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Biomedical subjects

E Verna

Publications and source records attributed to E Verna.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Ultrasonic decalcification in aortic stenosis. Clinical and doppler echocardiographic results].

Ten elderly patients with aortic valve stenosis and with a small calcified annulus (less than 20 mm) were treated by ultrasonic valve debridement (UVD) while 17 other elderly patients underwent aortic valve replacement (AVR) during the same period. The clinical and doppler results were assessed for a mean follow-up period of 20 months. Patients with significant aortic regurgitation or associated valve disease were excluded. The patients were studied by m-mode, two-dimensional and Doppler echocardiography before, immediately after, and at 6 months interval after the procedure. A successful decalcification was achieved in 8 patients. The valve was replaced in 2 patients because of cusp perforation or unsatisfactory intraoperative result. All patients showed significant postoperative increase in the mobility of the valve cusps, decrease in the amount of calcium, decrease of the aortic mean valve gradient (from 62 +/- 25 to 23 +/- 6 mmHg, p less than 0.001) and increase of the aortic valve area (from 0.49 +/- 0.11 to 1.21 +/- 0.3, p less than 0.001). The mean valve gradient was slightly higher after UVD than after AVR and showed a slight trend to further increase during follow-up, although only one patient had evidence of restenosis. A mild aortic valve insufficiency was present postoperatively in 6 patients. Worsening of insufficiency was noted in 2 patients during the follow-up period and one subject was re-operated on. Surgical ultrasonic debridement of the aortic valve may be effective in selected surgical candidates with small calcified valve and annulus, but subsequent occurrence of aortic insufficiency and restenosis may seriously limit its application.

Aged↗
PubMed1991

Accuracy and safety of technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile (Sestamibi) myocardial scintigraphy with high dose dipyridamole test in patients with effort angina pectoris: a multicenter study. Italian Group of Nuclear Cardiology.

Clinical and physiologic evidence indicates that maximal coronary vasodilation is not achieved in a large number of patients with use of the standard dose of dipyridamole (0.56 mg/kg body weight over 4 min). The feasibility, safety and accuracy of technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile (Sestamibi) scintigraphy associated with intravenous high dose dipyridamole (0.56 mg/kg over 4 min followed 4 min later by an additional 0.28 mg/kg over 2 min) were evaluated in a multicenter study. Planar myocardial perfusion images were obtained at rest and after dipyridamole in 101 patients with effort chest pain and no prior myocardial infarction. High dose dipyridamole (62 patients) was used when typical chest pain or electrocardiographic (ECG) signs of ischemia, or both, did not occur during or after the standard dose (39 patients). With high dose dipyridamole, 34 patients had pain (18 patients) or ECG signs of ischemia (ST depression greater than or equal to 2 mm) (8 patients), or both (8 patients), whereas the other 28 patients had Sestamibi injection in the absence of symptoms or ECG changes. All patients underwent coronary angiography: 81 had significant coronary artery disease (greater than or equal to 50% reduction of lumen diameter) (affecting one vessel in 38, two vessels in 19 and three vessels in 24 patients) and 20 patients had normal coronary arteries. The overall sensitivity, specificity and predictive accuracy of Sestamibi scintigraphy were 81%, 90% and 83%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Reliability of standard apexcardiography for the measurement of sudden variations in mean pulmonary capillary wedge pressure.

We simultaneously registered the left apexcardiogram together with the left intraventricular pressure curve immediately before and after ventricular angiography in order to evaluate whether the relation existing between apexcardiographic protodiastolic filling period duration (cR interval) and left ventricular mean diastolic pressure (LVMDP) was maintained even in the presence of sudden variations of LVMDP. Administration of contrast media resulted in a significant increase of LVMDP (from 11.8 to 23.9 mm Hg) and in a simultaneous decrease of the cR interval (from 108.5 to 71.0 msec) and noninvasive LVMDP calculated as 36-0.24* cR closely correlated with the invasive values both before and after angiography (overall correlation r = 0.94). Apexcardiography thus confirms to be the only highly reliable noninvasive technique which can be used by the clinical cardiologist to measure LVMDP and/or mean pulmonary capillary wedge pressure.

