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Biomedical subjects

G Guagliumi

Publications and source records attributed to G Guagliumi.

13 recordsLinked to original sources
PubMed1992

[Emergency surgery of acute coronary insufficiency].

In our centre, during the last five years, emergency operations (within 6 hours) and urgent operations (within 72 hours) have represented 1/4 of all coronary surgery. 295 patients (pts) have been operated on since 1972: of these, 279 with simple revascularization, 5 with combined major surgery, and 11 as a consequence of mechanical complications of acute myocardial infarction. These last were all in cardiogenic shock: the overall 30-day mortality rate was 5.4% (3.6% in those pts with simple revascularization, 20% in those with combined major surgery, and 45.4% in pts with cardiogenic shock). In the subgroup with simple revascularization, the incidence of non fatal perioperative acute myocardial infarction (AMI) was 4.7% in 253 pts with unstable angina, 52.2% in 23 pts with abrupt closure during coronary angioplasty, and obviously 100% in 3 pts surgically treated during evolving AMI. We were able to identify in the univariate analysis as the only 30-day risk mortality factors: 1) a reduced ejection fraction (< 30%) and 2) the combination with endarterectomy. Other factors (female sex, age > 70, severity of angina, diffuse coronary artery disease and more than 3 by pass grafts) have shown a tendency to increase the mortality rate without statistical significance. No deaths occurred in pts revascularized in emergency situations due to coronary angioplasty complications. In recent years emergency and urgent coronary surgical operations have been increasing, with an increase in pts with higher risk factors. In pts with simple revascularization, 30-day mortality and incidence of myocardial infarction are similar to those of elective surgery. In pts with abrupt closure as a consequence of coronary angioplasty the mortality rate seems very low, while the incidence of infarction remains extremely high. These observations have allowed the development of an integrated protocol of intervention in acute unstable coronary syndromes.

Acute Disease↗
PubMed1991

Electrocardiographic markers of ischemia during mental stress testing in postinfarction patients. Role of body surface mapping.

In patients with coronary artery disease, radionuclide investigations have documented a high incidence of mental stress-induced myocardial ischemia in the absence of significant electrocardiographic changes and/or angina. To investigate the causes of the low electrocardiographic sensitivity, we recorded body surface maps during mental arithmetic in 22 normal volunteers and 37 postinfarction patients with residual exercise ischemia. Myocardial perfusion was studied with thallium-201 or technetium-99 (SESTAMIBI) planar scans. In 14 patients, body surface maps were also recorded during atrial pacing at the heart rate values achieved during mental stress. While taking the body surface maps, the area from J point to 80 msec after this point (ST-80) was analyzed by integral maps, difference maps, and departure maps (the difference between each patient's difference map and the mean difference map for normal subjects). The body surface mapping criteria for ischemia were a new negative area on the integral maps, a negative potential of more than 2 SD from mean normal values on the difference maps, and a negative departure index of more than 2. Scintigraphy showed asymptomatic myocardial hypoperfusion in 33 patients. Eight patients had significant ST segment depression. The ST-80 integral and difference maps identified 17 ischemic patients. Twenty-four patients presented abnormal departure maps. One patient presented ST depression and abnormal body surface maps without reversible tracer defect. In 14 of 14 patients, atrial pacing did not reproduce the body surface map abnormalities. The analyses of the other electrocardiographic variables showed that in patients with mental stress-induced perfusion defects, only changes of T apex-T offset (aT-eT) interval in Frank leads and changes of maximum negative potential value of aT-eT integral maps significantly differed from those of normal subjects. Our results confirm the low electrocardiographic sensitivity for detecting mental stress-induced myocardial hypoperfusion in postinfarction patients. ST analysis in the body surface map increases the information content of the electrocardiographic signal. T wave analysis appears to offer fewer diagnostic advantages.

Cardiac Pacing, Artificial↗
PubMed1990

[Circulatory assistance in high-risk coronary angioplasty].

