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Biomedical subjects

A Ramondo

Publications and source records attributed to A Ramondo.

At least 37 records · Page 2Linked to original sources
PubMed1993

[The early and late complications after percutaneous balloon coronary angioplasty].

The coronary arteries from the hearts of 7 patients, 6 male and 1 female, age ranging from 39 to 69 years (mean 56), who died early or in the mid term from percutaneous transluminal coronary angioplasty (PTCA), were investigated by histology, immunohistochemistry and electron microscopy. Atherosclerotic coronary artery disease was present in all: single vessel disease in 2 and double vessel disease in 5. Indication to PTCA was stable angina in 1 patient, unstable angina in 2, postinfarction angina in 2 and acute myocardial infarction in the remaining 2. Thrombolysis was an associated procedure in 3 cases. Time interval between PTCA and death was less than 48 hours in 6, and 4 months in 1. Cause of death was myocardial infarction due to coronary occlusion complicating PTCA in 3 patients, and myocardial infarctions preceding PTCA in 4 patients. 9 coronary segments underwent dilatation: 5 in the anterior descending coronary artery, 3 in the right coronary artery and 1 in the left circumflex artery. Angiographically, the PTCA had been effective (decrease of stenosis > or = 40%) in 5 and failed in 4. Basically, the atherosclerotic plaques were eccentric in 3 and concentric in 6; the histotype was fibrotic in 4, atheromatous in 4 and fibro-atheromatous in 1. Only one case did not show any complication and the dilatation was effective as a consequence of plaque compression and stretching of the underlying tunica media. Complications observed in the other cases with early death consisted of: a) plaque cracks with intimal flaps and hematomas in all 6; b) laceration of the tunica media, even of the disease-free wall, with dissecting hematoma in 2; c) occlusive thrombosis in 3 and d) atheroembolism in 1. The 4 coronary segments, which appeared occluded angiographically soon after PTCA, were clinically interpreted as dissection in 3 and thrombosis in 1, whereas at histology the closing mechanism was an intimal hematoma with flap in 2, occlusive thrombosis in 1, and medio-adventitial dissecting hematoma with thrombosis in 1. Only ruptures of atheromatous plaques were complicated by thrombosis. The patient who died at 4 months exhibited a pattern of restenosis due to intimal smooth muscle cell proliferation. In conclusion, our postmortem study shows that PTCA may be associated with severe damage of the coronary artery consisting of plaque crack and laceration even of the disease-free wall, intimal and medial hematomas, thrombosis and atheroembolism.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[Morphofunctional correlations in dilated cardiomyopathies].

The aim of this study was to state whether in patients with dilated cardiomyopathy indices of left ventricular function (i.e. left ventricular end-diastolic and end-systolic volumes, ejection fraction, end-systolic pressure to end-systolic volume ratio, mass to volume ratio, elastic stiffness constant) are related to histologic findings, namely percentage of myocytes, of fibrosis and of interstitium. We have studied 26 patients (18 males and 8 females) aged 13-65 years, who underwent right and left heart catheterization, quantitative angiography, coronary angiogram, and in whom a diagnosis of dilated cardiomyopathy was established. All of them had a biopsy specimen taken from the right aspect of interventricular septum, following the technique of King's College. Histology was automatically evaluated with a computerized system for the percent content of myocytes, of fibrous tissue and interstitium. Correlation with hemodynamic parameters was calculated with the least square method. A significant correlation was found between percentage of fibrosis, left and right ventricular ejection fraction and preload index, and between percent myocytes and right ventricular ejection fraction and duration of disease. Thus, left ventricular function indices do not correlate with percent myocytes, as previously shown: this could be due to the fact that alterations in contractile machinery are due primarily to alterations in cell biochemistry. Moreover, the inverse relationship between myocyte content and duration of the disease may reflect those mechanisms, which tend to perpetuate failure in a dilated heart by increasing subendocardial fibrosis. However, the correlation found between myocyte content and right ventricular ejection fraction may be due to the fact that biopsy specimens were taken from the right ventricle.

Adolescent↗
PubMed1993

[Monovascular coronary disease in the pre-angioplasty era].

