PubMed Health⌕ Search

Biomedical subjects

G A Jessurun

Publications and source records attributed to G A Jessurun.

At least 19 recordsLinked to original sources
PubMed2000

Functional integrity and aging of the left internal thoracic artery after coronary artery bypass surgery.

OBJECTIVE: To study the endothelial function in the left internal thoracic artery after coronary artery bypass surgery and to identify predictors of early dysfunction, we performed a provocative test with acetylcholine in 23 male patients who underwent routine postoperative coronary angiography. METHODS: The change in mean diameter of the proximal thoracic artery was assessed by quantitative angiography after selective injections of acetylcholine and nitroglycerin. RESULTS: The thoracic artery showed a 6.8% (P <. 001) and 9.0% (P <.001) increase in mean diameter after acetylcholine and nitroglycerin administration, respectively. Vasodilative responses to acetylcholine and nitroglycerin administration were strongly correlated (R: 0.88; P <.001). Among the common risk factors, only age was associated with an impairment in the vasodilative response of the arterial graft (P =.001), and acetylcholine-induced vasodilation was inversely correlated to the age of the patient (R: 0.69; P <.001). CONCLUSIONS: Endothelium-dependent vasodilative response to acetylcholine administration seems well preserved in the left internal thoracic artery after surgery. Common risk factors, except for age, do not affect the functional integrity of the arterial graft. The vasodilative properties of the graft depend on the age of the patient and do not deteriorate over time after operation.

Acetylcholine↗
PubMed1999

Clinical follow-up after cessation of chronic electrical neuromodulation in patients with severe coronary artery disease: a prospective randomized controlled study on putative involvement of sympathetic activity.

The present study assessed the reoccurrence of myocardial ischemia after withholding electrical neurostimulation. After randomization, in the study or withdrawal group, spinal cord stimulation (SCS) was set active during the first 4 weeks, followed by 4 weeks of withholding stimulation. In the control group, SCS was switched off during 4 weeks before the end of the study. The control group had no crossover period. Measurements were done at baseline, then after 4 and 8 weeks. The first periods at 4 weeks of each sequence of both groups were compared. In addition, a comparison of clinical variables was performed between the study group 4 weeks after withholding stimulation and the control group 4 weeks following randomization. A total number of 24 patients with refractory angina and an implanted spinal cord stimulator were included in the study (n = 12) and control group. Angina pectoris complaints, nitroglycerin intake, ischemia, and heart rate variability using 48-hour ambulatory electrocardiographic monitoring were assessed. In addition, neurohormonal status and symptom-limited aerobic capacity were evaluated. There was no increase of anginal complaints or ischemia after withholding stimulation. Neurohormonal levels and aerobic capacity were not altered. We conclude that there is no adverse clinical rebound phenomenon after withholding neurostimulation in patients with refractory angina pectoris.

Aged↗
PubMed1999

Clinical outcome of patients treated with spinal cord stimulation for therapeutically refractory angina pectoris. The Working Group on Neurocardiology.

OBJECTIVE: To determine morbidity and mortality characteristics in patients treated with electrical neuromodulation for refractory angina pectoris. DESIGN: A retrospective multicentre study of patients treated with spinal cord stimulation between 1987 and 1997; 21 centres were contacted and 14 responded. SETTING: Specialist centres worldwide. PATIENTS: Questionnaires were returned on 517 patients, of whom 71% were male. One was lost to follow up. Mean (SD) age was 63.9 (10.1) years. Duration of angina pectoris was 8.1 (6.3) years. RESULTS: Before spinal cord stimulation, 66% of the patients had experienced myocardial infarction, 68% had three vessel disease, and in 24% the left ventricular ejection fraction (LVEF) was </= 40%. Percutaneous transluminal coronary angioplasty and bypass surgery were performed in 17% and 58% of the subjects, respectively. During a median follow up of 23 months (range 0 to 128), 103 patients died (52 from a cardiac cause, 25 from a non-cardiac cause, and 26 from an unknown cause). Annual all cause mortality was 7-8%; annual cardiovascular fatality was 3.5-5%. Mortality was univariately related to sex, number of diseased vessels, number of revascularisation procedures, previous myocardial infarction, LVEF, insulin dependent diabetes, beta blocking agents, and angiotensin converting enzyme inhibitors. Multiple variate analysis showed that LVEF, sex, beta blockers, and age >/= 71 years were independent predictors of mortality. During spinal cord stimulation, New York Heart Association functional class improved from 3.5 to 2.1 (p < 0.01); 25 of the deceased patients (24%) and 32 survivors (8%) experienced myocardial infarction; hospital admissions were significantly (p < 0.001) more common in the deceased group (66% v 37%). CONCLUSIONS: The clinical outcome of patients with intractable angina is not adversely affected by the chronic use of neurostimulation.

