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Biomedical subjects

C Mady

Publications and source records attributed to C Mady.

At least 73 records · Page 4Linked to original sources
PubMed1990

Surgical treatment of endomyocardial fibrosis: a new approach.

Endomyocardial fibrosis has been treated surgically for many years. For complete removal of fibrosis from both ventricles by the classic technique, each atrioventricular (AV) valve was removed and replaced with a prosthesis. Relapse of endomyocardial fibrosis has not been observed after surgical correction. Reoperations have been carried out because of complications of valve prostheses. A new surgical technique for removal of ventricular fibrous tissue with preservation of the mitral and tricuspid valves was used in nine consecutive patients with endomyocardial fibrosis. Initial results show a reduction of pulmonary hypertension, mean right and left atrial pressures and end-diastolic pressures in both ventricles. Tricuspid annuloplasty was performed in seven patients and mitral annuloplasty in five. No valve prosthesis was used. There was no death and New York Heart Association functional class improved from class III or IV in the preoperative period to class I or II in the postoperative period. These data suggest that resection of endocardial fibrous tissue can be indicated early in the clinical course and performed with preservation of the AV valves.

Adult↗
PubMed1990

[Endomyocardial fibrosis. Course in patients undergoing clinical and surgical treatment].

PURPOSE: To follow-up a group of patients during a period of time after either clinical or surgical approach. PATIENTS AND METHODS: A hundred and twenty-one patients were studied retrospectively with endomyocardial fibrosis (EMF) for a period that varied from one month to 11 years (mean = 32 months). Upon entrance, patients had from 5 to 64 years of age (mean = 30), being 41 male and 80 female. Biventricular involvement were present in 70 cases, whereas 36 showed pure left and 15 pure right ventricular involvement. The patients were divided in two groups: 62 treated clinically, and 59 surgically, the latest defined as fibrosis resection added to atrioventricular valve rebuilding or replacement. All surgical cases had a prior III to IV functional class (NYHA). RESULTS: In the clinical group there were 24 fatalities, 21 who were in class IV, 1 in class III, and 2 in class II. In the surgical group there were 18 fatalities, 12 early and 6 late. CONCLUSIONS: (1) All the patients who survived the operation showed functional class improvement; (2) surgical mortality decreased in the latest years; (3) clinical treatment is indicated to patients in classes I and II, groups with low mortality rates; (4) surgical treatment is indicated to patients in classes III and IV, provided that clinical mortality is high in these groups of patients.

Adolescent↗
PubMed1990

[Rupture of the left sinus of Valsalva forming a subepicardial pseudoaneurysm].

A healthy 44 year-old male patient presented a calcified mass in the middle mediastinum on a chest film. During diagnostic investigation cineangiograms showed a rupture of the left sinus of Valsalva forming a large pseudoaneurysm that produced important distortion of the left coronary artery and it's main branches. The patient was submitted to surgical repair through the closure of the orifice of the ruptured left sinus of Valsalva with a bovine pericardium patch. The subepicardium was filled with organized thrombi which were removed. He was discharged from the hospital after uncomplicated postoperative course. Pathological examination of the aortic fragment did not yield the etiology of the rupture.

Adult↗
PubMed1990

[Results of replacement of ascending aorta, and aortic valve with reimplantation of coronary arteries].

PURPOSE: To analyse a 10-year experience with the Bentall and De Bono technique for surgical treatment of aneurysms of ascending aorta. PATIENTS AND METHODS: From January 1980 to December 1989, the Bentall and De Bono technique was employed in 38 patients. Twenty-two patients had aneurysm of ascending aorta with aortic insufficiency; 14 had chronic aortic dissections. Four patients were operated on previously by other techniques. RESULTS: The immediate mortality was 5.2%; one patient due to low-output syndrome and one had neurological complications. Five patients (13.1%) died late postoperatively. The surviving 31 patients were followed up from two to 72 months (mean 25). Of these, 29 (93.5%) were in functional class I and two in class II. Sixteen patients had late evaluation by one or more of the following methods: digital angiography, chest computerized tomography, echocardiography, or conventional angiography, 6 to 60 (mean 33) months after operation. All of them had good conditions of composite valve graft and coronary artery reattachment. The immediate and late results were similar in patients with aneurysms and aortic dissections. CONCLUSION: The aortic valve and aortic ascending portion replacement with reimplantation of coronary arteries is of low mortality and fairly good late outcome.

