Biomedical subjects
Publications and source records attributed to C L Cunha.
A case of a 62-year-old patient with Ebstein's anomaly is presented. Despite the severe anatomical abnormalities, he was asymptomatic until 61 years of age. Anatomic aspects, clinical features and the diagnostic techniques used are analyzed.
Twenty-eight patients with cardiac amyloidosis were studied by echocardiography -- 26 by M-mode and 13 by two-dimensional (2D) studies. All had heart failure and biopsy-proved amyloidosis, M-mode features included (1) normal left ventricular (LV) dimension in all; (2) thickened ventricular septum (88%), LV posterior wall (77%), and right ventricular (RV) anterior wall (79%); (3) decreased thickening of ventricular septum (96%) and of LV posterior wall (65%) and reduced LV global function (62%); (4) left atrial enlargement (50%); and (5) pericardial effusion (58%). Two-dimensional echocardiography provided additional features: (1) thickened papillary muscles (five of 13); (2) thickened valves (four of 13); (3) better appreciation of thickened RV wall; and (4) a characteristic "granular sparkling" appearance of thickened cardiac walls -- presumably secondary to the amyloid deposit -- which was noted in 12 of 13 patients. Thus, M-mode echocardiography is helpful in the recognition of cardiac amyloidosis. However, the better appreciation with 2D echocardiography of thickened cardiac walls with a "granular sparkling" appearance in patients with unexplained cardiac failure is virtually diagnostic of cardiac amyloidosis.
A group of 80 patients were studied retrospectively to determine whether preoperative echocardiography is useful in predicting operative results in patients with aortic valve replacement for chronic aortic insufficiency. One year after operation, percent change of left ventricular dimension (%delta D) and ejection fraction (EF) were higher and end-systolic left-ventricular internal dimension was smaller in patients with good results than in those who had poor results (p less than 0.05). Regarding probability of 5 year survival, patients with a %delta D of more than 35% had good prognosis, those with 31% to 35% had a fairly good prognosis, and those with 30% or less had increased risk of death, especially if they were in New York Heart Association (NYHA) Functional Class III or IV. All deaths occurred in patients with preoperative values of 31% or less. Patients with EF of 60% or more had a better prognosis than those with a value of less than 60%. In addition, 10 early postoperative echocardiographic studies showed no correlation between early regression of end-diastolic left ventricular internal dimension and long-term operative results; 18 late postoperative studies showed reduction in this dimension in patients with good surgical results, and the only one with a poor result had an enlarged dimension. Thus echocardiographic indices of left ventricular function (%delta D) and EF) may be useful as prognostic indicators in patients undergoing aortic valve replacement for aortic insufficiency.
This report represents a retrospective analysis of preoperative echophonocardiographic studies in 118 patients who had surgery for the repair or replacement of malfunctioning prosthetic valves. A variety of prostheses implanted in the mitral, aortic, and tricuspid positions were assessed. The most frequent prosthetic malfunctions were regurgitation, thrombosis, ball variance, and infective endocarditis. There were echophonocardiographic abnormalities in 71% of the cases. The retrospective diagnosis of prosthetic dysfunction varied according to the type of prosthesis, type of malfunction, and site of implantation of the valve. A high percentage of the prostheses did have echophonocardiographic abnormalities, and consideration of these, in conjunction with clinical data, may help the clinician in the evaluation of prosthetic heart valves.