Showing papers by "Kim A. Eagle published in 1992"
Journal Article•
TL;DR: Both MRI and TEE are atraumatic, safe, and highly sensitive methods to identify and classify acute and subacute dissections of the entire thoracic aorta and Anatomic mapping by MRI may emerge as the most comprehensive approach and morphological standard to guide surgical interventions.
239 citations
TL;DR: Two hundred two elective aortic reconstructions performed in the period from January 1989 to June 1990 were reviewed and coronary artery disease clinical markers and surgical factors were analyzed with stepwise logistic regression for the prediction of operative mortality rates and major cardiopulmonary complications.
77 citations
TL;DR: It is concluded that preoperative planar DTS is most useful to stratify selected nonvascular surgery patients at intermediate or high risk by clinical assessment, however, for almost half of those patients with known or suspected coronary artery disease, DTS may be unnecessary because of sufficiently low predictive value based on simple clinical descriptors.
Abstract: The ability to stratify cardiac risk before nonvascular surgery using clinical markers and dipyridamole-thallium scanning (DTS) was assessed for patients with known or suspected coronary artery disease unable to exercise. Of 100 consecutively studied patients who proceeded to nonvascular surgery, 9 (9%) experienced greater than or equal to 1 perioperative cardiac ischemic event, including death in 2 patients (2%) and nonfatal myocardial infarction in 2 (2%). Logistic regression identified 2 clinical predictors (age greater than 70 years and history of heart failure), and 1 DTS (thallium redistribution) predictor of events. Of 45 patients with neither clinical variable, none (0%; 95% confidence intervals [CI] 0 to 8%) had events. Of 55 patients with greater than or equal to 1 clinical marker, 9 (16.4%; 95% CI 7 to 26%) had events. Within this subgroup, 1 of 31 patients (3.2%; 95% CI 0 to 16%) without thallium redistribution had events compared with 8 of 24 (33.3%; 95% CI 14 to 52%) with redistribution. An algorithm combining 5 independent clinical and 2 DTS predictors, derived previously in vascular surgery patients, was validated in the 100 nonvascular surgery patients. It is concluded that preoperative planar DTS is most useful to stratify selected nonvascular surgery patients at intermediate or high risk by clinical assessment. However, for almost half of those patients with known or suspected coronary artery disease, DTS may be unnecessary because of sufficiently low predictive value based on simple clinical descriptors.
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TL;DR: A retrospective chart review of 195 consecutive patients who had an intraaortic balloon pump placed at the Massachusetts General Hospital during the calendar year 1988 highlights the common but previously unrecognized complication of delirium in IABP patients.
Abstract: We conducted a retrospective chart review of 195 consecutive patients who had an intraaortic balloon pump (IABP) placed at the Massachusetts General Hospital during the calendar year 1988 to determine the incidence of complications associated with IABP treatment. Demographics, medical and psychiatric history, hospital course, medical and neuropsychiatric complications observed while on the IABP, pharmacological management, and outcome were recorded. Patients ranged in age from 26 to 81 years, with a mean of 62 years. Women comprised only 25% of the sample but had a mortality (40%) twice that of men (20%; p = 0.008). An IABP was inserted for cardiogenic shock in 52% of patients, for refractory angina in 36%, and intraoperatively in 12%. Patients were treated with an IABP for a mean of 4.4 days (range, several hours to 36 days). Complications included delirium (34%), mortality (25%), peripheral vascular insufficiency (17%), bleeding (14%), acute renal failure (14%), infection (8%), and stroke (4.6%). Deliri...
6 citations
5 citations
TL;DR: From top to bottom the tracings represent the surface electrocardiogram (Lead V1) and bipolar intracardiac electrograms recorded from the high right atrium (HRA) and right ventricular apex (RVA) during right atrial pacing.
Abstract: From top to bottom the tracings represent the surface electrocardiogram (Lead V1) and bipolar intracardiac electrograms recorded from the high right atrium (HRA) and right ventricular apex (RVA) during right atrial pacing (S denotes a stimulus artifact of the right atrial pacer). Radiofrequency current (55 V for 30 seconds) was applied through the distal electrode of an exploring catheter positioned on the ventricular side of the mitral annulus close to the ventricular insertion of the accessory atrioventricular connection. Within three beats after the application of radiofrequency current (solid arrow), conduction over the accessory pathway was eliminated and ventricular . . .
1 citations