Haemodynamic effects of intravenous urapidil in patients with advanced left ventricular failure.
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Antihypertensive Agents↗
Biomedical subjects
G Drobinski
Publications and source records attributed to G Drobinski.
[Initial and mid-term results of coronary angioplasty in early post-infarction unstable angina].
The aim of this study was to assess the immediate efficacy and the medium-term risks and results of percutaneous transluminal coronary angioplasty (PTCA) in early post-infarction unstable angina. Thirty-six patients were included for a series of 248 consecutive PTCA procedures performed between December 1985 and January 1989. The average age was 56 years (range 35 to 84 years). The initial infarct was anterior (N = 16), inferior (N = 15), lateral (N = 5), without a Q wave (N = 22), transmural (N = 14) and treated by thrombolysis in 42 p. 100 of cases. The interval between initial infarction and PTCA was 16 +/- 3 days. A primary success was obtained in 33 cases (92%). One patient died of electromechanical dissociation at the beginning of the procedure. Two infarcts occurred due to acute coronary occlusions. None of the patients required emergency coronary bypass surgery. The specific risk of PTCA in early post-infarction unstable angina is acute coronary occlusion. This complication was observed in 9 patients (25%) and it required immediate repeat PTCA, associated with thrombolytic therapy in four cases. Coronary occlusion was more common in patients with transmural infarcts than in those without Q-waves (43% vs 14%; p less than 0.01) and in patients treated initially by thrombolysis compared with those not treated by thrombolysis (40% vs 15%; p less than 0.05). No fatalities or reinfarctions occurred during follow-up (average 9 +/- 8 months, range 2 to 35 months). A good clinical result was maintained in 71 per cent of patients treated by PTCA alone. Seven repeat PTCA procedures and 3 coronary bypass operations were performed during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Results of percutaneous valvuloplasty for calcific aortic stenosis with different balloon catheters.
Percutaneous aortic valvuloplasty is a palliative treatment for patients with calcific aortic stenosis who would be poor candidates for surgical treatment. The results and associated complications of this procedure were analysed in a series of 47 patients in which different types of dilating catheters were used. In 25 patients a single balloon (19 mm) was used (group A), in 13 patients a bifoil balloon (2 x 15mm) (group B), and in the remaining nine patients (group C) a trefoil balloon (3 x 10mm) was used. An increase in aortic valve area was achieved in all patients. The results obtained with the bifoil balloon were better than with the other types of balloon catheter, with an increase in aortic area of + 118% vs. + 74% (monofoil) and + 76% (trefoil) (P less than 0.05). The tolerance of the inflation procedure was also better with this type of balloon, as it allowed for shorter inflation and deflation times. These results show that balloon aortic valvuloplasty, when indicated, is best performed with a bifoil balloon dilating catheter, and undue complications usually do not occur.
Aged↗
Clinical and ultrasound results after aortic valve replacement: intermediate-term follow-up with the St. Jude Medical prosthesis.
Mortality, morbidity, quality of life, and left ventricular (LV) function were evaluated in 49 patients after aortic valve replacement with the St. Jude prosthesis. Total follow-up was 2577 patient-months; survivors were followed-up for 4 to 7 years by clinical examination and echocardiography. The actuarial survival rate at 6 years was 79.6%, and there were no valve-related deaths. The linearized rates for thromboembolism and hemorrhage were 0.93% and 3.26% per patient-year, respectively. In 34% of the survivors the quality of life was poor. In the first three postoperative months, patients with aortic stenosis (n = 12) had a significant decrease in the muscle cross-sectional area (p less than 0.01) and patients with aortic regurgitation (n = 11) had decreases in both LV end-diastolic diameter (p less than 0.05) and cross-sectional area (p less than 0.001). All of these results were maintained at 5 years without modification of LV systolic function. Despite the good overall results, six patients deteriorated and had major LV dilatation. Multivariate logistic regression analysis identified two independent preoperative variables associated with a poor outcome defined as death of LV dysfunction (p less than 0.05): age and end-diastolic diameter. Thus meticulous follow-up showed a high incidence of hemorrhage and a poor quality of life in many of the survivors. It was concluded that in high-risk patients (age and end-diastolic diameter) surgery should probably be considered earlier.
Aortic Valve↗
Diagnosis of coronary aneurysms in siblings: treatment with a new surgical procedure.
We report the cases of two brothers who simultaneously developed myocardial infarction, and in whom we found coronary artery aneurysms at echocardiography. In one case a new surgical procedure was performed. The aneurysm was bypassed by an aorto-coronary vein graft and the coronary ostium of the related coronary artery was closed. Thus, perfusion of the dependent vessels of the aneurysm was maintained, and the risk of distal embolism was prevented. The aetiologies of coronary artery aneurysms are discussed. In our patients the aneurysms were probably congenital, but we cannot exclude the possibility of previously undiagnosed Kawasaki's disease.
