Biomedical subjects

E Ban Hayashi

Publications and source records attributed to E Ban Hayashi.

17 recordsLinked to original sources

PubMedDate not supplied

[Primary angioplasty: comparison of working hours and night].

A prospective, observational, comparative study of 100 patients with acute myocardial infarction and primary angioplasty was performed to establish if there was statistically difference between the lag of time when symptoms begin and the time of the emergency admission to the time of arrival at the catheterization suite during working hours vs the "on call" hours. Patients were allocated in two groups accordingly to morning hours or on call hours. Time of onset of symptoms to the catheterization suite arrival between the two groups was no significantly different. Time from emergency room arrival to catheterization suite arrival was significant different < 0.05, however success rate between groups 86% vs 80% and complications rate were statistically non significant between both groups. We conclude that primary angioplasty is a highly effective method of reperfusion. Even though the time from the emergency room arrival to the catheterization suite arrival was significantly less during day than the on call hours, there is no difference between the success rate and complications incidence in both groups.

Aged↗

PubMedDate not supplied

[The benefit of a coronary stent in the reduction of major cardiac complications in acute coronary syndromes].

To assess the incidence of in-hospital major adverse cardiac events (MACE), we analyzed 694 procedures in 613 consecutive patients during one year period. Patient population included 550 (79.2%) patients with unstable angina, 43 (6.2%) with stable angina and 101 (14.5%) with acute myocardial infarction. Elective percutaneous transluminal coronary angioplasty (PTCA) was performed in 593 (85.4%) patients, rescue PTCA in 7 (1%), and primary PTCA in 94 (13.5%). Angiographic lesion morphology was as follows: type A 30%; type B 58%; type C 12%. We compared patient population who received stent with PTCA-balloon only. Technical success was 95% and clinical success was achieved in 80% of the cases. Overall mortality was 1% in the stent group and 3% in the conventional PTCA. The incidence of MACE was 4% and 15.1% in the stent and angioplasty balloon groups respectively. We found a dramatic impact on reduction of the incidence of acute complications in the groups with stenting for unstable angina (p = 0.0001) and acute myocardial infarction (p = 0.0001). The major clinical advantage of stenting over balloon angioplasty was a lower need for repeated procedures.

Acute Disease↗

PubMedDate not supplied

[Percutaneous mitral valvulotomy].

Percutaneous balloon mitral valvotomy has become the first choice option for the treatment of mitral stenosis. Any patient with the disease is a candidate for the procedure. However there are patient's subgroups which the procedure success will reach a 100% accordingly to a meticulous selection of the cases. Long-term results has been excellent and may be compared with those of surgical closed mitral commissurotomy. We report our long-term follow-up experience of 127 patients followed during a mean of five years in which results have been very favorable.

Adolescent↗

PubMedDate not supplied

[The primary outcome in transluminal coronary angioplasty: the recent experience of the Instituto Nacional de Cardiología (1991-1992)].

Percutaneous balloon coronary angioplasty had a slow start in Mexico, and until recently only a relatively small number of procedures have been performed. Since March 1991, the Instituto Nacional de Cardiología has state-of-the-art fluoroscopic imaging and easy access to a variety of balloon coronary angioplasty catheters and accessories. Under these conditions, an increasing number of PTCAs have been performed (221 procedures in an initial 15 month period). The primary results of PTCA in this patient population is presented as a reference source for results of PTCA in our population. Indication for PTCA was stable angina in 31%, unstable angina in 64% and AMI in 5%. Forty-two percent of the procedures were for multivessel PTCA, with a total of 355 lesions approached (1.6 segments per patient). There were 34% type A, 51% type B and 15% type C lesions. Mean percent stenosis was reduced from 81% to 29% (p < 0.001). There was a 94% success rate in type A lesions, 89% in type B and 77% in type C lesions. Six patients required urgent CABG (2.7%), thirteen had a myocardial infarction (5.9%) and mortality was 1.35% (including one patient with cardiogenic shock who had a noncomplicated failure and had a late in-hospital death). We conclude that with adequate support and equipment, angioplasty results compare favorably to those reported by more experienced groups in developed nations. Also, the necessary number of procedures for the maintenance of competence in PTCA can be done in our country.

