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Biomedical subjects

G A Barletta

Publications and source records attributed to G A Barletta.

At least 19 recordsLinked to original sources
PubMed1993

Quantitative evaluation of left ventricular shape in anterior aneurysm.

The purpose of the study was to analyze left ventricular (LV) shape in post-infarction anterior aneurysm by utilizing quantitative analysis of wall curvature. Forty-one patients (39 men, 2 women; mean age 56 years) subjected to surgical intervention for LV aneurysm complicating an anterior myocardial infarct were retrospectively evaluated. In all patients the presence of resectable aneurysmal tissue had been confirmed by direct surgical examination. Patients with inferior myocardial infarction and patients who had undergone percutaneous transluminal coronary angioplasty (PTCA) or bypass surgery were excluded. Pre-intervention ventriculograms (RAO projection) were analyzed. LV wall excluded. Pre-intervention ventriculograms (RAO projection) were analyzed. LV wall motion was studied by applying the centerline method. Regional curvature of end-diastolic and end-systolic outlines was calculated at 90 equidistant points from aortic corner (point 1) to mitral plane (point 90). Patients with LV anterior aneurysm show a typical pattern of alterations in wall curvature, which is characterized by a shifting of the angiographic apex (the point with the greatest curvature) towards the mitral plane, and by a sharp shift of curvature values at the antero-basal and infero-apical regions, marking the borders of the sac. These hinge points closely correspond to the external limits of wall motion abnormalities. Significant correlations were found between degree of regional curvature alterations and severity of global LV dysfunction, as indicated by decrease of ejection fraction and increase of end-systolic volume. In conclusion, quantitative evaluation of LV shape by means of wall curvature analysis allows recognition of the characteristic morphologic changes of the aneurysm, i.e., wall expansion and deformation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Catheterization↗
PubMed1990

Effects of diltiazem on postextrasystolic potentiation in coronary heart disease patients.

The effects of the calcium antagonist, diltiazem (D), on left ventricular (LV) response to postextrasystolic potentiation (PESP) were investigated in 15 coronary artery disease patients. Several haemodynamic and LV function parameters, as well as regional wall kinetics, were analysed. During LV angiography, which was performed before and after D administration (0.25 mg kg-1 bolus and 1.4 microgram kg-1 min-1 infusion), programmed atrial stimulation was applied with the sequence: S1-S1 = 600 ms; S1-S2 = 400 ms; S2-S3 = 800 ms. The results indicate that D exerts a mild negative inotropic effect which is more evident in the postextrasystolic beat (postextrasystolic ESP/ESV and dP/dtmax were significantly lower after D) but the postextrasystolic increase of EF is maintained by the effects of the drug on loading conditions of the left ventricle. Our results indicate that both a reduction of afterload and an increase of preload take place after D. The greater preload reserve induced by the drug (EDVI was significantly higher in each patient after D) was associated with a slight increase in left ventricular filling rate, while end-diastolic compliance and pressure did not show significant variations. These results suggest that the increase in left ventricular preload is due to an increase in left atrial driving pressure, an improvement of left ventricular relaxation or both. D does not affect regional wall kinetics either in basal or in the postextrasystolic beat when overall areas are considered, however its effect seems to be related to the degree of basal regional contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Associated coronary and cardiac anomalies in the tetralogy of Fallot. An angiographic study.

