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C R Conti

Publications and source records attributed to C R Conti.

At least 37 records · Page 2Linked to original sources
PubMed1996

Transesophageal echocardiographic guidance of transseptal left heart catheterization during radiofrequency ablation of left-sided accessory pathways in humans.

UNLABELLED: Radiofrequency ablation (RFA) of left-sided accessory pathways can be achieved using catheters introduced by a retrograde or transseptal approach. Transesophageal echocardiography (TEE) has previously been demonstrated to be safe and efficacious in guiding transseptal puncture in patients during mitral valvuloplasty (MV). This study was undertaken to assess the feasibility, safety, and clinical utility of TEE during transseptal puncture and RFA of left-sided accessory pathways. METHODS: TEE was performed during transseptal puncture in 30 patients (41 +/- 12 years, 19 females), 15 patients during attempted RFA of a left-sided accessory pathway and 15 patients during attempted balloon MV. RESULTS: There was no difference in age, sex distribution, or procedural complications when MV patients were compared to RFA patients. At baseline, left atrial dimension was increased and congestive heart failure was more common when MV patients were compared to RFA patients (P < 0.05) Adequate baseline two-dimensional and Doppler TEE images were obtained in all patients. One patient sustained mild esophageal bleeding during the TEE. Positioning of the transseptal catheter in the fossa ovalis was facilitated and confirmed by TEE in 29 of 30 cases. One case of cardiac perforation occurred and was associated with inadequate TEE localization of the fossa ovalis. Thrombus was detected on the transseptal catheter by TEE in two cases prior to systemic heparinization. In both cases, thrombus was removed without embolic event. CONCLUSIONS: TEE safely guides transseptal puncture in patients undergoing RFA of left-sided accessory pathways. TEE markers of the fossa ovalis facilitate puncture and may reduce the risk of cardiac perforation particularly in patients with a normal size left atrium. TEE may be especially valuable for identifying thrombus during transseptal puncture.

Adolescent↗
PubMed1995

Unstable angina: cost of conservative and invasive strategies using TIMI3 B as a model.

Obviously, conservative therapy would be less expensive than invasive therapy if patients were held in the conservative category and received only medical therapy along with exercise test with thallium. However, based on the TIMI 3 B outcomes, costs are similar (but not equal) even if one attempts a conservative strategy since a significant number of patients in the early conservative arm underwent angiography (64 patients) and PTCA (26 patients) or surgery (24 patients) and the number of days for rehospitalization was greater in the early conservative than in the early invasive group. I believe the TIMI 3 B study reflects the reality of clinical practice in 1995. It seems to me that either strategy is acceptable both from the medical and economic outcome standpoints. Given the model used here, I do not think that the early invasive strategy will ever be cheaper than the early conservative strategy unless all of the patients in the early conservative strategy who eventually are revascularized have CABG, and all of the patients in the early invasive strategy who are revascularized have PTCA.

Angina, Unstable↗
PubMed1995

Management of myocardial infarction patients with an occluded infarct-related artery: additional commentary.

The evidence is becoming stronger (but not conclusive) that restoration of flow in the infarct-related artery at a later date than is generally accepted might decrease mortality. The CORAMI report suggests a good outcome with rescue angioplasty, but, unfortunately, there was no control group. Since urgent rescue PTCA opened the infarct-related artery in the 29% of patients who remained occluded after thrombolysis, those cardiologists advocating emergency PTCA in all infarcting patients argue that 100% of occluded vessels can be opened with PTCA. I don't argue that fact but would point out that 71% of these same patients would have had unnecessary angioplasty since the occluded artery would have opened with thrombolytic therapy. The randomized trial performed by Ellis and colleagues was a difficult one because of physician bias. It took three years to complete at 20 sites, and in the presence of an occluded anterior descending coronary artery some investigators were reluctant to randomize all of their patients to conservative therapy. Obviously, a large trial would be appropriate to confirm Ellis and colleagues' observations but I doubt this will ever be done. Based on what is now known, I think it is worthwhile to consider rescue angioplasty in patients with a known occluded infarct-related artery. Unfortunately, that means performing coronary angiography almost immediately in all patients with infarcting myocardium in order to identify those with persistant occlusion.

