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Biomedical subjects

A Righetti

Publications and source records attributed to A Righetti.

At least 73 records · Page 4Linked to original sources
PubMed1982

[Physical and psychological future of patients with coronary disease. To whom should ambulatory rehabilitation be proposed? (author's transl)].

To ambulatory rehabilitation programme was proposed to 91 patients during their stay in hospital for myocardial infarction or aortocoronary bypass surgery. A retrospective study showed that 51 patients did follow the programme, whereas 40 patients preferred their own method of self-rehabilitation. Serial exercise tests demonstrated progressive and considerable improvement in physical aptitude among those who followed the programme, but the psychological, socio-familial and professional outcome was globally the same in both groups. The present study therefore confirms the numerous advantages of the rehabilitation programme but also shows that many of the potential candidates to such programmes are capable of returning by themselves to a normal and active life.

Ambulatory Care↗
PubMed1981

[Physical training in high altitude].

Hemodynamic parameters and myocardial extraction of lactate and free fatty acids (FFA) have been studied at rest and during exercise (bicycle) in 9 mountain climbers who spent 4 weeks in the Himalayas at an altitude of 5500-7000 m. All investigations were performed before and immediately after the stay at high altitude. The combined effect of physical training and hypoxemia of high altitude did not alter the hemodynamic parameters, calculated VO2 max, production of lactate or decrease of FFA during the exercise test, but myocardial extraction of lactate and FFA changed. After returning from the expedition myocardial extraction (at rest and during exercise) of lactate increased and that of FFA decreased. The reasons for these alterations and their goals and implications are discussed.

Adult↗
PubMed1981

[Isotope angiocardiography: amelioration of the measurement of ejection fraction by a new treatment of the image].

Some of the limitations affecting radioisotopic images are their insufficient resolution, structure boundaries and accurate subtraction of background noise. In order to improve the signal-to-noise ratio the images of the recorded heart cycles are treated by the Karhunen-Loeve transformation. Edge detection is based on compression of the image to a bitmap at a chosen level and following of all bits set to one by a pointer. The outlines of the structures as determined by edge tracking are used to define the regions of interest within the enhanced images. Background subtraction applies the principle of interpolative background subtraction by computing an individual background for each point in an irregular region of interest. The resultant images are used to calculate an index of cardiac efficiency which shows high correlation (r = 0.92) with the ejection fraction of contrast biplane left ventricular angiography.

Cardiac Output↗
PubMed1980

[Overall and regional sensitivity of myocardial thallium-201 scintigraphy compared with the number and location of coronary lesions and the presence of previous myocardial infarction].

An evaluation is presented of (1) the overall sensitivity and specificity of 201Tl myocardial scintigraphy in 230 patients with suspected coronary artery disease and (2) the effects of the number and location of the diseased vessels, and the presence of previous infarction, on regional sensitivity in 151 patients. Overall sensitivity was 91% (80%, 95%, 97%) in patients with 1, 2 or 3 vessels respectively. Overall specificity was 81% or 89% if 7 patients with infarction and normal coronaries were excluded. In 80% of patients with one diseased vessel, in 41% of patients with 2 diseased vessels, and in only 24% with 3 diseased vessels were all lesions detected. 201Tl scintigraphy detected 52% of circumflex lesions as compared to 75% of right coronary and 74% of left anterior descending lesions. Of the 151 patients with proven coronary disease, 75 had a previous infarction. Overall and regional 201Tl sensitivity were greater (but not significantly) in this subgroup as compared to patients without myocardial infarction.

Adult↗
PubMed1980

Graphical computer techniques for improving the detection of myocardiac ischemia.

Traditional investigative methods to detect and localise cardiac abnormalities are often difficult and time consuming. The use of minicomputers has made a dramatic impact on non-invasive diagnostic techniques in cardiac patients. The Cardiology Division of the Geneva University Hospital has assembled a minicomputer-based data acquisition/visualisation system to study cardiac structures and their associated motions using radionuclide techniques.

Computers↗
PubMed1980

[Pseudo Q waves in myocardial necrosis: a pitfall with a Wolff-Parkinson-White appearance].

The diagnosis of inferior myocardial infarction was wrongly made in a patient with a history of chest pain and Q waves in Leads 3 and aVF. Despite a normal PR interval, ventricular preexcitation was suspected on the deformation of the upstroke of the QRS complex, suggestive of a delta wave. Ventricular and coronary angiography and exercise Thallium 201 myocardial scintigraphy allowed the diagnosis of myocardial infarction to be eliminated. Endocavitary electrophysiological recordings confirmed the presence of an accessory atrioventricular conduction pathway (Kent bundle) and explained the intermittent appearances of the WPW syndrome on ECG. The patient was investigated after the acute episode, and the absence of cardiac enzyme estimations at that time made the rectification of the diagnosis more difficult.

Adult↗
PubMed1979

[Congenital absence of the circumflex artery. Association with an infarction without coronary disease].

A 31 year old man had a congenitally absent circumflex coronary artery, one of the least described of all the congenital abnormalities of the coronary arteries. Before confirmation of the diagnosis, an ectopie circumflex artery was excluded by the two angiographical signs observed by Page and by non-selective coronary arteriography. This abnormality was thought to have played a role in myocardial infarction in this young patient without coronary risk factors and with no obvious coronary artery narrowing on coronary arteriography.

Adult↗
PubMed1978

[Echocardiographic serial study on movements of the interventricular septum after aorto-coronary bypass].

The data presented show that echocardiographically detected abnormal septal movement is frequent early after coronary bypass surgery but that these abnormalities decrease in many patients during late follow-up. Increased anterior movement of the whole heart during systole and decreased regional myocardial contraction both contribute to the septum abnormalities. However, the overall left ventricular function remains unchanged after coronary bypass surgery.

