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César Morís

Publications and source records attributed to César Morís.

18 recordsLinked to original sources
PubMed2006

Prevalence and spectrum of mutations in the sarcomeric troponin T and I genes in a cohort of Spanish cardiac hypertrophy patients.

We sequenced the coding exons of the cardiac troponins T (TNNT2) and I (TNNI3) genes in 115 Spanish HCM-patients (32% with a family history of the disease). Only two (2%) had mutations in the TNNT2 (Arg278>Cys and Arg92>Lys). These mutations were associated with variable clinical outcomes. No patient had TNNI3-mutation. We also genotyped these patients and 320 healthy controls for a 5 bp insertion/deletion (I/D) polymorphism in intron 3 of TNNT2. DD-homozygotes for the 5 bp I/D polymorphism were significantly more frequent among the patients (OR=1.83, 95% CI=2.10-5.16).

Adolescent↗
PubMed2006

Intimal dehiscence during endovascular treatment of thoracic aortic dissection.

Endovascular treatment of thoracic aortic pathology has become a valuable alternative therapeutic option to open surgery, however complications both during implantation and the postoperative period may occur. In this case report we present an intimal dehiscence during endovascular procedure. Diagnosis was made by transoesophageal echocardiography.

Aortic Dissection↗
PubMed2006

An incidental finding during cardiac catheterization.

Coronary artery obstruction during cardiac catheterization is rare. It is a serious complication and has been reported to occur in 0.15 to 0.5% of cases. Thromboembolism, air embolism and coronary dissection have been described as the most common causes of intraprocedural coronary occlusion. Aortic valve masses can also cause coronary obstruction. We report the case of a young woman with a complication and an incidental finding during angiographic procedure. A surgical treatment was needed.

Adult↗
PubMed2006

Value of the American College of Cardiology/American Heart Association angiographic classification of coronary lesion morphology in patients with in-stent restenosis. Insights from the Restenosis Intra-stent Balloon angioplasty versus elective Stenting (RIBS) randomized trial.

BACKGROUND: The implications of the American College of Cardiology/American Heart Association (ACC/AHA) lesion classification in patients with in-stent restenosis (ISR) are unknown. METHODS: Four hundred fifty patients included in the RIBS randomized study were analyzed. A centralized core laboratory assessed ISR classifications including ACC/AHA, the classification of Mehran et al (Circulation 1999;100:1872-8), diffuse/focal, and a new quantitative ISR index (lesion length/stent length). Logistic regression models were constructed for prespecified outcome measures including (1) unsatisfactory acute results and (2) recurrent restenosis rate. RESULTS: Complex (B2/C) lesions (78%) more frequently obtained unsatisfactory acute results (20% vs 8%, P = .007), smaller minimal lumen diameter after the procedure (2.45 +/- 0.5 vs 2.73 +/- 0.5 mm, P = .001) and at follow-up (1.48 +/- 0.8 vs 1.94 +/- 0.8 mm, P = .0001), and had a higher restenosis rate (43 vs 24%, P = .001) than simple (A/B1) lesions. On logistic regression analysis, all classification schemes were useful to predict unsatisfactory initial results (area under the curve: 0.63, 0.61, 0.59, and 0.62) and recurrent restenosis (area under the curve: 0.60, 0.64, 0.61, and 0.63). The predictive ability of these schemes persisted despite adjustment for potential confounders. Although the ACC/AHA classification was a better predictor of acute results, the classification of Mehran was superior to predict restenosis. CONCLUSIONS: The ACC/AHA classification provides a useful tool to determine acute procedural results and the long-term angiographic outcome of patients with ISR.

Aged↗
PubMed2006

[Anomalous coronary arteries originating in the contralateral sinus of Valsalva: registry of thirteen Spanish hospitals (RACES)].

The registry contains information collected during 2003 from thirteen Spanish hospitals on the incidence, clinical presentation, initial course, diagnostic imaging, and treatment of anomalous coronary arteries originating in the contralateral coronary sinus. In a total of 23,300 coronary angiograms, 98 anomalous coronary arteries were detected (incidence 0.4%): 46 circumflex coronary arteries (47%), 25 right coronary arteries (25.5%), 10 left main coronary arteries (10.2%), three left anterior descending arteries (3.1%), six single coronary arteries (6.1%), and eight other anomalies (8.2%). The most frequent indication for angiography was angina (43.9%). The initial course of the anomalous coronary artery was not identified in 40.8% of cases. In two patients (2%), diagnostic imaging was used to identify the initial course. Associated atherosclerotic disease was present in 51% of patients. In addition, 18.4% had associated valvular disease, with the aortic valve being affected most often (15.2%). Some 16.3% of patients underwent treatment for the coronary anomaly. The incidence was similar to that observed in other published series, with anomalies in the circumflex coronary artery being diagnosed most frequently. Diagnostic imaging was underused.