Numerous studies have pointed out the frequent association of tetralogy of Fallot (TF) with other cardiovascular defects and coronary tree anomalies. We found cardiac defects in 181 (68%) out of 265 patients with TF investigated by catheterization and selective coronary angiography. These anomalies were isolated in 88 cases (49%) and associated with others in 93 patients. In the case of an isolated anomaly associated with TF, the coronary tree was involved in 37.5% and the cardiovascular system in the remaining 62.5%; in the case of two anomalies, the coronary system was involved in 66% of the patients and the cardiovascular apparatus in 34%; in the case of three or more anomalies, the coronary arteries were involved in 71% and the cardiovascular system in 29%. Anomalies in the course and/or distribution of coronary arteries were present in 96 patients (36%): 10 had a single coronary ostium, 13 a left anterior descending artery arising from the right coronary artery, one a circumflex artery arising from the right coronary artery. Small fistulas between coronary arteries and the pulmonary artery were found in 20 cases; anastomoses between coronary and bronchial arteries or right atrium in 42. In 39 patients we observed a large conus artery or large anterior ventricular branches crossing the right ventricle. A right aortic arch was found in 56 patients (21%), a stenosis of the trunk and/or the peripheral pulmonary artery in 35 (13%) and pulmonary artery atresia in five. Four patients showed a complete atrioventricular canal, three an atrial septal defect (primum type) with cleft of the mitral valve, 61 (23%) an atrial septal defect (ostium secundum). Eleven patients had anomalies of the systemic venous return, 26 (10%) a patent ductus arteriosus. Four patients had valvular abnormalities. In our series, a large proportion of cardiac defects associated with TF consists of anomalies of coronary arteries. Our data confirm the usefulness of performing preoperatively routine coronary angiography in patients with complex congenital heart disease.

Abnormalities, Multiple↗
PubMed1989

[Transesophageal color-coded Doppler echocardiography: diagnosis of regurgitation of mitral valve prosthesis].

In patients with mechanical mitral prosthesis, the presence of dysfunction and regurgitation of the prosthesis may be difficult to assess by standard precordial color flow Doppler. Moreover, the kind of mitral prosthesis regurgitant jet is often impossible to determine. We have recently studied 4 patients with clinically suspected mitral prosthesis dysfunction. In all of them the conventional transthoracic color flow technique was unable to evidentiate prosthesis regurgitation, whereas the transesophageal color flow Doppler assessed a partial displacement with a peri-prosthetic regurgitation in 3 patients, and a prosthetic endocarditis with intra-prosthetic regurgitation in 1. All studies were performed using an Aloka SSD 860 and 5 MHz transesophageal color Doppler transducer, using a topical anesthesia with 10% lidocaine. The procedure was well tolerated without any complication in all patients. Transesophageal color flow Doppler has specific improved capabilities over transthoracic conventional color flow Doppler and represents an important advance even for the noninvasive evaluation of patients with suspected mitral prosthesis regurgitation.

Adult↗
PubMed1988

Right bundle-branch block in coronary artery disease: a hemodynamic and angiographic study.

Thirty-four patients with right bundle-branch block (RBBB) and coronary artery disease (CAD) (RBBB was not pre-existent to clinical development of CAD) and 52 consecutive CAD patients without conduction disturbances were studied and compared to verify whether the presence of RBBB implies more severe and extensive left ventricular myocardial damage as well as more severe CAD. The two groups did not differ either in age or in New York Heart Association functional class. The incidence or location of previous myocardial infarction (MI) was not different in the two groups. No significant differences were found in left ventricular volumes or ejection fraction. Higher end-diastolic left ventricular pressure and more severe and diffuse left ventricular wall asynergy were present in RBBB patients. At coronary arteriography, more severe involvement of the right coronary artery in CAD patients without conduction disturbances was the only significant finding. The group of patients with CAD and RBBB without MI showed significantly less involvement of the left anterior descending coronary artery and significantly more severe damage of the inferior wall of the left ventricle than the group with CAD without RBBB and MI. Patients with inferior wall MI and RBBB had more severe asynergy of the posterobasal region of the left ventricle than did patients with inferior wall MI without RBBB. The group of patients with anterior wall MI and RBBB had a higher left ventricular end-diastolic pressure, a lower left ventricular ejection fraction, and a greater extent of myocardial damage compared to similar patients of the control group. The groups with MI and RBBB had the same Gensini's score as similar groups without RBBB. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Coronary artery anatomy in corrected transposition of the great arteries.