Academies and Institutes↗

PubMedDate not supplied

[Changes in auriculoventricular conduction due to the effect of ethanol].

Transcoronary ablation of atrioventricular conduction by dehydrated alcohol was attempted in one patient with refractory ectopic atrial tachycardia. Ethanol (1.5 ml) was delivered after selective catheterization of the atrioventricular nodal artery in a patient in whom the artery could be identified by cineangiography. The mean creatine kinase (MB fraction) at four hour to six hour after ablation was 40 U. No electrocardiographic QRS changes was seen. The procedure was successful. The patient is asymptomatic 3 months after procedure. Transcoronary alcohol ablation of atrioventricular conduction should be considered in patients in whom electrical techniques have been unsuccessful.

Adult↗

PubMedDate not supplied

[Detection of early occlusion of aortocoronary by-passes. Usefulness of a non-angiographic method].

A total of 83 bypasses were studied. Angiographic results demonstrated occlusion in 3 of 24 bypass of internal mammary artery placed in the anterior descending artery, 2 in the right coronary artery, 1 in the posterolateral of the circumflex and 1 in the first diagonal branch, with a total occlusion average of 8.4% within the first 8 days. We found a good correlation between the coronarographic angiograms and the positivity or negativity of the echo-electrocardiographic tests, during atrial pacing. We believe that this simple method could be done routinely in all the patients after coronary surgery, to decide the need of a new coronary angiogram. Furthermore, this study shows that the occlusion of a single coronary bypass does not produce myocardial infarction, detectable by enzymatic measures or by resting EKG. This method also detects the early post-operatory sinus sick syndrome.

Adult↗

PubMedDate not supplied

[Percutaneous mitral commissurotomy with Inoue balloon. Short-term results. Initial experience at the Ignacio Chavez National Institute of Cardiology].

Percutaneous transvenous mitral commissurotomy (PTMC) using balloon catheters has emerged as an alternative to surgery for patients with mitral stenosis. This report details our recent experience of PTMC with the Inoue balloon in 20 consecutive patients with mitral stenosis from april 2 to july 27, 1991. Mean age was 35.6 +/- 9.5 years. Mitral valve area increased form 1.04 +/- 0.3 to 2.32 +/- 0.5 cm2 (p less than 0.0001). Mitral valve gradient decreased from 19.2 +/- 8.8 to 6.6 +/- 2.3 mmHg. (p less than 0.0001). Two patients developed mitral regurgitation greater than 2+/4 after the procedure. In none the residual left to right shunt was greater than 1.2L. There was no mortality. We conclude that in selected patients, excellent results are obtained PMTC with the Inoue balloon. Complications are minimal.

Adult↗

PubMedDate not supplied

[The usefulness of transesophageal echocardiography during percutaneous balloon mitral valvulotomy].

The purpose of this study is to report the experience at Instituto de Cardiología de México with transesophageal echocardiography during percutaneous mitral valvulotomy and to compare its utility with transthoracic echocardiography. Sixteen patients with isolated or predominant mitral stenosis were examined and underwent percutaneous mitral valvulotomy with a single balloon catheter (Inoue [correction of Ionue] technique). Transthoracic echocardiography was done in all cases previous to the procedure. The procedure orientation was done with transesophageal in thirteen patients and with. Transthoracic echocardiography in the other three. The results were successful in all cases. Transesophageal echocardiography was more useful in the initial evaluation in patients with poor transthoracic windows, in those with clinical and/or transthoracic evidence of atrial thrombosis, as well as in procedure orientation, spontaneous contrast detection, mitral regurgitation and atrial septal defect evaluation after the procedure. Transesophageal echocardiography is superior to transthoracic technique in procedure orientation, early evaluation of results and potential complications. However, its practical utility is limited and its routine use is not recommended.