Femoral vein to artery cardiopulmonary by-pass was used during coronary angioplasty in five high risk patients. In four patients the target vessel supplied more than half of the viable myocardium; in one of these, the ejection fraction of the left ventricle was less than 20%. In one patient the relative contraindications for surgery were the patient's age and the presence of concomitant renal failure. Cardiopulmonary support was established by using cut-down cannulae insertion in three patients and by using the percutaneous system in two. In the latter, the support was stand-by, but the abrupt closure of the artery ten minutes after the end of the successful procedure, required the prompt activation of the support and the patient was treated with emergency saphenous graft. The use of the cardiopulmonary support either as a prophylactic or as a stand-by, enabled coronary angioplasty to be performed on these high-risk patients. The clinical and anatomical data relative to the five patients as well as the possible use of the cardiopulmonary support system either as a prophylactic or standby application during high-risk PTCA are discussed.

Adult↗
PubMed1986

Can body surface mapping improve the diagnostic power of standard electrocardiography in effort myocardial ischemia?

Limitations of the standard 12-lead electrocardiogram in sensitivity, specificity and information content on the effort induced ischemic process might be partly due to an inadequate sampling of cardiac electrical events. An extensive array of electrodes is an effective way to verify this hypothesis. Actually body surface mapping provides: a 10-15% increase in diagnostic yield mainly in patients with mild coronary artery disease and elusive signs of ischemia in standard leads a very approximate indication of the extent of coronary artery disease a substantial contribution to the identification of the site of ischemia. Regarding the last point, preliminary results of an ongoing study are reported. One hundred and three patients with recent myocardial infarction have been studied by exercise test with simultaneous recording of surface map and Thallium 201 scan. So far in the subset with inferior myocardial infarction (76 patients) three different map patterns corresponding to different ischemic regions (anterior, inferior and posterior) have been identified. In anterior myocardial infarction (27 patients) a characteristic map pattern for exercise-induced myocardial ischemia has been observed, apparently able to discriminate between ischemia and the changes of early repolarization induced by the dyskinesia of the infarcted ventricular wall. In conclusion, electrocardiographic mapping makes a practical contribution to the understanding of ischemia-induced cardiac electrical events.

Action Potentials↗
PubMed1981

Exercise hemodynamics 1 month, 2 months and 1 year after myocardial infarction: prognostic considerations.

Sequential electrocardiographic and hemodynamic changes were studied at rest and during symptom-limited bicycle exercise in oligo-asymptomatic patients after myocardial infarction (MI). The exercise tests were performed after the acute episode on days 29 +/- 4 (E1) and 62 +/- 6 (E2) in 128 patients; on days 37 +/- 5 (E1) and 380 +/- 4 (E3) in 97 patients; on days 37 +/- 4 (E1), 72 +/- 6 (E2) and 394 +/- 30 (E3) in 44 patients. All patients underwent an intensive physical training during the second month after the MI. All groups showed a significant increase in work capacity and reduction in heart rate and rate-pressure product at similar work load (E2 and E3 vs. E1). These changes were independent from the level of exercise pulmonary wedge pressure (E-PWP). On the average a reduction of PWP was observed in more compromised patients after training, which became more marked at 1 year. At similar work load 1 year after MI the cardiac index reduced in less compromised patients (E1-PWP greater than 30 mm Hg) while it remained unchanged in patients with E1-PWP less than or equal to 30 mm Hg. Continuation or interruption of the physical training did not seem to affect the hemodynamic evolution. The incidence of ST-segment depression did not change from 1 month to 2 months and 1 year after MI, while both incidence and amount of ST-segment elevation significantly decreased and the sum of R-wave voltages in 12 lead ECG increased at 1 year. In conclusion, oligo-asymptomatic patients, trained and treated by drugs, trend to improve in the first year post-infarct.

Adult↗
PubMed1980

[Pharmacological tests in the polycardiography of valve defects].

Pharmacological tests are often indispensable in non-invasive polycardiographic diagnosis. Their advantages include easy execution, repeatability, and the absence of significant side-effects. Amyl nitrate, angiotensin and isoproterenol are most commonly employed for this purpose. Cases in which such tests enabled a correct evaluation of valve disease, congenital heart disease, and malfunction of a valve prosthesis to be made are presented.

Amyl Nitrite↗