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Biomedical subjects

H Spindola-Franco

Publications and source records attributed to H Spindola-Franco.

At least 19 recordsLinked to original sources
PubMed1992

Magnetic resonance imaging of suspected atrial tumors.

Two-dimensional echocardiography has become the standard technique for evaluation of cardiac and paracardiac mass lesions. We have used magnetic resonance imaging (MRI) as an independent assessment of cardiac-associated masses in patients with echocardiograms demonstrating sessile atrial tumors. MRI was performed in seven patients, ages 33 to 84, whose echocardiographic diagnoses included left atrial mass (five), right atrial mass (one), and interatrial mass (one). In four of the patients with a diagnosis of left atrial mass, MRI showed extracardiac compression of the atrium, simulating a tumor (hiatal hernia, tortuous descending aorta, bronchogenic cyst). MRI was entirely normal in one patient with an apparent left atrial mass. MRI elucidated extension of an extracavitary mass into the interatrial septum in two patients. One of these patients with an echocardiographic right atrial mass had extension of a lipoma into the interatrial septum without atrial tumor. MRI confirmed the echocardiographic diagnosis of an interatrial mass in the other patient. We conclude that MRI, because of its ability to define anatomic relationships and tissue characteristics, is a powerful noninvasive tool for evaluating suspected cardiac mass lesions. Although echocardiography remains the primary screening test for the detection of cardiac masses, MRI is a more specific modality for precise diagnosis. Correct MRI interpretation may obviate the need for invasive studies or surgery.

Adult↗
PubMed1989

Congenital anomalies of the coronary arteries. Classification and significance.

An understanding of the anomalies of the coronary arteries is imperative for physicians dealing with diagnosis and treatment of coronary artery disease. Although not as common as acquired coronary artery disease, congenital coronary anomalies contribute to significant morbidity and mortality. In addition, they may present difficulties for the angiographer at the time of catheterization, as well as a challenge for the radiologist in interpretation. To facilitate a better understanding of these anomalies, a new classification is presented, together with illustrations and discussion of the clinical significance.

Coronary Vessel Anomalies↗
PubMed1988

Correlation between left ventriculography, auscultation, and M-mode and two-dimensional echocardiography in mitral valve prolapse.

Mitral valve prolapse (MVP) is a common valvular abnormality which is observed in as many as 5% of the general population. Although invasive as well as noninvasive tools have been developed to determine the existence of this disorder, none is perfect and false negative as well as false positive diagnoses abound. Because MVP is a relatively benign disorder, it has also not been easy to make the usual clinical-pathological correlations. Left ventriculography is considered by many to be the gold standard, but this designation is probably not deserved. The angiographic criteria used by most do not permit unequivocal separation of normal mitral valve systolic bulging from pathologic MVP, and the interobserver and intraobserver variability of interpretation is high. However, false positive diagnoses can be eliminated if MVP is diagnosed only when para-annular displacement of mitral leaflet tissue is detected during systole rather than simple leaflet bulging. Although mid-systolic clicks and late systolic murmurs have proven to be the auscultatory hallmarks of this disorder, many patients have these signs without other diagnostic findings, consequently making it impossible to confirm the presence of MVP. Furthermore, the appearance of diagnostic echocardiographic abnormalities in patients with normal cardiac examinations implies that auscultation is not a sensitive marker of MVP. Both M-mode and two-dimensional echocardiography have technical limitations and the repeatability of interpretation of these tests is disappointingly low (80 to 90%). Because of these difficulties the angiographic-echocardiographic correlation is only fair. Nonetheless echocardiography has generally been accepted as the diagnostic modality of choice. Future technical improvements will likely enhance the diagnostic accuracy of this technique.

Echocardiography↗
PubMed1986

Angiographic and hemodynamic correlations in hypertrophic cardiomyopathy with intracavitary systolic pressure gradients.