Adult↗

PubMedDate not supplied

[Use of technetium 99m radio-angiocardiography in the identification of myxoma of the right atrium. Presentation of 2 cases].

A right atrial myxoma was identified in two patients with radio-angiocardiography-99m Tc. Tumor is identified as a persistent photon-deficient region in both first-pass and equilibrium images. In addition there is an abnormal accumulation and sluggish disappearance of the radionuclide from the right atrium. Even though sensitivity of the procedure should be confirmed, it is a helpful non-invasive technique of great value in the diagnosis oF right atrial tumors.

Adolescent↗

PubMedDate not supplied

[Hemodynamic changes caused by prazocin in patients with uncomplicated arterial hypertension].

Hemodynamic changes produced by prazosin were evaluated in 19 patients with mild non complicated essential hypertension using M mode echocardiography. Patients received an initial dose of the drug of 0.5 mg tid, which was augmented gradually. As a whole, arterial pressure was reduced significantly. Heart rate did not show changes. Telediastolic and stroke volumes augmented significantly (p less than 0.05) and consequently cardiac output was increased. Systemic vascular resistance decreased notably (p less than 0.01). Left ventricular function indexes (EF, % shortening, Vcf) were not modified at all. These findings suggest that prazosin is a good antihypertensive drug and its actions upon the different hemodynamic parameters in normal and non complicated hypertensive patients are complex. Generally, it decreases systemic vascular resistance, without modification of contractility. Decreases in afterload were evident and something interesting, in contrast with other papers, is the demonstration of an augmented telediastolic volume, which indicates that the venodilatator effect with the consecutive decrease in blood return to the heart is masked by other effects. Nevertheless, it is necessary to perform a more detailed study with more sensitive methods in order to elucidate the complex hemodynamic interactions produced by prazosin in patients with mild non complicated essential hypertension.

Adult↗

PubMedDate not supplied

[Ventricular rigidity in mitral stenosis measured by an echocardiographic and hemodynamic method].

Ten patients with mitral stenosis underwent right and left heart catheterization. In order to assess the diastolic properties of these ventricles an hemodynamic-echocardiografic techniques was employed. Left ventricular pressure and an echocardiogram of the body of the left ventricle were simultaneously registered. Ventricular volume was determined using the minor axis (T) of the left ventricle measured form the echogram and assuming the long axis (L) from the L to T relationship observed in the left cineventriculography. Using a microcromputer, a smoothed volume-time curve was obtained, together with its first derivative and a pressure-volume loop. The exponential portion of the diastolic loop was used to obtain a felt ventricular stiffness index at zero volume. End diastolic volume and ejection fraction were normals. Left ventricular filling was impaired but ventricular stiffness was found in the normal range. It is concluded that the proposed method permits the simultaneous obtention of pressure volume data. The processing of complex data can be achieved with a pocket microcomputer. There is no evidence of a left ventricular compliance defect in mitral stenosis.

Adult↗

PubMedDate not supplied

[Percutaneous mitral valvuloplasty with the Inoue balloon. The initial experience and 3-year clinical follow-up at the Instituto Nacional de Cardiología Ignacio Chávez].

In 113 patients with mitral stenosis a balloon mitral valvuloplasty (VMPB) was performed. There were 97 female and 16 male patients. Mean age was 40 +/- 11 with range of 18 and 70 years. 95 patients had sinus rhythm and 18 were on atrial fibrillation. Previous mitral commissurotomy was reported in 13 patients and 5 were pregnant at the moment of the procedure. Patients were carefully selected using both clinical and echocardiographic studies as well as the Wilkins score (SW). Transesophageal echocardiography (ETE) was performed when transthoracic echocardiography was not satisfactory. After right and left catheterization, VMPB was performed. In 106 patients (93.8%) a significant increase of the area mitral valve (AVM) was obtained. Echocardiographic results showed an AVM increase from 0.95 +/- 0.19 to 1.61 +/- 0.34 cm2 (p < 0.0001). Mean mitral gradient (GTM) decreased from 16.18 +/- 4.69 to 9.14 +/- 3.2 mmHg (p < 0.0001). Functional class improved in all patients in the long term. As complications there was severe mitral regurgitation (IM) reported in 6 patients who subsequently underwent mitral valve exchange, 2 of then died during surgery (one of them by bleeding and the other by non reparable rags on the atrium). A patient had cerebrovascular event (EVC) one week after the VMPB. In 3 of them non-significant interatrial communication (CIA) was produced. One patient died two months after the procedure due to bacterial endocarditis (EBSA). VMPB can be considered as a safe and effective treatment to patients with mitral stenosis.