Adolescent↗
PubMed2005

ABCA1 polymorphisms and prognosis after myocardial infarction in young patients.

High-density cholesterol (HDL) levels are affected by genetic influences and certain behaviors. Low levels of HDL-C are considered as an independent risk factor for premature coronary heart disease. In patients with Tangier disease, characterised by low HDL levels, mutations in the ATP binding cassette transporter have been described. We have analysed three polymorphisms of the ABCA1 gene (-477C/T, R219 K, and I883M) in a cohort of young male survivors of myocardial infarction in order to know their influence in long-term prognosis. In premature heart disease, knowing prognosis factors is specially relevant.

ATP Binding Cassette Transporter 1↗
PubMed2005

Fluvastatin reduces the 4-year cardiac risk in patients with multivessel disease.

BACKGROUND: To evaluate the impact of the extent of coronary disease (single- or multivessel) and of fluvastatin treatment on the incidence of long-term cardiac atherosclerotic complications in the Lescol Intervention Prevention Study (LIPS). METHODS: A total of 1063 patients with single-vessel disease and 614 patients with multivessel disease were randomized to receive fluvastatin (40 mg bid) or placebo for at least 3 years following a first successful percutaneous coronary intervention. The incidence of cardiac atherosclerotic events (cardiac death, non-fatal myocardial infarction, and coronary re-interventions not related to restenosis) was evaluated. RESULTS: Patients with multivessel disease tended to be older and presented a higher prevalence of associated risk factors and cardiovascular antecedents. The presence of multivessel disease markedly increased the risk of cardiac atherosclerotic events compared with single-vessel disease among patients allocated to placebo (RR 1.67 [95% CI: 1.24-2.25]; p<0.001). In patients treated with fluvastatin, however, no significant differences in long-term outcomes were observed between patients with multivessel disease and patients single-vessel disease (RR 1.28 [95% CI: 0.90-1.81]; p=0.2). CONCLUSIONS: Multivessel coronary disease impaired the 4-year outcomes after percutaneous intervention. However, the hazardous effect of multivessel disease was significantly reduced by long-term fluvastatin treatment.

Angioplasty, Balloon, Coronary↗
PubMed2005

[Percutaneous treatment of thoracic aorta diseases. A multidisciplinary approach].

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. PATIENTS AND METHOD: Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. RESULTS: Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 +/- 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. CONCLUSIONS: Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure.

Aorta, Thoracic↗
PubMed2005

[Drug-eluting stents in patients with left main coronary lesions who are not candidates for surgical revascularization].

INTRODUCTION AND OBJECTIVES: Surgical revascularization is the treatment of choice in patients with left main coronary artery stenosis. Conventional stents are not a valid alternative because of the rate of restenosis and sudden cardiac death. Drug-eluting stents, which reduce the rate of restenosis, may represent an alternative to cardiac surgery. The objective of this study was to describe the results with drug-eluting stents in patients with left main coronary artery stenosis who were poor candidates for surgical revascularization. PATIENTS AND METHOD: We prospectively followed a consecutive series of patients who were poor candidates for surgical revascularization and were treated with implantation of a drug-eluting stent in the left main coronary artery between May 2002 and April 2004. In-hospital and long-term results were analyzed. Follow-up included angiographic and intravascular ultrasound (IVUS) studies. RESULTS: Forty-two patients (25 men, 59.5%) with a mean age of 70.1 (10.5) years were studied. Fourteen (33%) had diabetes, and 7 (16.7%) had a protected left main coronary artery. The reasons for ruling out surgery were poor distal vessels in 19 (45.2%), previous surgery in 9 (21.4%), age in 6 (14.3%), primary angioplasty in 5 (11.4%), and other reasons in 3 (7.2%). Four patients (9.5%) died before discharge, three of them after primary angioplasty. No in-hospital revascularization procedures were needed. Median follow-up time was 288 days; mean follow-up time was 315 (241) days. Another four patients died after discharge (9.5%) on days 5, 24, 34 and 115. Angioplasty was repeated in one patient, and another was referred for heart transplantation. CONCLUSIONS: Drug-eluting stents represent a valid alternative in patients with left main coronary artery stenosis who are poor candidates for surgical revascularization. Randomized studies with a longer follow-up should be performed to evaluate their benefits in patients eligible for surgery.

Adult↗
PubMed2005

[Direct stenting in saphenous vein grafts. Immediate and long-term results].

