Effects of diaspirin crosslinked haemoglobin during coronary angioplasty in the swine.

OBJECTIVE: Percutaneous transluminal coronary angioplasty produces a transient interruption of coronary blood flow during balloon inflation, giving rise to temporary regional myocardial ischaemia. Diaspirin crosslinked haemoglobin (DCLHbTM) transports oxygen in a similar way to whole blood and can be perfused through the angioplasty catheter during balloon occlusion. The aim of this study was to test the hypothesis that DCLHb may increase myocardial oxygenation and reduce myocardial ischaemia during coronary angioplasty. METHODS: The effect of DCLHb on cardiac function was measured in diazepam sedated swine. Mean arterial blood pressure, peak systolic left intraventricular pressure, maximum rate of left ventricular pressure development (dP/dtmax), pressure-rate product, cardiac output (CO), and ECG were monitored continuously. Variables were compared during control, during 1 min balloon occlusion of the proximal left anterior descending coronary artery with a 2.5-3.5 F angioplasty catheter, during 1 min of DCLHb perfusion (40 ml.min-1) without balloon occlusion, and during 4 min balloon occlusion with DCLHb perfusion (40 ml.min-1) of the occluded region. Measurements were made during balloon occlusion plus DCLHb at 1 min (B + D1), 2 min (B + D2), and 4 min (B + D4). RESULTS: Balloon occlusion decreased cardiac function as compared to control: arterial blood pressure -16%, intraventricular pressure -14%, dP/dtmax -34%, and pressure-rate product -40%. DCLHb alone did not significantly change haemodynamic measurements from control. At B + D4 haemodynamic variables were increased as compared to balloon occlusion alone: arterial blood pressure +32%, intraventricular pressure +29%, dP/dtmax +20%, and pressure-rate product +19%. Only intraventricular pressure and mean arterial pressure were increased compared to control. The S-T segment of the ECG was depressed by 0.109(SEM 0.019) mV during balloon occlusion without DCLHb, while only decreasing by 0.069(0.027) mV at B + D1, by 0.046(0.018) mV at B + D2, and by 0.058(0.018) mV at B + D4. CONCLUSIONS: There is an improvement in cardiac function and a lessening of S-T segment depression during percutaneous transluminal coronary angioplasty balloon occlusion with DCLHb perfusion.

Atrial fibrillation following pulse methylprednisolone therapy in an adult.

The authors believe this to be the first case report of atrial fibrillation following pulse methylprednisolone therapy in an adult. The literature regarding the complications of pulse methylprednisolone therapy is reviewed, with particular emphasis on the incidence and pathogenesis of arrhythmias.

Effects of diasprin cross-linked hemoglobin (DCLHb) on cardiac function and ECG in the swine.

The effects of DCLHb on cardiac function were measured in diazepam sedated (2-4 mg/min) swine. Mean arterial blood pressure (MAP), peak systolic left ventricular pressure (IVP), rate of left ventricular pressure development (dP/dt), pressure rate product (PRP), cardiac output (CO), and ECG were monitored continuously. Hemodynamic parameters were compared during control, DCLHb infusion (40 ml/min), one minute balloon occlusion (BO) of the proximal left anterior descending coronary artery (LAD) with a 2.5-3.5 F, 20 mm balloon angioplasty catheter, and four minute balloon occlusion with DCLHb (BO + DCLHb) perfusion (40 ml/min) of the LAD occluded region. Control hemodynamic values were as follows; MAP 91 +/- 6 mmHg, IVP 102 +/- 6 mmHg, dP/dt 2519 +/- 351 mmHg/min, PRP 15809 +/- 1515 mmHg.min, and CO 2.72 +/- 0.29 L/min. There was a significant reduction in cardiac function with BO as compared to control; MAP 16% decreases, IVP 14% decreases, dP/dt 34% decreases, and PRP 40% decreases. In contrast BO + DCLHb significantly increased all measurements of cardiac function, with the exception of CO as compared to control; MAP 32% increases, IVP 29% increases, dP/dt 20% increases, and PRP 19% increases. The S-T segment of the ECG was depressed by a significant 0.134 +/- 0.006 mv from control during BO. There was a significant decrease 0.093 +/- 0.045 mv in the BO + DCLHb group. These data demonstrate an increase in cardiac function and a decrease in S-T segment depression during balloon occlusion with DCLHb perfusion. Further studies are needed to define the mechanism of action of DCLHb mediated increases in cardiac function.

Atrial fibrillation and electrical appliance injury.

Electrocardiographic changes and cardiac arrhythmias have been reported frequently in patients suffering high tension (greater than 1,000 V) electrical injuries as well as low tension (less than 350 V) electrical injuries. An association of atrial fibrillation with low tension electrical injury from a household appliance, however, has not been described in the recent literature. We describe a patient with atrial fibrillation induced by a shock from a household toaster. Pathophysiologic mechanisms and approach to treatment are reviewed, emphasizing the transient nature of most electrically induced arrhythmias.

Adenoid cystic carcinoma of the trachea--a cause of pseudo-angina pectoris.

Primary tracheal tumors are rare. Typically slow growing, they present late in the course of disease, with obstructive respiratory symptoms. A 25-year-old man developed external substernal chest pain and pressure with dyspnea that were relieved with rest. Noninvasive evaluation identified a tracheal tumor, adenoid cystic carcinoma by biopsy, which was previously undescribed as a cause of pseudo-angina pectoris. The patient's evaluation, management, and 20-month follow-up are presented. A mechanism for the patient's noncardiac exertional chest pain is proposed. Previous experience with adenoid cystic carcinomas of the trachea is reviewed.

Pregnancy in a woman with partial absence of the left pericardium. A case report.

Absence of the left pericardium is a rare congenital anomaly, occasionally associated with chest pain syndromes. There have been six cases of death due to strangulation of the left atrial appendage in patients with this condition. We present the first report of a patient with this anomaly who was followed through pregnancy.

Reversible valvulitis in Wegener's granulomatosis.

A patient with Wegener's granulomatosis sustained a myocardial infarction. Subsequent echocardiography showed aortic valvulitis, which resolved with therapy with cyclophosphamide and prednisone.

Reoperation for correction of anomalous origin of the left coronary artery from the pulmonary artery with return of left ventricular function.

An adult patient is presented in whom anomalous origin of the left coronary artery from the pulmonary artery was diagnosed in infancy. Initial treatment included a palliative poudrage procedure. Resulting widespread, dense adhesions were encountered during reoperation in adulthood and precluded direct reimplantation of the left coronary artery into the aorta. Instead, a tunnel within the pulmonary artery was constructed from the aorta to the left coronary ostium using a baffle of woven Dacron. Preoperative and postoperative studies showed improvement in ejection fraction and resolution of diaphragmatic hypokinesis.