Tertiary Cardiothoracic Centre Research Articles

Transthoracic Doppler echocardiographic analysis of phasic coronary blood flow velocity in hypertrophic cardiomyopathy.

OBJECTIVE: To use transthoracic Doppler echocardiography to assess coronary blood flow non-invasively in patients with hypertrophic cardiomyopathy. DESIGN: High frequency transthoracic Doppler echocardiography was used to assess resting phasic coronary...

Changing trends in pacemaker prescription in patients aged 80 and over: A single center audit of 962 patients

This study was done at a UK tertiary referral Cardiothoracic center to evaluate the influence of the British Pacing and Electrophysiology Group (BPEG) guidelines for pacemaker prescription on pacing practice in patients aged 80 and over. Prospective evaluation was made of indications for pacing and pacing mode used in these patients undergoing their first endocardial pacemaker implant at our center from April 1992 to September 1993. Indications for pacing and pacing mode used in patients aged 80 and over paced at our center from 1984 to 1991 and entered into the United Kingdom (UK) national pacing database were retrospectively analyzed. Data were compared for both groups with the BPEG recommendations for pacemaker prescription. The patients were divided into two groups: group 1 consisted of 369 patients aged 80 and above of 926 consecutive patients undergoing their first endocardial permanent pacemaker implant from 1992 to 1993; group 2 included 593 patients aged 80 and above out of a total of 2622 patients paced at our center and entered into the national pacing database from 1984 to 1991.

Hypoxaemia during transoesophageal echocardiography.

To establish the incidence and severity of arterial oxygen desaturation during transoesophageal echocardiography performed under light intravenous sedation; to determine which patients are at greatest risk; and to assess the effects of supplementary oxygen treatment. Prospective study of 150 patients referred for transoesophageal echocardiography. Echocardiography laboratory in a tertiary cardiothoracic referral centre. Transcutaneous arterial oxygen saturation. During transoesophageal echocardiography mean (SD) arterial oxygen saturation (SaO2) fell in 144 of 150 patients (96%) from 95.4%(2.6%) to 90.7%(6.3%) (p < 0.001). Significant hypoxaemia, defined as SaO2 < 90%, was found in 27 of 150 patients (18%); in this group SaO2 fell from 92.9%(3.5%) to 81.8%(9.6%) (p < 0.001), but rose rapidly on oxygen to 95.5%(2.4%) (p < 0.001). Two patients became profoundly hypoxaemic with SaO2 values of 35% and 74%. The principal risk factors for hypoxaemia during transoesophageal echocardiography were mitral valve disease, severe mitral regurgitation, and New York Heart Association symptomatic class III or IV. Transcutaneous oximetry and supplementary oxygen should be available routinely during transoesophageal echocardiography.

Conservative surgery of the mitral valve: a report of the first 100 cases from one unit and one surgeon.

To report the first 100 mitral valve repairs performed in a unit with an aggressive approach to conservative mitral valve surgery. Case notes were reviewed retrospectively and patients invited for clinical examination and cross sectional and Doppler echocardiography. Tertiary cardiothoracic referral centre. Between December 1985 and April 1991 mitral valve repair was carried out on 100 patients (66 males). Patients with pure mitral stenosis were excluded. Sixty seven had degenerative and 15 rheumatic mitral valve disease. Median age was 66 (range 12 to 79) years, with an interquartile range of 59 to 71 years. Operative procedures included annuloplasty ring in 97, resection of the posterior leaflet in 67, resection of endocarditic portion of posterior leaflet in four, commissurotomy in six, and correction of anterior leaflet abnormalities in seven. Thirty nine concomitant cardiac procedures were performed in 32 patients. Six operations were emergencies, and three of these required concomitant procedures. Mortality, operative failure rate, patients' functional state and degree of residual mitral regurgitation, incidence of thromboembolism, and endocarditis. Follow up ranged from one to 59 months, median 14 months, and an interquartile range of four to 23.5 months. Early mortality was 1%, late mortality 5%, and there was a 2% reoperation rate. Eighty four patients had moderate to severe mitral regurgitation preoperatively. At follow up mitral regurgitation was absent or mild in 78. Eighty six patients were in New York Heart Association (NYHA) class I-II at follow up compared with 80 in NYHA class III-IV preoperatively. There were no thromboembolic events. This study shows that satisfactory results can be obtained with mitral valve repair in a fairly elderly population with a high incidence of concomitant cardiac disorders. We suggest that these encouraging results will lead to earlier mitral valve repair in mitral regurgitation.

Limited value of the resting electrocardiogram in assessing patients with recent onset chest pain: lessons from a chest pain clinic.

To evaluate a clinic set up specifically to assess patients with recent onset chest pain, particularly those presenting with a normal resting electrocardiogram. Retrospective review of case notes. Cardiac department of a tertiary referral cardiothoracic centre. 250 consecutive patients with recent onset chest pain seen within 24 hours of general practitioner referral. Clinical diagnosis and management. 40% of patients were seen within seven days of the onset of symptoms. Twenty seven per cent had non-cardiac symptoms and could be discharged while 60% were considered to have cardiac pain. Sixty six patients (26%) were admitted directly from the clinic and 48 of these underwent coronary angiography within three weeks. Seventy patients (28%) have so far undergone intervention (angioplasty or coronary artery surgery), 22 within one month of presentation. One hundred and nine patients (44%) presented with a normal resting electrocardiogram, 21 of whom were considered to have unstable angina. Forty one of these patients were investigated of whom 37 were found to have significant coronary disease and 26 have undergone intervention. This experience highlights the inadequacy of a routine electrocardiogram reporting service in patients with recent onset of chest pain. An alternative facility offering immediate and complete cardiac assessment produced patient benefit with early diagnosis and intervention. Investigation of these patients, however, accounted for 5% of cardiac catheterisation laboratory throughput; this was a significant additional and unscheduled workload.