 years (to eliminate occult disease at baseline). There was no association between activity levels and cardiovascular morbidity or mortality. We conclude that women who were more active lived longer; this effect was not the result of decreased cardiovascular disease.
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American heart journal · Sep 1994
Comparative StudyQuantitation of aortic valve area in aortic stenosis with multiplane transesophageal echocardiography: comparison with monoplane transesophageal approach.
The accuracy and reliability of two-dimensional monoplane and multiplane transesophageal echocardiography (TEE) in the quantitation of aortic valve area were compared in 54 patients with aortic stenosis. Fifty patients had aortic valve area calculated by the continuity equation and transthoracic Doppler echocardiography (TTE); 25 underwent cardiac catheterization. Two-dimensional echocardiograms adequate for quantitation of aortic valve area were obtained in 21 (39%) patients with monoplane TEE and in 51 (94%) with multiplane TEE. ⋯ Multiplane TEE provided a better correlation of aortic valve area measurements with either TTE (y = 0.97 x + 0.03; r = 0.96; SEE = 0.11 cm2) or catheterization (y = 0.84 x + 0.11; r = 0.90; SEE = 0.12 cm2) than the monoplane TEE (y = 0.88 x + 0.13; r = 0.83; SEE = 0.15 cm2 and y = 0.41 x + 0.42; r = 0.81; SEE = 0.15 cm2). Severe aortic stenosis with valve orifice area of < or = 0.75 cm2 during TTE examination was found by multiplane TEE with a sensitivity of 96% and a specificity of 96%. Thus aortic valve area can be directly and reliably measured by two-dimensional multiplane TEE in majority of patients with aortic stenosis.
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American heart journal · Sep 1994
Retrograde coronary blood flow during cardiopulmonary resuscitation in swine: intracoronary Doppler evaluation.
Cardiopulmonary resuscitation-generated coronary perfusion pressure and intracoronary flow velocity was studied with high-fidelity pressure transducers and an intracoronary Doppler catheter in 11 swine undergoing closed-chest manual cardiopulmonary resuscitation. Retrograde coronary blood flow in the mid left anterior descending coronary artery was documented during the compression (systolic) phase of chest compression. ⋯ Even when the aortic minus right atrial pressure gradient was raised throughout the cardiac cycle of closed-chest manual cardiopulmonary resuscitation, antegrade coronary flow occurred only during the relaxation phase of chest compressions. This study indicates that coronary blood flow during ventricular fibrillation and closed-chest cardiopulmonary resuscitation occurs only during diastole or the release phase of chest compression and supports the use of diastolic coronary perfusion pressure as a reflection of myocardial blood flow during closed-chest manual cardiopulmonary resuscitation.