dicumarol and Arrhythmias--Cardiac

Replacement of the mitral valve with the Björk-Shiley tilting disc valve prosthesis was performed in 203 consecutive patients with isolated mitral valvular disease at Karolinska Sjukhuset, Stockholm, Sweden, during the 6-year period ending December 1975. Results with the Delrin and pyrolytic carbon disc prostheses were analysed with actuarial techniques and compared in terms of mortality rate, incidence of thrombo-embolism and frequency of re-operation. Early (4%) and late mortality rates (7.5 deaths per 100 patient years) were similar with both types of prostheses. No case of primary mechanical prosthetic failure was encountered. The pyrolytic carbon disc prostheses have obviously decreased the incidence of systemic emboli from 9.6 to 5.3 per 100 patient years and so far eliminated mortality due to embolization. This benefit is probably related to the increased opening angle from 50 degrees to 60 degrees in the pyrolytic carbon disc model, which causes less resistance to blood flow. Thrombotic obstruction of the prosthetic valve, however, has been a persistent problem in the order of 3.3 incidences per 100 patient years. Only one patient in twelve involved was referred to our clinic and could be saved by an emergency re-operation. The development of the ring-shaped radiopaque marker in the tilting disc occluder provides a valuable tool for instant diagnosis of partly or completely obstructed disc motion caused by thrombosis. Disc motion can be easily visualized by cineradiography or fluoroscopy. Early diagnosis of and emergency operation for thrombotic obstruction of the prosthesis will reduce the mortality due to this dangerous complication.

Topics: Adolescent; Adult; Arrhythmias, Cardiac; Child; Dicumarol; Evaluation Studies as Topic; Female; Follow-Up Studies; Heart Failure; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Myocardial Infarction; Thromboembolism; Time Factors; Warfarin

Topics: Acute Disease; Adult; Anticoagulants; Arrhythmias, Cardiac; Chronic Disease; Coronary Disease; Dicumarol; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Prothrombin Time; Thrombelastography; Thrombosis; Warfarin

Topics: Age Factors; Aged; Anticoagulants; Arrhythmias, Cardiac; Cerebrovascular Disorders; Coronary Disease; Death, Sudden; Dicumarol; Female; Humans; Long-Term Care; Male; Myocardial Infarction; Retrospective Studies; Sex Factors; Thromboembolism

Topics: Aged; Arrhythmias, Cardiac; Dicumarol; Female; Humans; Hypoprothrombinemias; Intestinal Obstruction

Topics: Arrhythmias, Cardiac; Dicumarol; Diet; Diet Therapy; Heart Failure; Heart Massage; Heparin; Humans; Meperidine; Morphine; Myocardial Infarction; Oxygen Inhalation Therapy; Rest; Therapeutics; Thromboembolism; Ventricular Fibrillation

Topics: Anticoagulants; Arrhythmias, Cardiac; Blood Cell Count; Cerebrovascular Disorders; Coronary Disease; Diabetes Mellitus; Dicumarol; Heart Failure; Heparin; Humans; Hypertension; Kidney Diseases; Liver Diseases; Myocardial Infarction; Peptic Ulcer; Pulmonary Embolism; Shock; Thromboembolism; Thrombophlebitis; Thrombosis; Varicose Veins; Warfarin

Thirty-three patients with chronic auricular fibrillation were treated with digitalis and quinidine and in addition were given Dicumarol(R) to reduce the risk of embolism. In 21 of the patients the fibrillation was caused by rheumatic heart disease, and in 12 by arteriosclerosis or hypertension. Normal sinus rhythm was restored in 55 per cent of the 33 patients, in 67 per cent of those with arteriosclerosis or hypertension, and in 45 per cent of those with rheumatic heart disease. Embolism did not occur.

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Brugada Syndrome; Cardiac Conduction System Disease; Dicumarol; Digitalis Glycosides; Embolism; Heart Conduction System; Quinidine; Rheumatic Heart Disease