Single-vessel coronary disease has been considered so far a benign condition, for which the medical therapy may represent the optimal treatment. In order to assess the effectiveness of this approach, we studied 323 patients who had come to our attention for ischemic heart disease and resulted affected by single-vessel coronary artery disease. From our data it appears that single-vessel coronary artery disease is frequently associated with myocardial infarction and post-infarction aneurysm. Coronary angiography indicated that left anterior descending coronary artery is the most frequently affected vessel, and that its involvement is often associated with lethal outcome. Forty-two out of the 323 patients underwent coronary artery bypass surgery; the remaining patients were medically treated. Surgical patients showed a better improvement respect to the medical group, while survival was not statistically different. An unexpected result was the relatively high risk in circumflex artery lesion. These data may justify a broader utilization of invasive therapy in recent onset angina, in light of the excellent results recently obtained with percutaneous transluminal coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1991

Value and limitations of transesophageal echocardiographic monitoring during percutaneous balloon mitral valvotomy.

To determine the utility of transesophageal echocardiographic monitoring during percutaneous balloon mitral valvotomy, we analyzed data from 40 consecutive patients who had been randomly assigned to undergo balloon mitral valvotomy under transesophageal echocardiographic guidance or without echo. All procedures were carried out under general anaesthesia. The completion rate (100% vs 73%), the procedure time (108 +/- 28 min vs 65 +/- 18 min), the X-ray exposure time (62 +/- 13 vs 33 +/- 12 min), resulted significantly (P less than 0.001) more favorable in the echo-monitored patients. Moreover, a lower rate of major complications (cardiac tamponade, large residual atrial shunting, and severe mitral regurgitation) was noted in the echo-monitored patients. The achieved final area of the mitral valve did not differ significantly between the two groups. From an evaluation of results as a whole, 96% of the echo-monitored procedures were successful, whereas only 40% of the procedures conducted without echocardiographic control achieved a satisfactory final result in absence of major complications. We conclude that transesophageal echocardiography is a safe, effective, and valuable tool to monitor each step of balloon mitral valvotomy in order to shorten the time of the procedure, and to improve the results of this complex interventional catheterization technique.

Adult↗
PubMed1991

Haemodynamic effects of nisoldipine by oral route.

The aim of this study is to investigate the acute haemodynamic effect of orally administered nisoldipine. Eight patients with stable angina and normal overall ventricular function were submitted to cardiac catheterization and angiography before and one hour after administration of nisoldipine 20 mg per os. Cardiac output increased, peripheral resistance decreased and aortic compliance increased, determining a marked decrease in overall peripheral impedance. Left ventricular ejection fraction hardly increased and contractility did not vary. Left ventricular end diastolic pressure decreased, owing to a decrease in left ventricular wall stiffness. Thus nisoldipine acts as a peripheral dilating agent, decreasing arteriolar tone and, possible, venous tone, and increasing left ventricular muscle distensibility.

Administration, Oral↗
PubMed1991

Successful emergency percutaneous balloon mitral valvotomy in a patient with massive left atrial thrombosis: utility of transesophageal echocardiographic monitoring.

Emergency percutaneous balloon mitral valvotomy was carried out successfully in a 65-year-old woman with severe mitral stenosis and massive left atrial thrombosis. Transesophageal echocardiography was of great value in monitoring each step of the procedure in order to avoid systemic embolization due to improper manipulation of the dilating apparatus within the left atrium.

Aged↗
PubMed1991

[Short- and mid-term results of percutaneous aortic valvuloplasty for calcific aortic stenosis in elderly patients].

In order to evaluate the short and mid-term results of percutaneous aortic balloon valvuloplasty, 40 consecutive elderly patients with symptomatic severe calcific aortic stenosis, underwent the procedure consecutively, with follow-up by clinical evaluation and Doppler echocardiography. Over a mean follow-up period of 11.2 months there were 5 deaths, and 12 patients underwent subsequent aortic valve replacement. Doppler echocardiography revealed an increase in aortic valve area from 0.62 +/- 0.20 cm2 to 0.91 +/- 0.23 cm2 after the procedure, but there was a significant trend toward restenosis by 12 months follow-up in 23 of 32 patients (72%). Restenosis was accompanied by symptomatic deterioration in 18 of 23 patients (78%). Although balloon valvuloplasty may often improve haemodynamics and relieve symptoms, these benefits seem to be short-lived in most cases. Restenosis has a high rate of occurrence. Aortic balloon valvuloplasty should be reserved for truly inoperable cases and for haemodynamically-unstable patients, who may later undergo surgery.

Aged↗
PubMed1990

Mitral valve disruption following percutaneous balloon valvuloplasty.