Aged↗
PubMed1999

Electrical neuromodulation for disabling angina pectoris related to isolated stenoses of small epicardial coronary arteries.

Patients with symptomatic small vessel coronary artery disease may be inadequate candidates for revascularization procedures. They may suffer from refractory angina, which does not respond to maximal anti-anginal drug therapy. In addition to patients with end stage coronary artery disease and syndrome X, this newly defined group of subjects with an isolated stenosis of a small coronary artery may benefit from electrical neurostimulation. We describe two patients with intractable angina caused by a significant narrowing of a diagonal branch. This treatment modality should be considered as an alternative method for unsatisfactory revascularization procedures.

Aged↗
PubMed1998

Coronary blood flow dynamics during transcutaneous electrical nerve stimulation for stable angina pectoris associated with severe narrowing of one major coronary artery.

To study the effect of transcutaneous electrical nerve stimulation (TENS) on coronary vasomotion, patients with New York Heart Association class III angina pectoris and significant single-vessel left coronary artery disease and who were also scheduled for elective percutaneous transluminal coronary angioplasty, were allocated to a study group (precordial actual TENS, n = 10) and a control group (precordial simulated TENS, n = 5, and TENS on the back, n = 3). Coronary volumetric flow was assessed in the stenotic and nonstenotic coronary artery before and after neurostimulation. The diameter (in millimeters) of the stenotic coronary artery was reduced in the study group after actual TENS (from 2.73 +/- 0.55 by 0.12 +/- 0.11; p = 0.008). In the nonstenotic coronary artery, the diameter increased in the study group (from 2.64 +/- 0.43 by 0.24 +/- 0.15; p = 0.01). In both the stenotic and nonstenotic coronary arteries, no effect was shown on the average peak velocity (centimeters per second) in the study group. The coronary volumetric flow (milliliters per minute) was reduced in the stenotic artery of the study group (from 62 +/- 18 by 8 +/- 7; p = 0.007). In the nonstenotic coronary artery, volumetric flow increased in the study group (from 57 +/- 18 by 11 +/- 10; p = 0.007). In the control group, simulated TENS and TENS on the back had no effect on the diameter of the artery, average peak velocity, or volumetric flow. In addition, in all patients, TENS had no effect on the total volumetric flow of the left coronary artery and hemodynamic variables during the study period. This observation suggests that TENS modulates regional coronary vasomotion in patients with coronary artery disease.

Aged↗
PubMed1998

Amiodarone-induced pulmonary toxicity. Predisposing factors, clinical symptoms and treatment.

Amiodarone is frequently used for the treatment of cardiac arrhythmias. Although the therapeutic efficacy of amiodarone has been established, its use is limited by its safety profile. Amiodarone-induced pulmonary toxicity is one of the most life-threatening complications of this therapy. It is a relatively rare adverse effect of amiodarone and is easily missed by any physician who is suddenly confronted with nonspecific pulmonary complaints during amiodarone treatment. There are several cumulative factors which may enhance the susceptibility of patients for amiodarone-induced pulmonary toxicity, such as advanced age and pre-existing pulmonary dysfunction. Several case studies and clinical trials of amiodarone have shown the possible occurrence of amiodarone-induced pulmonary toxicity during low dose and short-duration therapy. Therefore, the dose and duration of amiodarone treatment are not the only determinants of toxicity risk. Amiodarone-induced pulmonary toxicity is characterised by various clinical manifestations such as coughing, dyspnoea, fever, bodyweight loss, respiration-related chest pain and bilateral lung infiltrates with no excavated nodules. Once amiodarone-induced pulmonary toxicity has been diagnosed, therapeutic options are limited, but in most cases the disease is reversible, if diagnosed at an early stage.