Adult↗
Right heart failure due to an inter-atrial shunt after percutaneous mitral balloon dilatation.
Percutaneous mitral valve dilatation was performed in a 61-year-old female patient with severe mitral valve stenosis. The valve could be dilated, but a moderate left to right atrial shunt was present after the procedure. Although the mitral valve area had increased from 1 cm2 to 1.7 cm2, the patient presented 1 week later with right heart failure, explained by right heart volume overload resulting from the persistent shunt. Clinical status quickly improved with diuretics. Although this evolution has not been previously reported, it may be expected in older patients with decreased compliance of pulmonary arteries and right heart chambers.
Cardiac Volume↗
[Course of aortic valve insufficiency in percutaneous aortic valvuloplasty].
The risk of occurrence or aggravation of aortic valve regurgitation after percutaneous aortic valvuloplasty was evaluated by angiography in 50 consecutive patients: 17 men, 33 women, mean age 77.6 years. In all cases angiography was performed with a pigtail catheter, trying to get the catheter in the same position for injections before and after dilatation. Forty-one patients showed no changes from the predilatation situation: aortic regurgitation was absent in 10 cases, minimal in 30 cases and moderate in 1 case. Minute leakage developed in a patient who had no aortic valve regurgitation prior to dilatation. Regurgitation decreased or subsided in 8 patients, i.e.: moderate leakage became minimal in 6 cases and minimal leakage completely disappeared in 2 cases. In the last 8 patients (3 men, 5 women, mean age 76 years) heart rate and transaortic diastolic pressure gradient were identical before and after dilatation, which means that the angiographic reduction of leakage was due to better closure of the valve. Aortic valve dilatation seems to carry a low risk of major aortic regurgitation. In patients who require percutaneous valvuloplasty for tight aortic valve stenosis, the presence of a small or moderate aortic leakage should not preclude the procedure from being performed.
Aged↗
[Echocardiographic detection of adriamycin cardiotoxicity. Study of the relationship between the shortening fraction-constraint and the systolic shortening fraction-diameter of the left ventricle].
Cardiotoxicity is the main obstacle to the use of high-dosage adriamycin in chemotherapy. It is difficult to decide whether or not treatment should be continued when the cardiac function -- irrespective of the method by which it is evaluated -- is at the lower limit of normality. Some authors consider that chemotherapy can be pursued as long as the shortening fraction of the echocardiographic diameter remains within normal limits in relation to the end-systolic constraint. We have established the limits of normality of this relationship before chemotherapy in 53 patients with normal cardiovascular system. We conclude that the end-systolic constraint essentially depends on the end-systolic diameter, so that the results provided by the study of the shortening fraction end-systolic constraint relationship are qualitatively the same as those of the shortening fraction-end-systolic diameter relationship, which is much easier to obtain. It seems to us that the criteria of cardiotoxicity after administration of adriamycin 300 mg/m2 are: (1) shortening fraction lower than 25 p. 100; (2) ventricular dilatation (end-systolic diameter greater than 40 mm) without associated valve disease; (3) reduction of the shortening fraction (whatever its value) in relation to the end-systolic diameter by more than 2 standard deviations on the regression slope of the correlation; (4) more than 25 p. 100 reduction of the shortening fraction after administration of adriamycin 300 mg/m2, betraying a high sensitivity to the cardiotoxic effects of the drug. Such individual sensitivity, studied in 25 patients, seemed to vary widely from one subject to another and to be independent of the initial status.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Doppler ultrasound evaluation of aortic insufficiency using half-pressure time. Absence of arterial rigidity influence].
In 20 patients with pure aortic regurgitation we studied the relationship between the severity of regurgitation, as assessed haemodynamically by the percentage of leakage (%L), and the half-pressure (T 1/2 P) and half-velocity (T 1/2 V) times, as obtained from doppler aortic blood velocity curves, taking into account the rigidity of the systemic vascular circuit characterized by the pressure wave propagation velocity (PWPV). The systemic arterial circuit was supple in 14 patients (PWPV less than 7.5 m/sec) and rigid in 6 patients (PWPV greater than 7.5 m/sec). The regression slopes between %L and T 1/2 P and between %L and T 1/2 V were calculated with their confidence limits in the 14 patients with supple arteries. The 6 patients with rigid arteries fitted into this nomogram, thus demonstrating that systemic arterial rigidity makes no difference in the relationship between %L and doppler indices. The half-velocity and half-pressure times measured by doppler ultrasound were acquired from a velocity signal directly determined by the aortic regurgitation, without any detectable effect of vascular circuit rigidity. Being equivalent by nature to the signal decrease time constant, they are independent of the absolute protodiastolic value of diastolic pressure gradient or blood flow velocity. For this reason these two doppler parameters are reliable to evaluate the severity of aortic regurgitation.