Adult↗
PubMed1990

Management of complicated coronary angioplasty by intracoronary urokinase and immediate re-angioplasty.

Percutaneous transluminal coronary angioplasty was complicated by acute coronary occlusion, dissection of the arterial wall, or angiographic evidence of intraluminal thrombosis in 33 high-risk patients from 153 consecutive angioplasty procedures (21.5%). Ten patients (group I) were managed with nitroglycerin (0.2 to 0.4 mg i.c.) and repeated attempts at mechanical guide wire recanalization or dilation, but they did not receive thrombolytic therapy. In the remaining 23 patients (group II), intracoronary urokinase (100,000 to 360,000 U.I.) was administered over 15-20 min after onset of coronary occlusion or thrombosis and continued during attempts at repeated dilation of the stenosis. The incidence of sudden coronary artery occlusion was 70% in group I patients and 52% in group II. The angiographic evidence of thrombus formation was observed in a higher, but not significant, proportion of group II patients (65%) as compared with group I (30%). The incidence of intimal tearing or dissection was similar in the two groups of patients (40 vs. 34.7%). The overall final success rate of the complicated angioplasty series was 48% (6/33). However, the success rate was lower (10%) in group I than in group II patients (10 vs. 65%; P less than 0.005), and the frequency of emergency coronary artery bypass grafting was lower in group II patients (13 vs. 60%; P = 0.01), suggesting that thrombolytic therapy with urokinase may be effective in the management of acute coronary occlusion and thromboembolic complications of coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1989

Quantitative regional contraction analysis of cineventriculography: reporting, filing, and retrieval functions using a personal computer.

A new method for the semiobjective evaluation of left ventricular wall contraction is proposed that uses a percent reduction of areas. The calculation model uses orthogonal coordinates, an internal reference system, and the concept of nonuniform reduction of the cavity, with its obliteration at the apex. From a normal patient population (ten males, four females; aged 45 +/- 13 years), a "normal reference curve" of contraction was obtained. A second patient group (56 males, two females, aged 56 +/- 7 years) with definite contraction abnormalities was then analyzed. A third group (eight males, one female, aged 56 +/- 10 years) was studied before and after nifedipine administration (1 mg over 2 min IV). Specific algorithms compare individual patient contraction curves with the normal reference curve and compute the score point system of contraction analysis. Data are automatically codified and filed during introduction. This saves time and allows a rapid retrieval of data grouped under different coded features. These features include the location and type of wall contraction abnormalities. This method of reading ventriculograms has been shown to be in accordance with the diagnosis of experienced observers and can detect small contraction changes that are induced pharmacologically. The method is proposed as a valuable tool for semiobjective evaluation of left ventricle wall contraction and to facilitate data collection in multicenter collaborative studies.

Algorithms↗
PubMed1989

Emergency coronary angioplasty in patients with severe left ventricular dysfunction or cardiogenic shock after acute myocardial infarction.

