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Biomedical subjects

A Esteves Filho

Publications and source records attributed to A Esteves Filho.

16 recordsLinked to original sources
PubMed2000

Normalization of left ventricular dysfunction in systemic hypertension.

BACKGROUND: In hypertensive heart disease, it is uncertain whether the impairment of left ventricular (LV) systolic function might be reverted by antihypertensive treatment. HYPOTHESIS: This study was undertaken to address the likelihood of recovery of LV dysfunction and to identify factors potentially related. METHODS: Twenty-six patients with primary (n = 16) and renovascular (n = 10) hypertension participated in the study and were classified into Groups A (n = 12) and B (n = 14) according to normalization or persistent left ventricular dysfunction (fractional shortening < 0.30) after 36 weeks of follow-up. All patients received standard medical therapy and appropriate procedures for renovascular disease correction. Logistic regression analysis was used to identify variables associated with recovery. RESULTS: Patients in Group A compared with those in Group B were younger (41 +/- 14 vs. 52 +/- 10 years; p < 0.05), had a greater frequency of renovascular hypertension (8 vs. 2; p < 0.05), showed shorter LV end-diastolic (54 +/- 5 vs. 61 +/- 8 mm; p < 0.05) and end-systolic dimensions (41 +/- 6 vs. 49 +/- 9 mm; p < 0.05), and lower mass index (215 +/- 64 vs. 261 +/- 47 g.m-2; p < 0.05) before treatment, whereas fractional shortening (0.24 +/- 0.4 vs. 0.20 +/- 0.5; p > 0.05) and diastolic blood pressure (116 +/- 12 vs. 122 +/- 19 mmHg; p > 0.05) were similar. On follow-up, Group A patients showed lower diastolic blood pressure (89 +/- 15 vs. 105 +/- 20 mmHg; p < 0.05) and mass index (142 +/- 34 vs. 222 +/- 40 g.m-2; p < 0.05). Logistic regression analysis identified systolic dimension and renovascular hypertension as factors associated with fractional shortening normalization. CONCLUSION: The recovery of LV dysfunction is expected to occur most likely in patients with renovascular hypertension and the shortest systolic dimensions.

Adult↗
PubMed1999

Essential thrombocythemia and acute myocardial infarction treated with rescue coronary angioplasty.

A 48-year-old man with essential thrombocythemia suffered an extensive anterior acute myocardial infarction; this is a rare association. A pharmacological thrombolysis was performed, without success. He subsequently underwent successful rescue coronary angioplasty. To our knowledge, there is no other report in the literature relating the triad of essential thrombocythemia, acute myocardial infarction and rescue coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1998

[Stenting in a recently implanted stent in a saphenous vein graft for optimizing angiographic results].

A 60 year-old woman with progressive angina who had been submitted to saphenous bypass-graft to right coronary artery and a left mammary artery graft to anterior descending artery eight years previously, underwent implantation of a Gianturco Roubin II stent in the proximal third of the saphenous vein graft. The result was suboptimal by persistence of a residual stenosis probably due to prolapse of atherosclerotic material through the coil spaces. Another stent (Palmaz-Schatz biliar stent) was implanted at the previously stented site with no residual stenosis. Another Palmaz-Schatz biliar stent was successfully implanted in the distal body of the graft to treat another lesion (passing through the previously stents without difficulty). Stenting a stent, in selected situations, is a useful tool to optimize the angiographic result of stent implantation.

Catheterization↗
PubMed1996

[Acute effects of ibopamine on left ventricular mechanics and contractility in patients with idiopathic dilated cardiomyopathy].

PURPOSE: The effects of ibopamine (IBO) on left ventricular (LV) mechanics and contractility have not been described. The aim of this study was to test the hypothesis that IBO has a contractile effect at a dose of 200 mg. METHODS: Ten male patients (43 +/- 7 years) with refractory heart failure due to idiopathic dilated cardiomyopathy were studied. The patients were submitted to simultaneous echo-Doppler and hemodynamic (microtip catheter) studies, before (B) and after (20, 40 and 60 minutes) a dose of 200 mg of IBO. LV pressure/diameter and stress/strain relations were obtained. Subsequently, heart rate (HR-bpm), cardiac output (CO-L/m), end-diastolic pressure (EDP-mmHg); fractional shortening (FS-%); maximal elastance (Emax-mmHg/cm/s); end systolic (ESS-g/cm2) and end-diastolic (EDS-g/cm2) stress; chamber (Kp-mmHg/cm) and muscle (K(m)-g/cm2) stiffness, and the time of constant relaxation (Tau-ms) were analyzed. RESULTS: Results were presented as mean +/- standard deviation for conditions before and after IBO (20, 40 and 60 minutes) respectively. There was no change in HR (99 +/- 7; 100 +/- 7; 99 +/- 8; 99 +/- 10). Significant increases were observed in CO (4.13 +/- 1.28; 4.95 +/- 1.38; 5.13 +/- 1.86; 5.18 +/- 1.57), FS (13.7 +/- 2.4; 15.4 +/- 2.8; 15.9 +/- 1.8; 16.1 +/- 2.0), and Emax (14.8 +/- 3.2; 16 +/- 3.6; 17.7 +/- 4.2; 17.6 +/- 4.2). A transient (20 minutes) increase followed by a decrease (40 and 60 minutes) occurred in EDP (26.3 +/- 4.2; 30.6 +/- 6.4; 24.6 +/- 5.6; 22.3 +/- 4.6), EDS (79.7 +/- 22.8; 91.7 +/- 29.6; 79 +/- 31; 63 +/- 17.3), and Kp (27.2 +/- 12.6; 60 +/- 26.7; 27.9 +/- 11.7; 28.1 +/- 11). CONCLUSION: IBO has a beneficial effect on LV systolic and diastolic function as well as on contractility in patients with heart failure due to idiopathic dilated cardiomyopathy.