Adult↗
[Development of an ultrasonic system for the recanalization of coronary arteries].
We have devised an electro-acoustic system for the production and propagation of ultrasounds. With this system, linear vibrations can be transmitted through guides that are routinely used for coronary dilatation. Experiments performed on anatomical specimens have shown that ultrasounds are effective in destroying atheromatous formations. In addition, we tested this effectiveness with a setting that modelled the use of this system on the coronary vessels in terms of prerequisites: presence of a carrying catheter, aqueous environment, attention to vascular sinuosities and protection of arterial walls. The biological safety of low-frequency ultrasounds was tested in vitro and in animals. In view of these preliminary results, the subsequent development of an electro-acoustic system to be used in man seems to be justified.
Animals↗
[Prevalence of patent foramen ovale in young patients with ischemic cerebral complications].
We compared the prevalence of patent foramen ovale (PFO), detected by two-dimensional contrast echocardiography, in a group of 60 adults aged under 55 who had experienced a cerebral ischaemic accident and had normal standard examination of the heart, and in a control group of 100 patients. The prevalence of PFO was significantly higher in neurological patients (40 p. 100) than in controls (10 p. 100; p less than 0.001). Within the neurological group, the prevalence of PFO determined blindly, i.e. without any knowledge of the aetiological diagnosis, increased with the uncertainty of diagnosis: 21 p. 100 when a cause could be determined (n = 19), 40 p. 100 when a facilitating factor of cerebral accident, such as mitral valve prolapse, migraine or consumption of oral contraceptives, could be identified (n = 15), and 54 p. 100 when neither cause nor facilitating factor could be found (n = 26; p less than 0.10). In view of the very high prevalence of clinically silent venous thrombosis, these results suggest that paradoxical embolism through a PFO might be responsible for cerebral ischaemic accidents more frequently than is generally believed.
Adult↗
[Evolution of the primary successes of percutaneous aortic valvuloplasty].
Between November 1985 and August 1988, we performed 89 percutaneous aortic valvuloplasties. Sixty-two of these were considered a primary success on the basis of two main criteria: stage I or II on discharge and greater than 50 p. 100 increase in aortic valve area. The mean age of these patients was 78.4 +/- 6.1 years. On actuarial analysis, after 5 months 98 p. 100 of the patients with primary success were alive and 89 p. 100 were in stage I or II and had not been operated upon or redilated. At 15 months 79 p. 100 of the patients with primary success were alive, but only 48 p. 100 were in stage I or II and neither operated upon or redilated. Ultrasonic data obtained one and twelve months after dilatation were compared in 8 patients who had kept the full functional benefit of angioplasty for 14.6 +/- 4.3 months (group 1) and 9 patients who had lost this initial benefit (group 2). In group 1 patients the aortic valve area had moderately and non significantly diminished from 0.92 to 0.72 cm2. In group 2 patients the aortic valve area had gone down from 0.89 to 0.63 cm2 (p less than 0.01), indicating restenosis. We conclude that after the 4th post-valvuloplasty month the medium-term success of the procedure undergoes some degradation, and in these patients the echocardiographic signs of stenosis are clear-cut.
Aged↗
Prevalence of patent foramen ovale in patients with stroke.
The cause of ischemic stroke in younger adults is undefined in as many as 35 percent of patients. We studied the prevalence of patent foramen ovale as detected by contrast echocardiography in a population of 60 adults under 55 years old with ischemic stroke and a normal cardiac examination. We compared the results with those in a control group of 100 patients. The prevalence of patent foramen ovale was significantly higher in the patients with stroke (40 percent) than in the control group (10 percent, P less than 0.001). Among the patients with stroke, the prevalence of patent foramen ovale was 21 percent in 19 patients with an identifiable cause of their stroke, 40 percent in 15 patients with no identifiable cause but a risk factor for stroke, such as mitral valve prolapse, migraine, or use of contraceptive agents, and 54 percent in 26 patients with no identifiable cause (P less than 0.10). These results suggest that because of the high prevalence of clinically latent venous thrombosis, paradoxical embolism through a patent foramen ovale may be responsible for stroke more often than is usually suspected.
Adult↗
Diagnosis of primary cardiac sarcoma. Report of 4 cases and review of the literature.