Emergency percutaneous transluminal coronary angioplasty (PTCA) was performed during an acute myocardial infarction (AMI) after either systemic or intracoronary thrombolytic therapy in six patients with severe ischaemic left ventricular dysfunction or cardiogenic shock, among 37 patients (17%) who were treated with PTCA during AMI over a 13-month period. Thrombolytic therapy with streptokinase (1.5 x 10 Units) was initiated after a mean (+/- SD) time delay of 5.5 +/- 1.3 h from the onset of symptoms. The infarct-related artery was found to be occluded (TIMI grade 0-1) in three patients and partially reperfused (TIMI grade 2) in the remaining patients at baseline coronary angiography. Intracoronary administration of urokinase (100-200,000 Units) was ineffective in those patients failing systemic thrombolysis and resulted in only a slight increase of residual lumen in three patients. The coronary artery could be opened by a guidewire mechanical technique in patients with persistent coronary artery occlusion and coronary dilation could be done in all patients. The mean percentage diameter stenosis of the infarct-related vessel was reduced from 98.8 +/- 2% to 27 +/- 11% (P less than 0.005). After the procedure, left ventricular ejection fraction increased from 27 +/- 8% to 41 +/- 7% (P less than 0.02), systemic blood pressure and cardiac index increased respectively from 86 +/- 10 to 126 +/- 14 mmHg (P less than 0.005) and from 2.2 +/- 0.6 to 3.3 +/- 0.6 (P less than 0.01). Left ventricular end-diastolic pressure decreased from 26 +/- 8 to 18 +/- 3 mmHg (P less than 0.05). Severe mitral regurgitation was relieved in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Acute myocardial infarct in a 14-year-old girl treated with contraceptives. Coronary arteriography and immediate thrombolytic therapy].

A 14 year old girl on oral contraceptive treatment for menstrual disorders, was admitted with an acute anterior myocardial infarction and underwent immediate coronary arteriography and intracoronary thrombolysis (urokinase 350,000 units) within 4 hours of the onset of symptoms. A segmental occlusion of the left anterior descending artery with no evidence of coronary atherosclerosis elsewhere was shown. A successful re-canalization was documented after fibrinolytic therapy. The present is the first reported case, in a patient of this age, with an angiographic demonstration during the acute phase of the thromboembolic pathogenesis of myocardial infarction in contraceptive users. The potential benefit of early thrombolytic treatment in this rare clinical setting is thus suggested.

Adolescent↗
PubMed1989

[Proposal of a standardized graphic system for collecting coronary angiographic data. Processing with a personal computer].

A standardized method for the representation and filing of coronary angiographies is proposed. Semi-automatic reference is guided by a computer algorithm. The final report displays a diagram which shows all the information in graphic and alpha-numeric form. Personalized coronary anatomy is drawn using the Coronary Artery Surgery Study (CASS) guidelines. The algorithm semi-automatically designs coronary segments according to CASS criteria. Five levels of percentage reduction in luminal transverse diameter (25, 50, 75, 90, 100%) can be represented. In addition, plaque morphology (concentric or eccentric, greater or less than 0.5 cm in size) and plaque complications, (calcification, ulceration, thrombosis, aneurysmal dilatation, wall irregularity, and diffuse disease) can be added as additional information. Twenty pathological entities (stenosis or plaque complications) can be filed for each patient. Collateral circulation can be represented by identifying the site of origin, one or more mid-points on the pathway, and the point of contact with the recipient vessel. As many as 10 single pathways can be identified. The same method can represent and file by-pass grafting using different symbols. Data can be easily put into the computer in three to four minutes. Coding and filing are automatically stored. Ten Mb can contain 4355 reports, including patient data and five lines of optional comment. Data can be retrieved in the original graphic form or the system can analyze filed data and retrieve series of patients with a given angiographic pattern. This option enables comprehensive research to be performed on any patient population, selecting subgroups of patients with specific anatomic and/or pathologic characteristics.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗
PubMed1988

Unusual origin and course of the first septal branch of the left coronary artery: angiographic recognition.

The anatomical variants of the origin and course of the first septal branch (S1) of the left coronary artery system have received little attention in the literature dealing with coronary angiography. We describe here the angiographic features of the ectopic origin of S1 from epicardial branches of the left coronary artery other than the left anterior descending artery as observed in 8 cases from a series of 700 consecutive patients (1.1%). The S1 originated from the left main coronary artery in 1 case, from a diagonal branch in 4, and from an intermediate branch in 3 cases. Previous reported cases are reviewed. Because the S1 may supply up to 15% of the blood to the myocardium, the recognition of this variable origin may have clinical implications and has to be considered as a part of the complete evaluation of coronary arteriograms of patients referred for coronary artery revascularization.