Congenitally corrected transposition of the great arteries is an unusual cardiac malformation with discordant atrioventricular and ventriculoarterial alignments. Because knowledge of the coronary artery anatomy is a prerequisite for successful repair of this cardiac anomaly, selective coronary arteriography was performed in 13 children (4 male and 9 female; age range 18 months to 16 years) and 1 adult (aged 59 years) with congenitally corrected transposition of the great arteries and associated intracardiac defects. The typical coronary distribution of corrected transposition (that is, coronary artery-ventricular concordance) was found in 11 patients. In one patient, a single coronary ostium was observed; the right sinus of Valsalva gave rise to a short common branch that divided into three arteries: a left circumflex artery going to the right, a well developed left anterior descending artery running into the anterior interventricular groove and a third vessel that continued on the normal course of the right coronary artery directed posteriorly. In one patient, the left circumflex artery was particularly small. In another patient, with severe hypoplasia of the left anterior descending coronary artery, the anterior ventricular wall of the heart was supplied by three small branches that ended a short distance from their origins. The adult patient had a large anterior ventricular branch arising from the morphologic left coronary ventricular as well as a large acute marginal branch, with a wide distribution, from the morphologic right coronary artery. Presurgical coronary angiographic documentation is helpful because, in congenitally corrected transposition as well as in complex congenital heart disease, coronary anomalies (in origin, course and distribution) are occasionally present and knowledge of their presence can help determine the most appropriate surgical approach.

Child↗
PubMed1988

'Programmed' left ventricular angiography: a new method for assessing left ventricular compliance.

In the present study a new method for evaluating left ventricular chamber compliance is reported. We induced a programmed postextrasystolic beat during routine left ventricular angiography through a temporary pacing catheter, placed at the sinoatrial junction (S1-S1 = 600 ms; S1-S2 = 400 ms; S2-S3 = 800 ms). Thirty-two patients with documented critical coronary artery disease and 5 normal subjects represent the study group. The method allows to have two couples of end-diastolic pressure and end-diastolic volume and we calculated the modulus of chamber stiffness with the formula: K = (1n EDP 3 - 1n EDP 1)/(EDVI 3 - EDVI 1), where EDP 1-3 and EDVI 1-3 are end-diastolic pressure and end-diastolic volume index in basal beat and in the postextrasystolic pause, respectively. Left ventricular chamber compliance (dV/dP) and specific compliance (dV/VdP) were also calculated. In order to assess the clinical value of the method, we divided the patients with coronary artery disease into three groups: 12 patients had angina and no previous myocardial infarction; 15 had a previous myocardial infarction and responded to postextrasystolic potentiation with an increase in left ventricular ejection fraction greater than or equal to 0.08 and 5 patients had myocardial infarction and did not respond to postextrasystolic potentiation. Diastolic indices showed significant differences between subgroups; patients with more severe disease and with systolic dysfunction had the highest values of the modulus of chamber stiffness and the lowest values of chamber compliance. Moreover, these indices were not correlated with basal end-diastolic volumes, but they were directly and significantly correlated with the actual increase in left ventricular filling.

Cardiac Output↗
PubMed1987

Diverging effects of postextrasystolic potentiation on left ventricular segmental wall motion in coronary heart disease.

The effects of postextrasystolic potentiation (PESP) on regional left ventricular (LV) wall motion were evaluated in 40 coronary artery disease (CAD) patients. Of the 40 CAD patients, 20 had a prior myocardial infarction and 20 had a history of angina pectoris. PESP was obtained by applying programmed atrial stimulation during LV angiography, in a way that basal cycle length, premature beat, and postextrasystolic pause were almost identical in all patients. Segmental wall motion was evaluated by calculating regional ejection fraction (EF) of 5 different areas with a computerized method before and after the premature beat. The results were compared to those obtained in a group of 8 normal subjects. LV areas were classified as normokinetic, mildly hypokinetic, severely hypokinetic, and hyperkinetic, on the basis of their regional EF in respect to normals, and classified as "responder" (R) and "nonresponder" on the basis of the magnitude of the increase of regional EF with PESP. Of a total of 200 areas 129 were normokinetic (68% R), 45 were mildly hypokinetic (78% R), 17 severely hypokinetic (76% R), and 9 were hyperkinetic (78% R). Infarcted patients had a higher percentage of hypokinetic areas in basal conditions (p less than 0.001), however, the percentage of hypokinetic areas that responded to PESP was not significantly different from noninfarcted patients. In CAD patients, as a whole, a significant direct correlation was found between basal regional EF and regional EF after PESP (r = 0.88, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1987

[Multiparameter evaluation of tricuspid insufficiency using two-dimensional echocardiography, Doppler and contrast echocardiography].