Adult↗

PubMedDate not supplied

[Coronary angioplasty in patients not accepted for surgical treatment. The initial experience of the Ignacio Chávez Instituto Nacional de Cardiología].

Coronary angioplasty has shown its efficacy in "high-risk" patients for surgical treatment (severe left ventricular failure, serious pulmonary or systemic disease). We studied a subgroup with multivessel coronary heart disease treated with coronary angioplasty because they were no candidates for surgery due to unsuitable coronary anatomy. Revascularization rate was determined in each patient as revascularization percentage obtained, compared with all the technically suitable lesions for coronary angioplasty. Ten patients (mean age 63 years) were studied, eight of them had unstable angina. Overall, 44 lesions were considered technically suitable for angioplasty and thirty-five could be dilated, technical success rate was 88% (31/35 lesions) and revascularization rate was 71% (31/44 lesions). Primary success rate was achieved in nine patients. Clinical follow-up varied from two to thirteen months (mean 7.8 months); eight patients have remained asymptomatic (class I of NYHA), another patient had stable angina and the other one had sudden death six months after the procedure. In conclusion, we demonstrated a high success rate in a short and long term with coronary angioplasty in a subgroup of patients with multivascular coronary heart disease that had been rejected for surgery due to unsuitable coronary anatomy.

Aged↗

PubMedDate not supplied

[Clinical experience with AVE Micro Stent. Results of the implantation of 204 stents].

To assess the efficacy and safety of the AVE Micro Stent, we deployed 204 stents in 144 consecutive patients during a one year period. Indications for stenting were acute closure in 3.4%, dissection in 5.4%, post balloon pTCA restenosis in 3.4%, non-favorable result in 16.7% and de novo in 71.1%. Patient population included 39 (27%) patients with stable angina, 86 (59.7%) with unstable angina, 16 (11.1%) with acute MI and 3 (2.1%) with cardiogenic shock. Angiographic lesion morphology were as follows: type A, 17.7%, type B1, 42.1%; type B2, 16.2%; type C, 24%. Procedural success was obtained in 204 of 205 attempted stents (99.5%) and clinical success was 93.1%. Oral anticoagulation was not routinely used. Enzymatic elevation consistent with myocardial necrosis occurred in 3.2% with Q wave MI in 0.7%. Three patients (2.1%) had bleeding at site of femoral puncture with one requiring transfusion and surgery. Mortality was 0.8% in the angina group, 6.25% in the MI group and one of the 3 patients with cardiogenic shock died and represents the only apparent stent thrombosis as she experienced sudden death one week after successful left main stenting. We conclude that high success rates can be obtained with the AVE Micro Stent due to it's excellent trackability, adequate radio-opacity and relative flexibility.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

[Coronary stents. Results during the hospitalization phase].