Adult↗
PubMed1985

Transluminal extraction of a catheter fragment from the aortic arch.

Many different techniques have been previously reported for non-surgical transluminal removal of foreign bodies from venous system or right heart chambers, while only few cases of transluminal extraction from arterial vascular bed or left heart chambers have been published. We report a successful attempt of a Judkins' catheter fragment extraction from the aortic arch by a homemade loop-snare device. Tying the distal end of a long flexible guide-wire on the tip of a 8F Cournand catheter we obtained an easy to handle device which is practicable using instruments always available in any catheterization room.

Adult↗
PubMed1985

[Phase and amplitude images using Fourier analysis in radioisotopic angiography. Comparison with contrast angiography for studying regional changes in ventricular contraction].

Phase-amplitude images and phase distribution histograms, derived from a temporal Fourier analysis of equilibrium ecg-gated blood pool studies, were used to assess the overall wall motion synchronism and to detect regional wall motion abnormalities in 69 consecutive patients with suspected or documented coronary artery disease, in whom biplane contrast left ventriculography and coronary angiography were performed. Four regions were considered on the 15 degrees caudal left-anterior oblique view radionuclide image, in order to identify the 7 conventional angiographic left ventricular wall segments (as the American Heart Association Council of Cardiovascular Surgery). Regional abnormalities on the phase-amplitude images from the 15 degrees caudal left anterior oblique view scans were studied in order to identify local hypokinesis, akinesis or dyskinesis (in accord to definitions used for contrast cineangiography) relative to seven conventional left ventricular wall segments. Results of phase-amplitude image analysis were compared with those of contrast cineangiography. The parametric images showed overall sensitivity of 82% and 92% respectively towards biplane and monoplane (left anterior oblique) contrast cineangiography, with a high degree of specificity (97%). Most akinetic and dyskinetic segments were correctly identified. A significant phase delay (greater than or equal to 70 degrees) from mean value, always occurred in dyskinetic segments and generally related to the severity of the wall motion abnormality. Lower accuracy was observed for hypokinetic regions; sensitivity was lower for apical and antero-lateral segments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Angioplasty of the common trunk of the left coronary artery with venous patch].

Surgical angioplasty of the left main coronary artery for severe iatrogenic stenosis has been done on a 40 year old female patient operated upon five months before for mitral and aortic valve prosthetic replacement. Postoperative angiocardiographic study showed patent left main trunk and the patient is angina-free six months post-operatively. Operative indication and surgical technique are discussed as an alternative to aorto-coronary by-pass surgery for left main proximal stenosis without peripheral lesions. It does not result from literature that this surgical technique has ever been employed in patients previously operated with open heart surgery.

Adult↗
PubMed1983

Transcoronary platelet thromboxane A2 formation without platelet trapping in patients with coronary stenosis-effect of sulphinpyrazone treatment.

Platelet count, and plasma thromboxane B2 (TXB2) and circulating platelet aggregates (CPA) were determined in the coronary sinus (CS), aortic bulb (AO) and cubital vein (V) in 21 patients with stable angina and in 6 control subjects before and after atrial pacing (AP). TXB2 measurements were repeated before and after AP in 6 of the 21 angina patients after 15 days' sulphinpyrazone treatment. Platelet count and CPA ratio were similar in angina patients and controls at all three sampling sites and were unchanged at AP peak. In the controls, basal TXB2 values in CS, AO and V were not significantly different and were unchanged at AP peak. In the angina patients compared with the controls, basal TXB2 values in the AO, CS and V were not significantly different whereas the CS/AO TBX2 ratio was significantly higher; at AP-induced ischaemia, CS TXB2 was significantly increased and the CS/AO TXB2 ratio was increased. A weak but significant direct correlation was found between CS/AO TXB2 ratio and coronary score. Sulphinpyrazone treatment reduced CS TXB2 levels at rest and after AP, but not the ischaemic threshold at AP.

Adult↗