The evaluation of the presence and severity of tricuspid insufficiency is still difficult even if many criteria of grading are available for different techniques. In this study the data obtained from Doppler mapping of the right atrium, from the analysis of the hepatic vein flow and from the contrast echocardiography of the inferior vena cava in 56 patients with mitral or mitral-aortic valvulopathy and with clinically suspected tricuspid insufficiency were submitted to the cluster analysis. This analysis was used to redistribute the study population according to the following parameters: diameter of the inferior vena cava, maximal systolic and diastolic flow of the hepatic veins, the length of regurgitant jet in right atrium and the duration of contrast in vena cava. The aim was to identify the variability range of each degree of severity. None of the analyzed parameters "per se" identifies the regurgitation severity because there is a large variability in the intermediate degrees. The cluster analysis shows a definite pattern of parameters for each cluster (1 = no significant regurgitation, 2 = mild, 3 = moderate, 4 = severe insufficiency).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Apical left ventricular asynergy in chronic aortic regurgitation.

Apical left ventricular (LV) wall motion abnormalities have been described in chronic volume overload. To evaluate if these abnormalities are due to an actual hypokinesia we analyzed the percent shortening of apical LV radiants (PS%) by an angiographic computerized method and the endocardial systolic movement (ESM) and thickening (%Th) of the same region using M-mode echocardiographic technique in 11 patients affected by pure aortic regurgitation (AR). In these patients mean apical radii shortening was reduced with respect to normal values. Both %Th and ESM were significantly reduced in AR when compared to normal subjects (24.5 +/- 31.7% vs. 63.8 +/- 35.8%, p less than 0.01 and 4 +/- 7 vs. 10 +/- 3 mm, p less than 0.01, respectively). In addition, %Th and ESM directly correlated with PS% (r = 0.79, p less than 0.01 and r = 0.77, p less than 0.01, respectively). PS% correlated positively with systolic eccentricity and inversely with end-systolic volume index (r = 0.64, p less than 0.05 and r = 0.57, p less than 0.05, respectively). Finally, in AR %Th was related to a normalized peak rate of systolic wall thickening (r = 0.85, p less than 0.01) and to a normalized peak rate of diastolic wall thinning (r = 0.68, p less than 0.05). These results showed that in AR a reduced apical radii percent shortening was associated with a reduced normalized peak rate of systolic wall thickening and of diastolic wall thinning, thus indicating an actual hypokinesis and an impaired contractility. Moreover, the observed abnormalities correlated with an altered LV dynamic geometry linked to chronic volume overload.

Adult↗
PubMed1984

Hemodynamics in borderline hypertension: acute effect of furosemide.

In order to identify the hemodynamics of borderline essential hypertension, radionuclide angiography was performed before and after bolus injection of furosemide (40 mg i.v.) both at 3 min (i.e. before diuretic effect) and at 30 min (i.e. after diuretic effect) in 16 borderline (B) patients and in 14 age-matched WHO classification I-II essential hypertensives (H) patients. 14 age-matched normotensive (N) subjects were used as controls. B patients were further subdivided into two subgroups according to a cardiac index under or above 3 liter/min/m2 in basal conditions. Baseline hemodynamic characteristics showed higher values of mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) in both H and B patients when compared with N subjects (p less than 0.001). Furthermore, B and H patients exhibited lower values of left ventricular peak filling rate (PFR) than seen in N subjects (p less than 0.01 and p less than 0.05, respectively). H patients demonstrated higher peak systolic blood pressure/endsystolic volume ratio (PSP/ESV) than seen in N subjects (p less than 0.05). PFR positively correlated with peak emptying rate (PER) only in N and B patients (p less than 0.05). After furosemide administration, even though differences were observed in the absolute values, B and H patients showed similar hemodynamic patterns. Only the B subgroup with cardiac index (CI) greater than 3 liter ('volume-dependent' patients) showed a decrease in left ventricular end-diastolic volume index (LVEDVI) at 30 min associated with a lowering of stroke index (SI; p less than 0.005 for both), when compared with pre-drug values. In B patients with CI less than 3 liter ('afterload-dependent' patients) no differences were observed either at 3 min or at 30 min in comparison with values obtained prior to drug administration. Moreover, in this subgroup, like in H patients, there was a negative correlation (p less than 0.01) between 3-min percent change of SVRI and 3-min percent change of SI. Our data suggest that in 'borderline' hypertension: (a) there may be an increase in peripheral resistance, as in established hypertension, especially when age-matched groups are considered; (b) the earliest sign of compromised left ventricular function is the reduction in diastolic PFR but, unlike established hypertension, this index is still correlated with systolic function; (c) cardiac output might be even somewhat reduced and also negatively correlated with vascular resistance ('afterload-dependent' hearts); (d) furosemide (acute administration) might contribute to a better definition of hemodynamic behavior.

