Surgical exclusion of focal paroxysmal atrial tachycardia.

A 37 year old man with no evidence of structural heart disease presented with paroxysmal atrial tachycardia that could not be induced in the electrophysiology laboratory. Epicardial and endocardial mapping of the tachycardia performed in the operating room showed earliest activation at the junction of the right superior pulmonary vein and left atrium. An encircling incision excluded the portion of the left atrium containing the earliest point of activation and both right pulmonary veins from the remainder of the left atrium.

Cardiac transplantation in perspective for the future. Survival, complications, rehabilitation, and cost.

Two hundred twenty-seven cardiac transplant procedures have been performed in 206 patients from January, 1968, to April, 1981. Postoperative survival rates, calculated by the actuarial method for program years 1968 to 1973 (66 patients), are 44%, 33%, 27%, 21%, and 18% at 1, 2, 3, 4, and 5 years after transplantation, respectively. Postoperative survival rates for program years 1974 to 1981 (140 patients) are 63%, 55%, 51, 44%, and 39% at 1, 2, 3, 4, and 5 years after transplantation, respectively.

Relative efficacy of blind left ventricular aneurysm resection for the treatment of recurrent ventricular tachycardia.

Coronary arterial bypass grafting and left ventricular aneurysm resection and the two combined have been reported effective in control of refractory ventricular tachyarrhythmias; 82 percent of a pool of 127 patients (from 22 reports) survived after surgery. However, the follow-up period in this group is short and the extent of medical therapy is not well defined. Actuarial analysis of results of conventional left ventricular aneurysm resection in 32 Stanford patients with well documented ventricular tachyarrhythmias shows an arrhythmia recurrence rate of 50 +/- 9 percent (mean +/- standard error of the mean) during the postoperative hospitalization.

Survival of primates following orthotopic cardiac transplantation treated with total lymphoid irradiation and chemical immune suppression.

Fractionated total lymphoid irradiation (TLI) has been used for attempts at induction of a donor-specific tolerant-like state in allograft recipients and for immunosuppressive effects. Cyclosporin A (Cy A) has been shown to suppress rejection of organ grafts in many species including man. The present study was designed to test the effectiveness of TLI in combination with either CY A or rabbit anticynomolgus thymocyte globulin (ATG) and azathioprine.

Long-term survival and function after cardiac transplantation.

Cardiac transplantation now permits prolonged survival for some patients with otherwise fatal heart disease. This report summarizes the hemodynamic and clinical characteristics of 25 patients who have survived five or more years after cardiac replacement. The average age of the patients at the time of operation was 40 +/- 10 (SD) years; 23 were men.

The use of echocardiography in diagnosing culture-negative endocarditis.

We reviewed M-mode and two-dimensional echocardiographic findings in 11 patients with abacteremic endocarditis to study the application of echocardiography in this setting. All patients had negative blood cultures but underwent surgery that confirmed the presence of active infective endocarditis. The infection involved native valves in five patients and prosthetic valves in six patients.

Dynamics of glomerular ultrafiltration following open-heart surgery.

To elucidate how individual determinants might lower the rate of glomerular ultrafiltration (GFR) in some patients following cardiac surgery, we performed hemodynamic measurements and clearance of inulin (as a measure of GFR), PAH (as a measure of effective renal plasma flow [ERPF]), and dextran-40. Two groups of 17 patients each were distinguished by the presence or absence of prerenal azotemia. Glomerular hypofiltration (GFR = 21 +/- 2 vs.

Therapeutic efficacy of intraaortic balloon pump counterpulsation. Analysis with concurrent "control" subjects.

During a 7-year period, intraaortic balloon pumping (IABP) was attempted in 319 cardiac surgical patients. The indications for IABP were stringent and consisted of unsuccessful discontinuation of cardiopulmonary bypass (39%), anticipated failure (40%) to wean from cardiopulmonary bypass, postoperative low cardiac output, or intractable ventricular tachyarrhythmias (15%). IABP support was successfully instituted in 280 patients and was unsuccessful in 39 patients ("controls").