INTRODUCTION AND OBJECTIVES: Percutaneous interventions on saphenous vein grafts are associated with a worse outcome than in native vessels, mainly because of the risk of embolization. Direct stenting may diminish aggression to the vessel. This study reports the results of direct stenting in saphenous vein grafts. PATIENTS AND METHOD: We compared 2 cohorts of consecutive patients treated with direct stenting (DS) and stenting with predilatation (PD) in saphenous vein grafts between September 1998 and March 2003. In-hospital and long-term results and predictors of mortality were analyzed. RESULTS: The DS group contained 71 patients with 83 lesions, and the PD group contained 46 patients with 54 lesions. There were no differences in age, risk factors, age of the graft, ejection fraction, stent length, need for postdilatation or number of stents per lesion, although the DS group contained more women (DS=38%, PD=17%, P=.02), and stent diameter was larger (DS=3.59 [0.59] mm, PD=3.21 [0.59] mm, P=.001) in the DS group. Creatine phosphokinase elevation was > or =2-fold in 10% (DS=7%, PD=16%, P=.1). One patient died in the hospital. Median follow-up time was 36.1 months. Survival was 94+/- 2% at 12 months, 87+/-3% at 24 months, 82+/-17% at 36 months, 67+/-8% at 48 months and 58+/-7% at 60 months. Revascularization rate was 14% for the target lesion and 20.5% for the target vessel, with no differences between groups in mortality or revascularization success rate. Predictors of mortality were ejection fraction and smoking habit. CONCLUSIONS: Survival after stenting in saphenous vein grafts is similar with direct and conventional techniques, although there was a tendency toward a lower incidence of myocardial infarction with the former. Although the in-hospital results were favorable, long-term survival was less favorable with both techniques.

Aged↗
PubMed2005

[Cardiac catheterization via the right radial artery with a Judkins left catheter. A prospective study].

Radial artery access improves the patient's well-being, permits earlier ambulation and diminishes vascular complications after cardiac catheterization. Using the same catheter to study the left and right coronary arteries may facilitate the technique. In a cohort of 100 patients we prospectively analyzed the possibility of studying both coronary arteries with a Judkins left 3.5 catheter. The variables studied were percentage of successful access, complications, and procedural time from insertion of the guiding catheter to the end of ventriculography. It was possible to catheterize both coronary arteries with the same catheter in 94 cases (94%) with a procedural time of 16.7 (6.8) min. In 6 patients a JR4 catheter was required, in one of them due to severe spasm of the right coronary artery ostium and due to impossibility to catheterize the ostium in the other 5. There were no cases of severe radial artery spasm.

Aged↗
PubMed2004

Floating thrombi on the Eustachian valve as a complication of venous thromboembolic disease.

Floating right heart thrombi can occur in 4-18% of patients with pulmonary embolism. Usually, the diagnosis is done by echocardiography and carries an important prognostic significance as thrombi can embolize at any moment and severe pulmonary embolism is the most frequent way of floating right heart thrombi presentation (mortality rate >40%). We present a case report of floating right thrombi in a patient with proven deep venous thrombosis complicated with nonmassive pulmonary embolism that was successfully treated with thrombolysis.

Adult↗
PubMed2003

A randomized comparison of repeat stenting with balloon angioplasty in patients with in-stent restenosis.

OBJECTIVES: This randomized trial compared repeat stenting with balloon angioplasty (BA) in patients with in-stent restenosis (ISR). BACKGROUND: Stent restenosis constitutes a therapeutic challenge. Repeat coronary interventions are currently used in this setting, but the recurrence risk remains high. METHODS: We randomly assigned 450 patients with ISR to elective stent implantation (224 patients) or conventional BA (226 patients). Primary end point was recurrent restenosis rate at six months. Secondary end points included minimal lumen diameter (MLD), prespecified subgroup analyses, and a composite of major adverse events. RESULTS: Procedural success was similar in both groups, but in-hospital complications were more frequent in the balloon group. After the procedure MLD was larger in the stent group (2.77 +/- 0.4 vs. 2.25 +/- 0.5 mm, p < 0.001). At follow-up, MLD was larger after stenting when the in-lesion site was considered (1.69 +/- 0.8 vs. 1.54 +/- 0.7 mm, p = 0.046). However, the binary restenosis rate (38% stent group, 39% balloon group) was similar with the two strategies. One-year event-free survival (follow-up 100%) was also similar in both groups (77% stent vs. 71% balloon, p = 0.19). Nevertheless, in the prespecified subgroup of patients with large vessels (> or =3 mm) the restenosis rate (27% vs. 49%, p = 0.007) and the event-free survival (84% vs. 62%, p = 0.002) were better after repeat stenting. CONCLUSIONS: In patients with ISR, repeat coronary stenting provided better initial angiographic results but failed to improve restenosis rate and clinical outcome when compared with BA. However, in patients with large vessels coronary stenting improved the long-term clinical and angiographic outcome.

Aged↗