Adult↗
PubMed1996

[Effects of partial ventriculectomy on left ventricular mechanical properties, shape, and geometry in patients with dilated cardiomyopathy].

PURPOSE: To investigate the short-term effects of the partial ventriculectomy (resection of lateral wall associated to mitral annuloplasty) on cardiac mechanics, contractility, shape and geometry of the left ventricle (LV). METHODS: Eleven male patients with severe congestive heart failure due to dilated cardiomyopathy were studied. The mean age was 51 +/- 7 years and the functional class was III (five patients) or IV (six patients) before the surgery. Patients were evaluated before and at 17 +/- 4 days after the surgery by simultaneous LV pressure and echocardiographic data. End-diastolic pressure (EDP-mmHg), wall stress (EDS-g/cm2) and diameter (EDD-cm); endsystolic wall stress (ESS) and diameter (ESD), fractional shortening (FS-%) and maximal elastance (Emax-mmHg/ cm/s); the diastolic slope of the pressure-diameter (Kp-mmHg/cm) and stress-strain (Km-g/cm2) loops; shape (L/ EDD, adimensional, where L is the LV long axis) and geometry (Th/EDD, adimensional, where TH is the LV diastolic thickness) were obtained. RESULTS: 1) The ressected muscle fragments (diamond shape) were 10.8 +/- 1.3 cm in length and 5 +/- 0.6 cm in width; 2) all patients were discharged from hospital (15-29 days) in class I (eight cases), II (two), and III (one); 3) it was observed a decrease in EDP (24.3 +/- 7.7 x 17.5 +/- 3.2, p = 0.016); in EDD (8.0 +/- 0.7 x 7.2 +/- 0.8, p = 0.002); in EDS (57.9 +/- 26.8 x 37.4 +/- 19.2, p = 0.005); in ESS (199 +/- 46.9 x 102.8 +/- 33.1, p = 0.004); in ESD (7.1 +/- 0.7 x 5.7 +/- 0.8, p < 0.001); in Kp (22.3 +/- 15.9 x 11.5 +/- 6.9, p = 0.014); and in K(m) (467.4 +/- 212 x 214.6 +/- 87.4, p = 0.01); and, 4) it was noted an increase in FS (11.5 +/- 1.8 x 19.8 +/- 3.9, p < 0.001); in Emax (13.8 +/- 2.2 x 18.6 +/- 3.2, p < 0.001); and in L/EDD (1.32 +/- 0.1 x 1.47 +/- 0.13, p < 0.007) and Th/Dd (0.11 +/- 0.04 x 0.17 +/- 0.08, p < 0.038). CONCLUSION: The partial ventriculectomy showed multiple significant beneficial effects in these dilated myopathic hearts.

Adult↗
PubMed1994

[Laser coronary angioplasty. Critical analysis of the first patients].

PURPOSE: To evaluate the success rate and complications, as well as the technical difficulties involved catheter laser coronary angioplasty, making evident the unsuccessful cases. METHODS: Twenty eight patients were treated with laser from August to November, 1993. The treatment was complemented with balloon angioplasty. Lesions were complex: 10 (36%) were type B and 18 (64%), type C. Concerning the obstruction grade, 18 (64%) were > or = 95%. Laser generator CVX 300(TM) Spectranectics as well as Extreme(TM) and Vitesse(TM) catheters with 1.4, 1.7 and 2.0mm in diameter, concentric and excentric, were used. Laser procedure success was defined as a reduction > 20% in the obstruction grade. The procedure success was attended when the residual stenosis was < 50% after a 15-minute observation, after balloon complementation. RESULTS: The unsuccess rate with laser catheter (Lc) was 34% (10 lesions) of which 3 cases were solved by other methods, 5 were not successful because of anatomic difficulties in surpassing the lesion and, in the two others the success criterium in the reduction of the obstruction grade of the coronary artery was not achieved, although the lesion surpassing was possible with the use of balloon catheter. The final success reached 89% (21 lesions). The procedure complications were a case of thrombosis, a perforation accompanied by a myocardial infarction and another myocardial infarction (non-Q wave), all with good outcome. CONCLUSION: The use of laser in the treatment of coronary artery obstructive lesions is a viable method. Nonetheless, more experience is necessary to demonstrate its actual value, optimizate the results and may be reduce restenosis rate.

Adult↗
PubMed1983

Hemodynamic effects of intravenous administration of amiodarone in congestive heart failure from chronic Chagas' disease.

Fourteen patients with congestive heart failure due to chronic Chagas' disease had hemodynamic studies before and 20, 40 and 60 minutes and 24 hours after intravenous amiodarone. Amiodarone was given initially as a bolus (5 mg/kg); after 1 hour a continuous infusion was maintained for 24 hours (total dose 900 to 1,050 mg). During the first hour of observation, heart rate and cardiac index decreased and mean right atrial, left ventricular end-diastolic pressures and pulmonary and systemic vascular resistances increased. Except for heart rate and mean right atrial pressure, all hemodynamic variables returned to control values at 24 hours. Thus, myocardial depression occurred with a dose of 5 mg/kg within the first hour of intravenous administration. Amiodarone must be cautiously administered by bolus, especially in patients with cardiac failure.

Adult↗