The authors report the most extensive series of malignant primitive cardiac tumours. The patients presented with pericarditis in three cases and with a ventricular rhythm disorder in one patient. The diagnosis was made by non-invasive imaging techniques in three of the four. Angiography was carried out in three cases and was the determining diagnostic procedure in one. Diagnosis of the cardiac tumour was made prior to death in all cases. A histological diagnosis was obtained surgically in two cases. From the therapeutic viewpoint, surgical excision followed by chemotherapy and/or radiotherapy may prolong life. The average survival period of our patients was 11 months. The prognosis appears to be better after early surgical intervention. In view of the variability of the clinical features of cardiac sarcomas, cardiac computed tomography scanning is a valuable complement to cross-sectional echocardiography and, in our opinion, essential for early diagnosis.
Adolescent↗
Results of serial coronary angiography in patients with homozygous familial hypercholesterolaemia.
We studied the progression of coronary angiographic findings in a series of 10 patients with homozygous familial hypercholesterolaemia. All patients had medical treatment; six had additional surgical treatment. They were followed over a period of 2-10 years (mean follow-up five years). Three types of evolution were observed: (a) normal coronary angiography with no development of any lesion over a period of eight years in two young patients; (b) regression of proximal coronary stenoses in three patients, and (c) progression of coronary angiographic status in five patients. A different evolution of proximal and distal segment lesions was observed; while more than two-thirds of proximal segments stenoses improved and no proximal lesion increased with a 45% decrease in plasma cholesterol level, no improvement was obtained at the distal level. Distal lesions tended to increase and new lesions appeared in spite of a major plasma cholesterol level reduction. When early treatment results in a cholesterol plasma level decrease of more than 45% and a level of about 4 g l-1 over a very long period of time, the coronary prognosis may be good.
Adolescent↗
Coronary artery spasm in a transplant patient.
The mechanism of coronary spasm is poorly understood. We report a case of coronary artery spasm in a cardiac transplant patient. Pharmacologic testing indicated denervation of the patient's heart. Therefore coronary artery spasm may occur despite cardiac denervation. This case demonstrates that intact autonomic nervous system and cardiac innervation are not essential for coronary artery spasm.
Adult↗
Evidence of the inaccuracy of standard echocardiographic and angiographic criteria used for the recognition of true and "false" left ventricular inferior aneurysms.
Diagnosis of so-called false aneurysms of the left ventricle after infarction is judged to be important because the risk of rupture is high and resection of aneurysms with a narrow orifice is usually successful. Aneurysms with larger communication orifices are less likely to rupture. Echocardiographic and angiographic criteria have been devised to classify left ventricular aneurysms into two distinct types. In four cases of inferior aneurysms the echocardiographic and angiographic criteria were typical of a "false aneurysm" but the defects were diagnosed as true aneurysms after intraoperative and histological examination. These aneurysms were characterised by their site in the inferior wall and by late diagnosis and treatment, which may have influenced their occurrence and determined the development of their characteristic shape. These findings suggest that the classic echocardiographic and angiographic diagnostic criteria for "false" aneurysms may have to be abandoned.
Angiography↗
[Atrial natriuretic factor, catecholamines and the renin-angiotensin system in cardiac insufficiency. Relation to hemodynamic parameters].
Plasma concentrations of atrial natriuretic factor (ANF), catecholamines (adrenaline, noradrenaline, dopamine) and aldosterone, and plasma renin activity (PRA) were measured in a group of 20 patients with moderate to medium heart failure (NYHA class II 7 patients, class III 13 patients), 24 hours after treatment was discontinued. Compared with a control group, plasma concentrations of ANF (p less than 0.01), noradrenaline (p less than 0.05), aldosterone (p less than 0.01) and PRA (p less than 0.01) were significantly increased. There was a significant difference between class II patients and class III patients in plasma ANF (p less than 0.01) and noradrenaline (p less than 0.02) concentrations, but not in PRA and aldosterone levels. A significant correlation was observed between plasma ANF concentration and left ventricular end-diastolic pressure (r = 0.68, p less than 0.001), pulmonary arterial pressure (r = 0.59, p less than 0.01), pulmonary capillary pressure (r = 0.51, p less than 0.02), cardiac index (r = 0.46, p less than 0.05) and left ventricular end-diastolic volume (r = 0.50, p less than 0.05). However, ANF concentration was not correlated with mean right atrial pressure. Plasma adrenaline concentration correlated with systemic arterial resistance (r = 0.80, p less than 0.001), pulmonary arterial pressure (r = 0.57, p less than 0.02), mean pulmonary capillary pressure (r = 0.62, p less than 0.001), cardiac index (r = 0.53, p less than 0.05) and left ventricular end-diastolic pressure (r = 0.58, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