Actuarial Analysis↗
PubMed1990

[Lymphocytic myocarditis. Response to treatment with immunosuppressive drugs].

PURPOSE: To evaluate immunosuppressive drugs on the treatment of myocarditis. PATIENTS AND METHODS: Right ventricular endomyocardial biopsy was performed in 102 patients with dilated cardiomyopathy. According to histopathologic aspect the patients were divided into two groups: I--with active lymphocytic myocarditis (ALM); II--without ALM: 51 patients. Ten patients from group I (Ib), with moderate or intense myocarditis were treated with prednisone and azathioprine during six months. RESULTS: After six months of observation, in group Ia (41 patients): 41 improved, 22% worsened and 12% died; in group Ib (10 patients): 60% improved, 10% worsened and 30% died; 51 patients in group II: 59% improved, 17% worsened and 10% died. Control biopsy on group Ib showed decrease of myocarditis in 62%. CONCLUSION: Immunosuppressive drugs do not always improve quality of life, or increase the survival, although in more than 50% of the cases it was possible to control inflammatory process.

Adolescent↗
PubMed1990

[Acute pulmonary edema as an early manifestation of systemic lupus erythematosus].

A 36 year-old male patient developed acute pulmonary edema due acute mitral insufficiency as early manifestation of systemic lupus erythematosus. The patient was treated with supportive measures, oxygen, furosemide, and isosorbide dinitrate. He was started on prednisone 60 mg daily 14 days later, after the diagnosis of lupus was established. The patients is asymptomatic with mitral systolic murmur 5 months after hospital discharge.

Adult↗
PubMed1990

[Indeterminate form of Chagas' disease. A polymorphic disease].

PURPOSE: To evaluate the association between the indeterminate form of Chagas' disease and abnormalities in non-invasive cardiovascular propedeutics. PATIENTS AND METHODS: Twenty-two patients in the indeterminate form of Chagas' disease, 17 female, with ages between 25 and 50 years were submitted to studies of: vectorcardiography, echocardiography, stress test, dynamic electrocardiography and scintigraphic studies (scintigraphic ventriculography and cardiac mapping with pyrophosphate of technetium), in a period of two months after first consultation. RESULTS: The analysis shows the percentual of altered exams: vectorcardiogram--68.2% (conduction disturbance--22.7%); echocardiogram--15.8% (apical hypokinesia); cardiac mapping 61.8%; scintigraphic ventriculography--68.2%; stress test--72.2% (reduced delta PS--50%, ventricular arrhythmia--50%); and dynamic electrocardiographic--50% (ventricular arrhythmias). We could observe also that the great majority of the patients has more than three exams altered (63.6%). The study of relation between methods, shows only association between reduced delta PS and ventricular arrhythmia, with concordant results in 72.7%. CONCLUSION: Indeterminate form of Chagas' disease appears to be a really chronic form, may be of attenuate aggressive potential, with indeterminate evolution and with polymorphic clinical exteriorization seeing only through invasive and non invasive propedeutic techniques.

Adult↗
PubMed1990

[Pericardial disease erroneously diagnosed as endomyocardial fibrosis. Report of 2 cases].

Two patients who were sent to operation with diagnosis of endomyocardial fibrosis (EMF) turned out to have pericardial disease. EMF had been suspected on the basis of clinical history, electrocardiographic, radiologic and echocardiographic data. The hemodynamic studies were "typical", and included apex amputation, flat ventricular surface and mitral and tricuspid insufficiencies. Thus, ventriculography should not be considered specific, but rather suggestive of endomyocardial fibrosis.

Adult↗
PubMed1989

[The value of the electrocardiogram in evaluating myocardial function in patients with Chagas' disease].

The authors studied the electrocardiogram of 1004 patients with Chagas' disease. The fit of this observation was the correlation between the electrocardiographic alterations with the cardiac compromise, which was analysed clinically, by thorax X-ray, echocardiogram and stress test. The results show that increased cardiothoracic index, and decreased ejection fraction, decreased difference between systolic blood pressure before the exercise and at the final of the stress test at maximal weight were associated with greater incidence of ventricular premature beat, intraventricular heart block, inactive area, ST-T alteration. chi 2 test shows that these association was significative. The presence of premature ventricular beats and inactive area on the electrocardiographic study seems to determine worse prognosis to the patients since these alterations were more frequent on the patients that died due to Chagas' disease.

Adolescent↗
PubMed1989

[Comparison of histologic changes in Chagas' cardiomyopathy and dilated cardiomyopathy].