Patients with congestive cardiomyopathy as cardiac transplant recipients. Indications for and results of cardiac transplantation and comparison with patients with coronary artery disease.

In recent years end-stage congestive cardiomyopathy has become an increasingly frequent clinical diagnosis in candidates for cardiac transplantation. Forty-six patients who underwent transplantation because of congestive cardiomyopathy and 59 because of coronary artery disease were studied between 1971 and 1978 at Stanford University. The overall 1 year survival rate was similar in the two groups: cardiomyopathy-transplant, 64 percent and coronary artery disease-transplant, 55 percent.

Cardiovascular responses to handgrip isometric exercise in patients following cardiac transplantation.

The effects of cardiac denervation on the hemodynamic responses to isometric handgrip contraction were studied in patients 1--5 years after allograft cardiac transplantation. The objective of these studies was to determine the role of cardioacceleration and myocardial contractility on the increase in systemic arterial pressure during isometric exercise. Initially, noninvasive measurement of brachial artery pressure and heart rate during 60 seconds of isometric exercise at 50% of maximal voluntary contraction (50% MVC) were recorded in 23 cardiac transplant patients, 18 ischemic heart disease patients, and 15 healthy controls.

A human T lymphocyte differentiation marker defined by monoclonal antibodies that block E-rosette formation.

A new human T cell surface antigen, Leu-5, has been defined using a set of monoclonal antibodies that block rosette formation between T lymphocytes and sheep erythrocytes (SRBC). Four antibodies obtained from 2 different fusions using 2 immunized mouse strains all reacted with the same antigen. All these antibodies gave identical quantitative immunofluorescence (FACS) profiles, all gave the same staining profiles and intensities when used singly or in combinations, and all precipitated the same molecule.

Nocardial infections in the immunocompromised host: A detailed study in a defined population.

A retrospective, clinical, epidemiologic, and risk-factor analysis was performed on 21 recipients of cardiac allografts who had experienced nocardiosis since the inception of the cardiac transplantation program at Stanford University Medical Center in 1968. The lung was the primary and only detectable site of infection in 17 (81%) of 21 patients, and there were three cases of disseminated disease. Presenting symptoms were either nonspecific (dry cough and fever) or absent (in 40%).

Coronary artery spasm in the denervated transplanted human heart: a clue to underlying mechanisms.

The mechanism of coronary artery spasm has been poorly understood but there has been some suggestion that cardiac autonomic innervation may play an important role. We report coronary artery spasm in a 43 year old man two years after he had received a transplant. Provocative pharmacologic testing suggested functional denervation of the patient's heart.

Operative treatment of an unresectable tumor of the left ventricle.

A 17-year-old girl presented with an enlarged cardiac silhouette on routine chest roentgenogram. After clinical evaluation, echocardiography, and pericardiocentesis failed to provide a diagnosis, exploratory thoracotomy and biopsy revealed an unresectable left ventricular fibroma. The tumor continued to enlarge and began causing ventricular arrhythmia.

The renal effects of sodium nitroprusside in postoperative cardiac surgical patients.

Sodium nitroprusside (SNP) is frequently used to control hypertension and/or improve systemic blood flow following cardiac operations. Although SNP causes renal vasodilation when infused into isolated kidneys, the reported effects of SNP on renal vascular resistance and blood flow in intact animals and humans have varied. To define the effects of SNP in postoperative cardiac surgical patients, renal clearances and hemodynamics were measured in seven patients within 24 hours of coronary bypass grafting.

Preparation, characterization, and primate testing of monoclonal antithymocyte globulin.

Monoclonal antibodies specific for T cells from both the human and rhesus primate species were detected by their ability to inhibit T cell rosette formation with sheep erythrocytes. The antibodies were shown by fluorescence techniques to react with all thymocytes and peripheral blood T cells but not to B cells, monocytes, platelets, or erythrocytes. Rosette inhibition titers of these antibodies were 30-fold lower when rhesus, rather than human T, cells were used as the rosette-forming cell in assay.