UNLABELLED: Between October 1991 and August 1996 two-hundred coronary stents were implanted (s) in 166 patients (pts) (1.27 s/pt). One hundred thirty-five lesions "de novo" were approached with stent, 44 because of a sub-optimal result post-angioplasty, 15 for restenosis and 17 for dissection. In thirty-six patients the indication of stenting was stable angina, in 68 unstable angina, in 37 for angina after myocardial infarction, in 11 for asymptomatic ischemia after myocardial infarction and in 14 during an acute myocardial infarction. Mean stenosis before stent implantation in all cases was 85 +/- 15%. Type of lesion in seventy cases was A, in 112 was B and 29 was C. Stents used were AVE in 146 lesions, Palmaz-Schatz in 33, Wiktor in 23, Gianturco-Roubin in 8 and Wallstent in one case. Medical treatment in 140 pts. (84.3%) after stent implantation was only with aspirin and ticlopidine. Technical success in all patients was 98.6% (208/211 pts) and primary success was 94.6% (157-166 pts). Unsuccessful procedures were because of sub-acute occlusion in three patients (1.8%), death in 3 pts. (1.8%) and urgent CABG was necessary in one pt. (0.5%). Major hematoma was a complication in 5 pts (3%). Mean residual stenosis after stent implantation in all cases was 2.2%. CONCLUSION: Stent implantation in our laboratory is a very safe procedure with a high rate of primary success with lowest complications in a great population of unstable angina.

Adult↗

PubMedDate not supplied

[Coronary stent in acute myocardial infarction].

UNLABELLED: From December 1995 to March 1997 fifty patients with acute myocardial infarction, had 57 stents implanted. Mean time since the beginning of symptoms to the procedure was 3.7 +/- 2.9 hours. Twenty-four stents were implanted "de novo", 17 for "sub-optimal" results, 5 for threatened closure and eleven for complex dissection. The arteries treated with stent were left anterior descending in 42%, right coronary in 42%, circumflex in 10%, vein grafts in 4%, intermedial branch in 1% and marginal obtuse branch in 1%. Stent used in most of the cases was AVE in 67% followed by Palmaz-Schatz, Wiktor, Crown, Gianturco-Roubin and Wallstent. Before procedure, coronary flow was TIMI 0 in 66% TIMI 1 in 10% and TIMI 2 in 24%. After procedure, TIMI 3 coronary flow was achieved in 92% of the arteries and other four had "no-reflow" phenomenon. Mean stenosis before procedure was 96% +/- 3.1 and after stenting was 1.76% +/- 2.6 with a stent/artery diameter rate of 1.01. Technical success was 100% and clinical success was achieved in 96% of the cases. Two cases were not successfully due to acute thrombotic closure in one patient and in another one because of cardiogenic shock after two days of a technical successful implantation of stent in LAD artery. There were not recurrent ischemic events (CABG, re-infarction or new coronary angioplasty procedure). Other two patients died for non-cardiac events (acute pancreatitis in one and by septic shock in other). At the time of discharge 96% of patients were treated with aspirin and ticlopidine. Major hematoma was evident in only one case. At a mean follow-up time of 5.6 months +/- 4.2 in 45 patients showed that 73% were in functional class I and none of them had re-infarction, death or needed a new revascularization. CONCLUSION: Stent implantation in acute myocardial infarction is feasible and safe procedure with a low rate of ischemic recurrent events.

Adult↗

PubMedDate not supplied

[The no-reflow phenomenon: its incidence and clinical characteristics in a series of cases].

The no-reflow phenomenon refers to the inability to reperfuse myocardial tissue despite removal of an occlusion of a coronary artery. No reflow is a complication that may occur after revascularization of patients. This study examined the incidence and, clinical characteristics of no-reflow in a patient population treated with conventional percutaneous transluminal coronary angioplasty at the Instituto Nacional de Cardiología "Ignacio Chávez". We reviewed 204 elective angioplasties and 62 direct angioplasties; 14 patients were included (4 from the first group and 10 from the second group). No-reflow were more frequently in men, the mean age was 56 years and diabetes and smoking were the risk factors more frequently reported. No-reflow was found in left anterior descending coronary artery in 7 patients, the time of reperfusion, in direct angioplasty, was 10.6 hours (mean) and the strategy most frequently used to reestablish normal anterograde flow was intracoronary verapamil. The overall incidence of no-reflow for the two modalities was 5.2% (16.12% for direct angioplasty and 1.9% for elective angioplasty). The current study shows that the no-reflow phenomenon is not uncommon after angioplasty; no-reflow appears higher than the previous reports for both modalities of treatment.

Angioplasty, Balloon, Coronary↗