Adult↗
PubMed1983

Short-term responses to cardiac rehabilitation after acute myocardial infarction. Cardiac function evaluation before and after physical training at rest and during stress test.

Whether physical training, soon after myocardial infarction (MI), has effects upon intrinsic cardiac function at rest and during exertion remains unresolved. We have evaluated ventricular function using radionuclide angiography at rest and during stress testing before and after 3 months' physical training. This has been correlated with the site of MI and with changes in the ST segment during the maximal exercise test performed before the postmyocardial infarction rehabilitation program. We have studied 27 patients, mean age 54 +/- 10 years, in NYHA class I or II. Twelve showed no changes in the ST segment during erogmetric stress test (group 1); seven showed ST segment depression greater than 1 mm in leads different from those of MI (group 2); eight showed ST segment elevation of 2 mm (group 3). Twelve patients had had anterior MI only (AMI group); twelve inferior MI only (IMI group). After rehabilitation, all patients showed an increased work capacity and a decreased double product at the same work load. In the total group, significant increases were found in the left ventricular ejection fraction (LVEF) and in the contractile regional performance (LVwm) at rest, as well as a lesser decrease in the LVEF during handgrip test. Group 1 showed a significant increase in LVEF, associated with a decrease in left ventricular end-diastolic volume (EDV) at rest. Group 2 showed unchanged variables after rehabilitation. Group 3 showed a better LVEF during handgrip with an increase of EDV at rest. The AMI group showed a better LVEF and LVwm at rest and a better LVEF during handgrip. IMI group showed a better right ventricular ejection fraction during handgrip without improvement in LVEF. No patient with IMI had septal asynergy. We conclude that the effects of rehabilitation were linked to the site of MI and to the functional dynamic status of both ventricles.

Electrocardiography↗
PubMed1982

Haemodynamic effects of carbochromen.

Carbochromen increases coronary flow and cardiac output. A previous study has advanced the hypothesis that the latter may be due to afterload reduction. Fourteen patients with coronary heart disease have now been studied by means of radionuclide angiocardiography. Gated blood pool angiocardiographic data were collected in basal conditions and, without moving the patient, 80 mg of carbochromen were administered i.v. Data were collected again, following infusion, during 3'-6'(1) and 7'-10'(2) periods. Changes in the following parameters have been evaluated: LV ejection fraction (EF), LV ejection rate (ER), system pressure (BP), heart rate (HR), cardiac output index (CO), stroke volume index (SV), LV end-diastolic volume index (EDV), systemic vascular resistance index (SVR), regional LV wall motion. During period 1 a significant decrease was observed in BP and SVR, the other parameters remaining unchanged. During period 2 there was a significant increase in CO, SV, EF, ER and a significant decrease in SVR. BP was unchanged. No changes were ascertained in HR and EDV. Eight patients, in basal conditions, showed asynergy in the LAO projection. Three of these patients showed improved wall motion during period 2. A possible central action of carbochromen should be pointed out. This conclusion can be drawn by observing the increase in the pump indexes, while BP and SVR show a decrease and EDV and HR no change. The left ventricular wall motion improvement observed in some of the cases confirms the possibility that carbochromen is capable of improving cardiac contractility. This effect may follow the regional myocardial perfusion increase.

Adult↗