Two cases of massive mitral regurgitation due to mitral valve disruption following percutaneous balloon valvuloplasty are reported. This severe complication occurred in two elderly women with recurrent mitral stenosis after previous surgical commissurotomy. Due to their unstable hemodynamic and clinical condition, both patients underwent emergency valve replacement. At surgery, the commissures appeared fused and heavily calcified; the chordae tendineae thickened, shortened, and fused; and the leaflets presented a large tear with sheared edges. Because the technical aspects of both procedures were unremarkable, the anatomic features of the mitral valve seemed to affect the occurrence of severe mitral regurgitation. Percutaneous balloon valvuloplasty should be therefore applied carefully to patients with prior surgical valvotomy, in whom the structural alterations of the mitral apparatus may predispose to severe valvular damage.

Acute Disease↗
PubMed1990

The concept of preload and its evaluation in the intact left ventricle.

Preload affects left ventricular pump function through the Frank-Starling curve by changing sarcomere length. However, common indices of preload, such as end-diastolic volume, or pressure, or stress, do not necessarily reflect sarcomere length. Ultimately, this depends on the elastic stiffness constant (k) and end-diastolic stress (sigma), which are not in simple relation with the above mentioned indices. An index of preload is proposed, (k sigma)(1/k). This index has been evaluated in 148 patients with different degrees of hemodynamic overload, and in 24 normal subjects. The preload index was found to be 1.448 +/- 0.034 in normal subjects. However, in the other patients evaluated preload index increased in mitral insufficiency (1.490 +/- 0.035), in decompensated aortic insufficiency (1.490 +/- 0.89) and in dilated cardiomyopathy (1.52 +/- 0.125), and markedly decreased in aortic stenosis (1.367 +/- 0.039) and in hypertrophic cardiomyopathy (1.41 +/- 0.034). It was always positively related to the afterload, measured as peak systolic stress. No positive relationship was found with end-diastolic volume nor pressure. Therefore, preload as a compensatory mechanism is differently recruited in response to various degrees of hemodynamic overload and parallels the afterload, in agreement with the concept of preload-afterload mismatch.

Aortic Valve Insufficiency↗
PubMed1990

Short-lasting hemodynamic and clinical benefits from percutaneous balloon valvuloplasty for calcific aortic stenosis.

In order to evaluate the short- and mid-term results of percutaneous aortic balloon valvuloplasty, 40 consecutive elderly patients, who had undergone balloon valvuloplasty for calcific aortic stenosis, were prospectively followed up by means of clinical and echo-Doppler examinations. Although valvuloplasty often dramatically improves hemodynamics and relieves symptoms, these benefits seem to be short-lived in most cases. Restenosis, defined as a loss of 50% or more of the increase in aortic valve area obtained by the dilatation, has a very high rate of occurrence. Aortic balloon valvuloplasty should therefore be reserved for truly inoperable cases and can be performed in hemodynamically unstable patients, who may later undergo surgery.

Aged↗
PubMed1989

Balloon dilatation of a porcine bioprosthetic valve in aortic position.

We describe a case of percutaneous balloon valvoplasty of a stenotic Hancock bioprosthesis in aortic position. The procedure reduced the peak systolic gradient from 110 to 25 mm Hg. The calculated area of the orifice increased from 0.59 to 1.07 cm2. A cineaortogram performed after the procedure showed trivial aortic regurgitation and the subsequent immediate course was uneventful. The mechanism of dilatation and the risks of the procedure are discussed.

Aortic Valve Stenosis↗
PubMed1989

[Results of emergency aortocoronary bypass in complicated coronary angioplasty].

Sixteen out of 293 (5.4%) procedures for percutaneous transluminal coronary angioplasty, performed between 1985 and 1988, were complicated by acute closure and required emergency revascularization surgery. The injured vessel was the left anterior descending artery in 14 cases and the right coronary artery in 2 cases. All patients had persistent chest pain associated with ST-segment elevation in 14 cases and ST-segment depression in 2 cases. Two patients developed cardiogenic shock and were in cardiac arrest at the beginning of operation; one of these died immediately after the operation. Thus the overall mortality rate was 6.2%. Enzyme evidence of myocardial infarction (CPK-MB greater than 40 UI/I) occurred postoperatively in 8 patients (50%), but only the 6 patients (37.5%) with electrocardiographic evidence of myocardial necrosis (new Q-waves or loss of R-wave voltage) showed akinesis of the myocardium perfused by the occluded vessel at the echocardiographic examination performed two weeks after the operation. The occurrence of myocardial infarction was correlated with the degree of preoperative ischemia and hemodynamic deterioration. A collateral flow was present in 3 cases and none of these showed evidence of myocardial necrosis after the operation. Our results show that emergency bypass surgery for failed coronary angioplasty is less satisfactory than elective surgery, and has a higher mortality and myocardial infarction rate. Thus, the risk of emergency operation for complicated dilation must be considered when selecting of candidates for coronary angioplasty.