Adrenergic beta-Antagonists↗
PubMed1995

Transesophageal echocardiography in the evaluation of cardiac myxoma: a case of familial myxoma.

The vast majority of atrial myxomas are readily apparent on standard transthoracic echocardiography. We present the case of a young woman with known history of familial myxoma, in whom a large left atrial mass was identified on transthoracic echocardiography. Transesophageal study more clearly delineated the extent and origin of the tumor. In addition, an unsuspected tumor in the right ventricle was also identified. These findings were confirmed at surgery, and both masses were excised. The advantages of transesophageal echocardiography in evaluation and management of this unusual subset of patients with cardiac tumor are discussed.

Adult↗
PubMed1995

Electroconvulsive therapy-induced transient T-wave inversions on ECG.

Electroconvulsive therapy (ECT), regarded as safe, well tolerated, and one of the most effective treatments for depression, is used frequently in patients with underlying coronary artery disease. ECT has been associated with ST depression and arrhythmias probably due to increased myocardial demand in patients with coronary artery disease. This report describes a case of transient new T-wave inversions in precordial leads V2 and V3 and flattening of T waves in leads III, V3, V4, V5, and a VF after two courses of ECT in a patient with minimal cardiac risk factors, normal echocardiogram, and normal pre-ECT electrocardiogram (ECG). These T-wave changes may represent increased sympathetic activity induced by ECT. Previous prospective studies of 26 and 21 patients undergoing serial ECT found only one new T-wave inversion and no pathologic Q waves on serial ECGs, suggesting that this is a rare finding.

Depression↗
PubMed1995

Asymptomatic Cardiac Ischemia Pilot (ACIP) study: impact of anti-ischemia therapy on 12-week rest electrocardiogram and exercise test outcomes. The ACIP Investigators.

OBJECTIVES: This report from the Asymptomatic Cardiac Ischemia Pilot (ACIP) study examines differences in the magnitude of reduction of myocardial ischemia as determined by exercise treadmill testing in patients randomized to three different treatment strategies: angina-guided medical therapy, ischemia-guided medical therapy and coronary revascularization. BACKGROUND: No prospective randomized clinical trials in patients with exercise electrocardiographic (ECG) abnormalities and asymptomatic cardiac ischemia on ambulatory ECG monitoring have compared the impact of different treatment strategies, including coronary revascularization, in terms of reducing myocardial ischemia. METHODS: The ACIP exercise protocol was used. Exercise variables measured included final exercise stage; presence of exercise-induced angina or ischemia; time to angina; time to 1-mm ST segment depression; number of exercise ECG leads with abnormalities; maximal depth of ST segment depression in any lead; sum of ST segment depression; ST/HR index; and rate-pressure product at time to angina, at time to 1-mm ST segment depression and at peak exertion. RESULTS: Peak exercise time was increased by 0.5, 0.7 and 1.6 min in patients assigned to the angina-guided, ischemia-guided and coronary revascularization strategies, respectively, from the qualifying visit to the 12-week visit (p < 0.001). At the qualifying visit, the sum of exercise-induced ST segment depression was 9.4 +/- 5.0 (mean +/- SD), 9.6 +/- 4.7 and 9.9 +/- 5.5 mm (p = NS) in the three treatment strategies, respectively. At the 12-week visit, the sum of exercise-induced ST segment depression was 7.4 +/- 5.7, 6.8 +/- 5.3 and 5.6 +/- 5.6 mm (p = 0.02) in the three treatment strategies, respectively. Each treatment strategy resulted in a significant reduction in all exercise-induced variables of myocardial ischemia measured at 12 weeks. CONCLUSIONS: Coronary revascularization significantly reduced the extent and frequency of exercise-induced myocardial ischemia compared with either medical strategy. The prognostic impact of these observations should be evaluated in a large-scale multicenter clinical trial.

Analysis of Variance↗