Coronary Artery Bypass↗
PubMed1978

Inferior myocardial infarction as a cause of asymmetric septal hypertrophy. An echocardiographic study.

The diastolic thickness of the septum and posterior left ventricular wall were measured with M mode echocardiography in 68 patients 2 or more months after a single transmural myocardial infarction. In 42 patients with inferior wall infarction, the septal thickness of 12.4 +/- 0.6 mm (mean +/- standard error of the mean) was larger than the mean measurement in 26 patients with anterior wall infarction (9.6 +/- 0.6 mm, P less than 0.01). Twenty-five of these 42 patients (59 percent) had increased septal thickness (greater than 11 mm), including 12 (48 percent) who had hypertension and 11 (26 percent) who had decreased posterior wall thickness. The ratio of septal to posterior wall thickness was greater in the patients with inferior infarction than in those with anterior infarction (1.36 +/- 0.06 versus 0.89 +/- 0.06, P less than 0.001). This ratio exceeded 1.3 in 22 patients with an inferior infarction (52 percent) but was increased in only 1 patient with an anterior infarction. Hypertension did not predict the presence or absence of an abnormal ratio. Increased septal thickness on echocardiography may occur after interior infarction and result in an abnormal septal to posterior wall thickness ratio that meets current echocardiographic criteria for asymmetric septal hypertrophy.

Adult↗
PubMed1977

[The perioperative myocardial infarct after aortocoronary bypass].

Two sets of criteria are developed for the diagnosis of perioperative myocardial infarction: 1) new, persistent Q waves and either an elevated 48-hour MB-CPK area or a positive pyrophosphate scan, 2) severe ischemic ST-T wave changes and both elevated MB-CPK area and a positive scan.

Coronary Artery Bypass↗
PubMed1977

Usefulness of preoperative and postoperative Tc-99m (Sn)-pyrophosphate scans in patients with ischemic and valvular heart disease.

To assess the usefulness of myocardial imaging with technetium-99m-stannous pyrophosphate for detecting acute myocardial necrosis in patients undergoind cardiac surgery, 66 such patients were stldied. Tc-99m (Sn)-pyrophosphate scans were obtained in all patients 3 to 6 days postoperatively and in 45 preoperatively. Electrocardiograms and serum samples for measuring myocardial isoenzyme of creatine kinase (MB CK) levels were obtained before and serially after cardiac surgery. Seven of the 46 patients undergoing myocardial revascularization had a definite new myocardial infarction as indicated by electrocardiogram and MB CK isoenzyme concentrations, and postoperative pyrophosphate scans were abnormal in all but one. In addition, six of the eight patients with possible myocardial infarction (elevated MB CK levels and persistent ST-T wave depressions) had an abnormal scan postoperatively. Seven of the 20 patients undergoing aortic or mitral valve replacement, or both, had a possible postoperative myocardial infarction by electrocardiogram and MB CK criteria and the myocardial scan was positive in two. All the patients with a normal electrocardiogram and normal MB CK levels had a normal pyrophosphate scan. Preoperative scans were obtained in 22 patients wit; valvular heart disease and were positive in two with a heavy calcified mitral valve on fluoroscopy and in one with a calcified aortic valve. After valve replacement, the pyrophosphate scan became normal in two patients and remained abnormal in the third patient with electrocardiograms and MB CK levels suggesting acute myocardial infarction. We conclude that the Tc-99m (Sn)-pyrophosphate scan is useful for analyzing the occurrence of acute myocardial infarction in patients undergoing cardiac surgery and that, in conjunction with the electrocardiogram, it permits confirmation or exclusion of that diagnosis. Furthermore, false positive pyrophosphate scans may occur in patients with heavy valve calcifications.

Adult↗
PubMed1977

Interventricular septal motion and left ventricular function after coronary bypass surgery: evaluation with echocardiography and radionuclide angiography.

To evaluate interventricular septal motion and left ventricular function after coronary bypass graft surgery, 40 patients were studied early postoperatively and serially for up to 16 months with echocardiography and radionuclide angiography. Early after operation mean left septal excursion decreased significantly from 4.6 +/- 0.4 (standard error) to 0.8 +/- 0.6 mm (P less than 0.001), and left septal motion was abnormal in 23 of the 40 patients. Mean right septal excursion reversed from 2.1 +/- 0.5 to -2.1 +/- 0.5 mm early after operation in the 22 patients in whom these measurements could be made, and 15 patients showed paradoxical right septal excursion. At a mean of 4 months after operation, only 7 of 35 patients followed up had abnormal left septal motion, and mean left septal excursion had returned toward normal (3.6 +/- 0.7 mm); mean right septal excursion remained reversed (--1.1 +/- 0.7 mm), and 6 of the 14 patients followed up had paradoxical motion. In the 22 patients whose wall thickness could be measured, mean septal thickening during systole decreased significantly from 35 +/- 4 to 21 +/- 3 percent early after operation (P less than 0.01). During late follow-up septal thickening returned toward normal (32 +/- 4 percent). Mean normalized posterior wall velocity increased significantly after operation from 0.76 +/- 0.03 to 1.01 +/- 0.05 sec-1 (P less than 0.001), but posterior wall thickening remained unchanged. Left ventricular end-diastolic dimension and the radionuclide-determined left ventricular ejection fraction were unchanged postoperatively. It is concluded that (1) echocardiographically detected abnormal septal movement is frequent early after coronary bypass graft operation; (2) both decreased myocardial contraction in the septum and increased anterior movement of the whole heart contribute to this abnormality; (3) the abnormalities in septal movement decrease during late follow-up in many patients but persist in some patients; and (4) posterior wall function tends to increase early after operation and therefore overall left ventricular function remains normal.

Adult↗