Adult↗
PubMed1989

[Natural history of dilated cardiomyopathy].

Seventy-seven patients with dilated cardiomyopathy (50 M and 27 F, aged 38 +/- 16 yrs) were followed up until Dec 31, 1985. Haemodynamic investigation was performed in all cases, and all pressure and left ventricular quantitative angiography parameters were collected. In no case did the coronary angiogram show significant lesions. Mean values of haemodynamic parameters for surviving and deceased patients were compared. Forty-six patients survived and 28 died during the follow-up period. Although all patients had an enlarged left ventricle and depressed contractility, survivors had either greater pressure/end systolic volume ratio or a greater stress/end systolic volume ratio. Survival curves confirm a particularly severe prognosis for patients with Suga index less than 1 or stress to end systolic volume ratio less than 2.5. Mass to volume ratio seems to affect two-year but not late survival. NYHA class does not indicate early survival. In conclusion, left ventricular function is obviously related to prognosis in these patients, but it seems still difficult to assess life expectancy from these parameters alone.

Adult↗
PubMed1988

[Coronary angioplasty in unstable angina. Immediate and short-term results].

We report the results of percutaneous transluminal coronary angioplasty (PTCA) in 67 consecutive patients with unstable angina. Twenty patients had new onset (less than 2 months) angina, 33 patients had crescendo angina and 14 had early postinfarction angina. Fifty-one patients had one-vessel disease, 12 patients had two-vessel disease and two patients had three-vessel disease; two patients had a stenosis of a venous graft. In cases with multivessel disease, we performed only the dilatation of the ischaemia-related vessel identified by morphologic features of coronary lesion and electrocardiographic changes during chest pain. The procedure was successful in 54 cases (80.6%). Seven patients (10.4%) had major complications. Emergency coronary artery bypass graft surgery was performed in 6 cases (8.9%) because of occlusion of the left anterior descending artery; despite emergency operation one patient died and two patients sustained a myocardial infarction. One patient had occlusion of the right coronary artery and inferior myocardial infarction. In all patients in whom angioplasty was successful unstable angina disappeared. At 6 months follow-up there were no infarctions or deaths but 14 of 42 patients (33%) had recurrent angina. Restenosis occurred in 16 of 33 patients (48%) who had repeat coronary angiography. Four patients with recurrence of unstable angina had repeat angioplasty; it was successful in 3 cases. One patient died of refractory cardiac arrest. The mortality rate of 71 procedures performed in 67 patients was 2.8% (2/71) and the overall myocardial infarction rate was 4.2% (3/71).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Aortic valvuloplasty associated with coronary angioplasty. Description of a case].

The authors report the case of a 57 year-old man with severe calcific aortic stenosis and single vessel coronary artery disease, symptomatic of angina pectoris, who refused surgical therapy and was treated with combined percutaneous aortic valvuloplasty and coronary angioplasty as a single procedure. Valvuloplasty was performed initially, and the calculated aortic valve area increased from 0.75 to 1.27 cm2. Subsequently, a 75% proximal right coronary artery stenosis was dilated to 20%. Two months later, at follow-up the patient was asymptomatic and the Doppler-determined aortic valve area was 1.01 cm2.

Angioplasty, Balloon↗
PubMed1988

[Origin of the right pulmonary branch from the ascending aorta].

The AA report a case of newborn admitted to the hospital at the age of 12 days because of severe congestive heart failure, with electrocardiographical and radiological findings of right ventricular overload and increased pulmonary blood flow. Cardiac catheterization showed the origin of the right pulmonary artery from the ascending aorta in the presence of an intact ventricular septum. Surgical repair was performed on an emergency basis by deconnecting the anomalous right pulmonary artery from the aorta and reattaching it to the main pulmonary artery. Postoperative angiographic study, performed 12 months later, revealed excellent anatomical and functional result.

Aorta↗
PubMed1987

Guidewire fracture: an unusual complication of percutaneous transluminal coronary angioplasty.

We report a patient in whom fracture of the guidewire occurred while attempting a percutaneous transluminal coronary angioplasty, requiring emergency surgical intervention. This case indicates that, despite the fact that complications of percutaneous transluminal coronary angioplasty are decreasing, the availability of open heart facilities remains mandatory during this procedure.

Angioplasty, Balloon↗