In this study the histopathologic features of Chagas' disease and idiopathic dilated cardiomyopathy were compared in 38 patients with congestive heart failure, classes II or III. Biopsy specimens were obtained with the Stanford model needle for right ventricle. Twenty-two patients presented non-chagasic dilated cardiomyopathy, and 16 were carriers of Chagas' disease. Twenty-three were male and 15 were female; their ages varied 18 and 49 years (mean 35.5). Fibrosis was slightly more frequently and intense in Chagas' disease than in dilated cardiomyopathy. Myocarditis aspect also was more frequent in Chagas' disease than in dilated cardiomyopathy (62.4% vs. 50%), with all cases showing a chronic form; acute myocarditis was observed only in dilated myocardiopathy. These differences, however, did not reach statistical significance. In conclusion, the presence of fibrosis, hypertrophy and moderate to severe degrees of chronic inflammatory infiltrate are suggestive of but not pathognomonic of Chagas' disease. On the other hand, dilated myocardiopathies are more frequently associated with less fibrosis or hypertrophy and the presence of mild degree of inflammatory infiltrate. The arrangement of this inflammatory infiltrate tends to be diffuse in dilated cardiomyopathy and in chagasic myocarditis it is multifocal, very similar to the histopathological aspect found in myocardial rejections episodes of transplanted hearts.

Adolescent↗
PubMed1989

[Cardiac thrombosis and embolism in patients having died of chronic Chagas cardiopathy].

The authors studied the files of 111 patients (mean age 47.5 years) with chronic Chagas' disease and severe heart failure who had died between 1978 and 1984; they were 72 men and 39 women. Eighty-one patients (73%) had cardiac thrombosis, 65 times (53%) in right chambers and 56 times (46%) in left ones. Sixty-seven patients (60%) had thromboembolic episodes, 41 (65%) to the lungs, 23 (38%) to other organs (target organs: the kidneys in 21 cases, spleen in four, brain in two, abdominal aorta in one, mesenteric artery in one and iliac artery in one). Right chamber thrombosis occurred 65 times, 35 (53%) with pulmonary thromboembolism. Left chamber thrombosis occurred 56 times, 24 (42%) with systemic thromboembolism. A total of 41 patients had pulmonary thromboembolism, only six (14%) without right chamber thrombosis; of 26 patients with systemic thromboembolism, only two (7%) did not have left chamber thrombosis. The authors concluded that the incidence of thrombosis and thromboembolism was high in the group studied, and that there was a relationship between chamber thrombosis and systemic or pulmonary thromboembolism.

Adolescent↗
PubMed1989

[The biopsy in the diagnosis of pericardial involvement by malignant tumor].

We performed pericardial biopsy by subxiphoid approach in twelve patients (eight men, four women) with cardiac tamponade or pericardial effusion without low cardiac output, in order to search for the underlying disease. Five patients (41%) had pericardial biopsy with malignant neoplastic invasion. In seven patients (59%) the biopsy was nonspecific; in these patients, the diagnosis was made by another methods. We concluded that the pericardial biopsy is a safe method, with high especificity but low sensibility in the diagnosis of malignant pericardial invasion.

Biopsy↗
PubMed1989

Determinants of survival in endomyocardial fibrosis.

This study describes the clinical course of 108 patients with endomyocardial fibrosis. There were 76 females and 32 males, with a mean age of 35 years. All patients underwent cardiac catheterization. The angiographic data show that 64 (59%) patients had biventricular involvement. From a clinical point of view, 91 (84%) were in New York Heart Association functional classes III and IV. According to the right and left ventricular intensity of fibrosis, the patients were classified as mild (40 [37%]), moderate (36 [33%]), or severe (32 [30%]) for the right ventricle and mild (19 [18%]), moderate (61 [56%]), or severe (28 [26%]) for the left ventricle. Tricuspid regurgitation was observed in 63 (58%) patients and mitral regurgitation in 65 (60%) patients. Fifty patients in functional classes III and IV underwent surgical treatment. Survival curves constructed according to functional classes showed better prognosis for those in classes I and II (p = 0.0452). Survival curves for patients in classes III and IV for clinical and surgical treatment showed a trend toward better results for the surgical group. Analysis of factors that may have influenced the course of endomyocardial fibrosis showed that biventricular involvement (moderate or severe), right ventricular fibrosis, and presence of tricuspid and mitral regurgitation were associated with greater mortality.

Adolescent↗