Rapid sustained recovery after cardiac operations.

After successful cardiac operations in the early 1980s the most common causes of prolonged hospitalizations were noncardiac disorders. We prevented or quickly corrected these noncardiac disorders after operations in succeeding patients and observed in the following 2 years that the shortest postoperative stays in the hospital were followed by the fewest rehospitalizations. In 240 consecutive patients the median length of hospital stay after operation was 4 days. The operations included coronary artery bypass procedures, aortic valve replacements, and mitral valve operations. Six patients (2.5%) were rehospitalized within 6 months after discharge and five patients (2.1%) were rehospitalized 6 to 24 months after discharge: Longer initial hospitalizations would not have prevented rehospitalizations. Forty of the 240 patients were discharged on the third postoperative day or earlier (one patient). None died or were rehospitalized in the following 2 years. Prevention or quick correction of noncardiac disorders allowed rapid recovery after heart operations, and rapid recovery indicated that health would be maintained.

Critical dose of digoxin for treating supraventricular tachycardias after heart surgery.

This study was conducted to ascertain if critical peak body stores of digoxin were needed to protect patients from the debilities that result from supraventricular tachycardias occurring after open heart operations. We gave digoxin peak body stores of 15 micrograms/kg of lean body weight to 100 consecutive patients after open heart operations. If supraventricular tachycardias persisted four hours, we increased peak body stores to 17 or 19 micrograms/kg. The operations included coronary artery bypass grafts, heart valve replacements, and congenital defect correction. After operation, 18 patients had atrial fibrillation or flutter. During supraventricular tachycardias, ventricular rates were 150 beats per minute or slower. In the 100 patients, the median hospital stay after operation was four days. No patient required rehospitalization. The patients who had supraventricular tachycardias stayed in the hospital no longer than the patients who were at all times in regular sinus rhythm. All patients who entered the hospital with regular sinus rhythm went home with regular sinus rhythm. The critical safe peak body stores of digoxin needed to prevent debilities resulting from supraventricular tachycardias after open heart operations were 15 to 19 micrograms/kg of lean body weight.

Pharmacologic effects of a nitrate coronary vasodilator on cardiac perfusion and function, measured semiquantitatively.

Peritrate (pentaerythritol tetranitrate), a nitrate coronary vasodilator, was capable of significantly increasing perfusion and function in ischemic heart muscle. The A2 image-processing computer with software developed by Burow was used to evaluate regional perfusion and segmental wall motion in six patients with ischemic areas in the myocardium. These image-processing techniques were satisfactory for evaluation of ischemic heart muscle.

Effect of coronary vasodilating drug on myocardial work.

The purpose of this paper is to show, by noninvasive measurements, previously undocumented effects on cardiac work of the nitrate coronary vasodilator Pentaerythritol Tetranitrate (Peritrate). The chew-and-swallow 40-mg tablets of this drug were given to 10 patients of type II AHA classification. The Diastolic Time Tension Index/Systolic Time Tension Index Ratio increased significantly from 1.15 (+/- 0.11 SEM) to 1.46 (+/- 0.13), p less than 0.05. The Double Product decreased significantly from 9813 (+/- 606) to 8336 (+/- 497), p less than 0.01. The Triple Product also decreased significantly from 3223 (+/- 235) to 2425 (+/- 206), p less than 0.01. The percent diastole of the R-R interval increased significantly from 65% (+/- 2.44) to 70% (+/- 1.73) p less than 0.05, while no significant change in heart rate occurred (63.2 bts/min to 62.4 bts/min). Correspondingly, there was a decrease of systolic time interval, from 0.33 second (+/- 0.2) to 0.29 second (+/- .01) p less than 0.01. A significant decrease in blood pressure was also noted. Systolic BP dropped from 155 (+/- 8.0) to 134 (+/- 7.2), p less than 0.01. Diastolic BP dropped from 89.2 (+/- 2.8) to 79.2 (+/- 2.2), p less than 0.01. This study shows that Peritrate produced significantly favorable changes in all the cited indicators of cardiac work.

Surgical correction of severe mitral prolapse without mitral insufficiency but with pronounced cardiac arrhythmias.

Despite what was considered adequate pharmacological treatment, the condition of six patients with severe mitral valve prolapse but with trivial or no mitral regurgitation deteriorated. These patients had marked weakness, chest pain, dyspnea, and arrhythmias. Because these patients found their condition to be intolerable, the prolapsed mitral valve was repaired. Electrocardiography, treadmill stress testing, and left ventirculography performed following operation showed complete repair of the valve and significant improvement over the preoperative findings in all six patients. Repair of the floppy mitral valve did not eradicate all abnormalities; however, it did significantly improve the chest pain, weakness, dyspnea, and arrhythmias in all six patients. Five patients no longer require any medication. The prolapsed mitral valve contributed significantly to the symptoms and arrhythmias, but it could not have been the sole cause for these patients' signs and symptoms. With complete correction of the prolapse in all six patients, few of the signs and symptoms of the disease persisted. Repair of severe mitral valve prolapse without mitral regurgitation is recommended only for those patients who continue to be severely symptomatic from chest pain, dyspnea, or ventricular arrhythmias after an extensive trial of adequate medical therapy.