Risks associated with intraaortic balloon pumping in patients with and without diabetes mellitus.

Between 1967 and 1982, intraaortic balloon pumping (IABP) was attempted in 733 patients. Of these, 132 were diabetic: 51 patients were managed with diet alone, 46 patients took oral hypoglycemic agents and 35 patients required insulin. Vascular complications associated with IABP occurred in 34% of the insulin-dependent diabetics, in 18% of other diabetics and in 14% of nondiabetic patients.

Intraaortic balloon pumping 1967 through 1982: analysis of complications in 733 patients.

Between June 1967 and December 1982, 872 attempts at intraaortic balloon pumping (IABP) were made in 733 patients. Nearly 75% of the patients were men; the proportion of women has increased in recent years. The principal indication for IABP support initially was cardiogenic shock, but over the years, preoperative support, weaning from cardiopulmonary bypass and unstable angina have become the primary indications.

Prinzmetal's variant angina: electrocardiographic and angiographic correlations.

Thirty patients with variant angina pectoris (VAP) were analyzed for electrocardiographic features during episodes of VAP. Twenty-nine of these patients had cardiac catheterization, and an autopsy study was performed in one. The patients showed predominantly concave upright T-waves during pain.

Left lower lobe atelectasis and consolidation following cardiac surgery: the effect of topical cooling on the phrenic nerve.

Retrospective and prospective analyses of chest radiographs of patients following coronary artery bypass surgery were undertaken. Left lower lobe pulmonary infiltrate and/or atelectasis developed in 13 of 40 (32.5%) patients who were operated upon without topical cooling of the heart with ice, and in 77 of 122 (63.

Procainamide-induced lupus erythematosus pericarditis encountered during coronary bypass sugery.

Procainamide is probably the most common offending drug responsible for the drug-induced lupus erythematosus syndrome today. Pericarditis has been reported to occur in from 14 to 18 per cent of the cases of procainamide-induced lupus erythematosus, and occasional reports of massive pericardial effusion, pericardial tamponade and constrictive pericarditis have appeared in the literature. We describe a patient who presented with features of procainamide-induced lupus erythematosus without any clinical evidence of pericarditis.

Echocardiographic source of early anterior systolic motion in late systolic mitral valve prolapse.

The echocardiographic features of patients with parachute mitral valve have revealed the combination of an early systolic movement of the mitral valve and late systolic prolapse. Cross-sectional echocardiographic and angiographic studies showed that the early systolic anterior motion was produced by the presence of a flail scallop of the anterior mitral leaflet in the left ventricular outflow tract.

Pre-P (Sino-atrial node region) activity recording from the right atrial cavity by signal averaging.

A mobile instrumentation and noninvasive method developed recently for external His bundle recording and employing the signal averaging technique was applied for intra-atrial recording of the pre-P (sino-atrial node region) activity. Recordings were obtained in ten anesthetized dogs and five patients at the time of right heart catheterization. A bipolar intra-atrial lead was used for triggering of the averaging process and a unipolar intra-atrial lead was used for signal recording.

Idiopathic hypertrophic subaortic stenosis and ventricular preexcitation.

Two patients who had idiopathic hypertrophic subaortic stenosis (IHSS) and type A ventricular preexcitation were studied and showed variations of the subvalvular flow gradients. The increase in subvalvular gradient, occurring at a time when preexcitation developed, was associated with significant increase of the systolic murmur and the systolic anterior motion of the mitral valve. In patient 1, the significant increase in subvalvular gradient during ventricular preexcitation was also confirmed by catheterization of the left side of the heart.

Noninvasive external recording of cardiac conduction system (His bundle) activity.

Successful and adequate external recording of the cardiac conduction system from the body's surface can be accomplished in 80 to 90 percent of subjects studied. High-gain amplification, signal averaging, and triggering with a conditioned QRS signal results in good recording reproducibility. Averaging of 128 consecutive cycles is adequate, but on occasion averaging of 256 cycles may yield better results.

Noninvasive recording of His-Purkinje activity in man by ORS-triggered signal averaging.

Mobile instrumentation and a clinically applicable method have been developed for external His bundle recording. High gain signal amplification (10)(5) filtering (30--300 HZ) and averaging (128 or 256 consecutive cycles) are used. Acquisition of signals arising in the P-R interval is triggered by the patient's QRS signal at the end of that interval.

Determination and importance of the magnification factor in the calculation of ventricular volume: development of a simple, accurate method.

A study of single-plane right anterior oblique left ventricular angiography was undertaken to determine the importance of obtaining correct positioning of a magnification grid and to develop a simple but accurate technique to minimize magnification errors. Theoretical and experimental volume determinations demonstrated 3% to 28% volume errors for grid placement errors ranging from 1 centimeter to 5 centimeters. An experiment was designed whereby cross table lateral radiographs of the chest were taken during contrast injections of the left ventricle.

Patient selection for cardiac surgery in left ventricular power failure.

Nineteen patients in acute left ventricular power failure following acute myocardial infarction were given support with intraaortic balloon pumping and underwent cardiac catheterization. Hemodynamic response to disastolic augmentation, results of left ventriculography, and observations of selective coronary arteriography were evaluated to determine which patients could survive without operation, which would require operation to survive, and which could be predicted not to survive operation. Of ten patients who underwent operation, three were long-term survivors.

Neurological abnormalities in the leg(s) after use of intraaortic balloon pump: report of six cases.

Six patients from a group of 39 who survived after treatment with the intraaortic balloon pump (lABP) had significant neurological deficits in one or both legs associated with the use of the lABP. The device was used in a group of 89 patients initially for cardiogenic shock but its use has been expanded for patients having the following conditions: preshock; severe congestive heart failure; refractory angina; and for those undergoing open-heart surgery. The six patients who had neurological sequelae had eight lABP insertions into the thoracic aorta through the femoral artery and had neurological abnormalities and/or electromyographic abnormalities in nine lower extremities ranging from a foot drop to almost total paralysis of the lower extremity.

Demonstration of lack of persistence of effectiveness of intra-aortic balloon pumping of short duration in acute myocardial ischemia.

Experimental studies were carried out to quantitate the effectiveness of intra-aortic balloon pumping (ABP) in reducing severity and extent of myocardial ischemia and the persistence of induced changes after cessation of pumping. Ligation of the anterior descending coronary artery was followed by one hr of observation, IABP for one hr (12 dogs) or 3 hrs (12 dogs) and an additional one hr of observation. Epicardial mapping utilizing 20 electrodes was used to obtain the ST segment elevations (Sigma ST) and numbers of electrodes showing ischemic ST CHANGES (NST) in each group.