Amiodarone↗
PubMed1997

Refractory angina pectoris in end-stage coronary artery disease: evolving therapeutic concepts.

Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortocoronary bypass grafting must be excluded on the basis of a recent coronary angiogram. This coronary syndrome, which represents end-stage coronary artery disease, is characterized by severe coronary insufficiency but only moderately impaired left ventricular function. Almost all patients demonstrated severe coronary triple-vessel disease with diffuse coronary atherosclerosis, had had one or more myocardial infarctions, and had undergone aortocoronary bypass grafting (70% of cases). We present three new approaches with antiischemic properties: long-term intermittent urokinase therapy, transcutaneous and spinal cord electrical nerve stimulation, and transmyocardial laser revascularization.

Aged↗
PubMed1997

Sequelae of spinal cord stimulation for refractory angina pectoris. Reliability and safety profile of long-term clinical application.

BACKGROUND: Spinal cord stimulation (SCS) is effective in the treatment of severe coronary artery disease (CAD) unresponsive to anti-anginal medication or revascularization procedures. However, there is still concern about its safety. OBJECTIVE: To investigate the reliability, morbidity, and mortality aspects of SCS in patients with refractory angina pectoris by studying the predictors of outcome, defined by efficacy, adverse events and mortality, in patients with CAD and SCS. METHODS: Fifty-seven patients (18 women) treated with SCS, aged 59.8 +/- 7.6 years (mean +/- SD) were studied retrospectively. They had suffered from manifest CAD for 9.4 +/- 4.9 years; 46 of them had experienced a myocardial infarction prior to the implantation; 28 had had a previous percutaneous transluminal coronary angioplasty; and 52 had undergone coronary artery bypass surgery. The mean left ventricular ejection fraction was 51.8 +/- 13.8%. All of the patients were being treated with two or three anti-anginal drugs. RESULTS: During 2042 patient-months follow-up, nine of the 57 patients died (annual mortality rate 6.5%). The percentage of adverse events requiring reprogramming or surgical reintervention was reduced from 83% for 18 patients with the Medtronic ITREL lead to 33% for 39 patients with the ITREL II system. The clinical outcome was correlated positively with a left ventricular ejection fraction > 40% (P = 0.0005), and negatively with a high cholesterol level (P = 0.0042), more prior revascularizations (P = 0.028), and a higher New York Heart Association classification (P = 0.04). CONCLUSIONS: Improvement of the SCS system reduced the equipment-related complication rate. The predictors of outcome are related to the traditional risk factors for CAD. The mortality rate of patients with refractory angina treated with SCS is similar to that of patients with CAD and stable angina pectoris.

Angina Pectoris↗
PubMed1996

An unusual case of cardiac tamponade following electrical cardioversion.

The clinical presentation of cardiac tamponade may uncover underlying pericardial disease. We describe a patient who was being treated for lone atrial fibrillation. In this case, direct current cardioversion for recurrence of atrial fibrillation was complicated by a life-threatening hemopericardium. A history of asbestos exposure was subsequently related to the subclinical pericarditis.

Asbestos↗
PubMed1996

Current views on neurostimulation in the treatment of cardiac ischemic syndromes.

Most clinicians are still unacquainted with the beneficial effects of neurostimulation as an additional therapeutic strategy for severe angina pectoris. Patients with therapeutically refractory angina pectoris suffer from chest discomfort during minimal exercise, despite maximal tolerated antianginal drug therapy (at least 2 out of a beta-blocker, calcium-antagonist or long-acting nitrate). In these patients, revascularization procedures, such as a percutaneous transluminal coronary angioplasty or coronary artery bypass surgery, are often technically impossible because of diffuse coronary artery disease or should be withheld as a consequence of absolute contraindications such as severe left ventricular dysfunction. All patients have inoperable multivessel disease, experienced one or more myocardial infarctions, and were treated by earlier invasive interventions. This group of patients are severely physically and psychologically disabled by their intractable angina pectoris. Available published data and the neurostimulation experience of the authors are reviewed in relation to the treatment of cardiac ischemic syndromes. We conclude that neurostimulation is an effective therapeutic adjuvant for patients with severe angina pectoris unresponsive to standard treatment. This treatment modality appears to be safe, and a promising tool for other ischemic cardiac syndromes.

Angina Pectoris↗