ABSTRACT
This study was conducted to establish the validity of left-sided cardiac output measurement with a Swan-Ganz catheter and assess its accuracy in estimating mitral valve area (MVA) by the Gorlin formula. The use of right-sided cardiac output after balloon mitral valvotomy (BMV) can give inaccurate measurements for Gorlin-derived MVA because of the atrial septal defect (ASD) created during the procedure. The left-sided cardiac output was measured with a Swan-Ganz catheter (proximal port in the left atrium and then in the left ventricle, and distal port in the ascending aorta) in 10 consecutive patients before and after BMV. Gorlin-derived MVA cardiac output by this method was compared with (1) Gorlin-derived MVA by means of right-sided cardiac output with and without balloon occlusion of the ASD and (2) MVA measured by echocardiography. Before BMV, a close agreement with a good correlation between left-sided and right-sided cardiac output was found (r = 0.83, p = 0.006). Furthermore, Gorlin-derived MVA by cardiac output with either method was comparable with valve area by echo. After BMV, left-sided cardiac output correlated well (r = 0.92, p = 0.0002) and was comparable with right-sided cardiac output with occlusion of the ASD (mean difference 0.17 +/- 0.49 L/min, p = 0.3) but was significantly lower than the value obtained with open ASD (mean difference 0.93 +/- 0.77 L/min, p = 0.004). Comparison of the correspondent MVAs yielded similar results. Gorlin-derived MVA with left-sided cardiac output and MVA by echo were also similar.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Cardiac Output/physiology , Catheterization, Swan-Ganz , Catheterization , Mitral Valve Stenosis/therapy , Echocardiography, Doppler , Feasibility Studies , Female , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve Stenosis/diagnosis , Mitral Valve Stenosis/physiopathology , Regression Analysis , Reproducibility of Results , Thermodilution/instrumentation , Thermodilution/methodsABSTRACT
Conventional techniques of coronary angioplasty for lesions at coronary bifurcations are well documented, are sometimes cumbersome, and have inherent limitations. We describe a technique for sequential atherectomy at coronary bifurcations. Further evaluation is needed to determine the overall safety, efficacy, applicability and durability of sequential directional atherectomy at coronary bifurcations.
Subject(s)
Atherectomy, Coronary/instrumentation , Coronary Artery Disease/therapy , Adult , Aged , Angina Pectoris/diagnostic imaging , Angina Pectoris/therapy , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Equipment Design , Follow-Up Studies , Humans , Male , Middle AgedSubject(s)
Aortic Diseases/surgery , Arteriosclerosis/surgery , Ischemia/surgery , Toes/blood supply , Adult , Angioplasty, Balloon , Aorta, Abdominal/surgery , Aortic Diseases/complications , Arteriosclerosis/complications , Embolism/complications , Embolism/etiology , Female , Humans , Ischemia/etiology , Syndrome , Vascular Surgical Procedures/methodsABSTRACT
Cardiac function in a 75-year-old woman with primary amyloidosis and a restrictive cardiomyopathy deteriorated markedly after the occurrence of high-grade atrioventricular block. Atrial synchronous cardiac pacing, which was unreported previously in this setting, produced a marked improvement in cardiac performance.