To correlate angiographic and hemodynamic events in hypertrophic cardiomyopathy (HC), 14 patients with HC were investigated using pressure recordings and caudocranial left anterior oblique contrast angiography. Patients were separated into 2 groups on the basis of the presence (group I) or absence (group II) of systolic anterior motion of the anterior mitral leaflet on caudocranial angiography. In group I (10 patients), the pressure gradient could be recorded with the left ventricular (LV) catheter in the nonobliterated inflow region of the left ventricle. Simultaneous micromanometer tracings and caudocranial angiography revealed that contact between the anterior mitral leaflet and the ventricular septum was an early systolic event (occurring 136 +/- 33 ms after the R wave of the electrocardiogram) and was coincident with the onset of the pressure gradient. Cavitary obliteration was present in only 7 of 10 patients in group I, and occurred late in systole well after the peak gradient (292 +/- 28 ms after the R wave). In group II (4 patients), the pressure gradients could be recorded only from the obliterated portion of the ventricle distal to the level of the papillary muscles. Total LV cavitary obliteration was present in all group II patients. In 1 patient, simultaneous micromanometer pressure recording and caudocranial angiography revealed that cavitary obliteration preceded the peak gradient by 40 ms. Thus, in group I patients the onset of the pressure gradient is coincident with mitral leaflet-septal contact, while cavitary obliteration is an inconsistent late systolic event.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1981

Production of left ventricular cavitary obliteration in normal man.

To determine whether left ventricular cavitary obliteration (a finding previously described only in hypertrophic states) can be induced in normal subjects, 16 patients without coronary artery disease or clinical evidence of hypertrophic obstructive cardiomyopathy were studied during cardiac catheterization. Resting left ventricular and aortic pressures and left ventriculography were repeated during the strain phase of Valsalva maneuver after administration of amyl nitrite. Cavitary obliteration during normal sinus rhythm was defined as disappearance of the sinus portion of the left ventricle during systole, and graded as absent, partial or total. Patients were placed into two groups on the basis of qualitative analysis of the resting left ventriculogram: the 10 patients in group A had normal left ventriculograms and the six patients in group B had hyperkinetic left ventricles. During the left ventriculogram done with amyl nitrite and Valsalva, left ventricular volumes in both decreased dramatically, from 69 ml/m2 to 43 ml/m2 (p less than 0.001) and ejection fraction increased from 70% to 82% in group A (p less than 0.01). None of the patients in group A had evidence of cavitary obliteration at rest, but eight developed total and two developed partial cavitary obliteration with the second ventriculogram. Three patients in group B had partial or complete cavitary emptying at rest and all developed total cavitary obliteration with provocation. Pressure gradients between left ventricle and aorta were produced in two group A patients and three group B patients. Thus, cavitary obliteration can be produced in normal left ventricles by manipulation of loading conditions.

Adult↗
PubMed1979

Coronary spasm: Prinzmetal's variant angina vs. catheter-induced spasm; refractory spasm vs. fixed stenosis.

An analysis of 2,394 selective coronary angiograms yielded 23 examples of coronary artery spasm. Of these, nine occurred in patients with Prinzmetal's variant angina and 14 were instances of catheter-induced spasm. Angiographic criteria can distinguish between the spasm of variant angina and catheter-induced spasm. The latter is usually asymptomatic, almost invariably in the right coronary artery, at the catheter tip, smooth, concentric, and less than 2 mm long. The former can occur in any coronary artery at a distance of 1--4 cm from the catheter tip, is usually irregular and eccentric, and is associated with angina, ST segment elevation, hypotension, and dysrhythmia. Response to nitroglycerin is often, but not always, complete in both. Stenoses that seem to be fixed in patients with Prinzmetal's angina should be suspected to be spasm even if unresponsive to nitroglycerin, especially when the rest of the vessel is normal. Additional pharmacologic manipulation and even recatheterization may be necessary to prove the dynamic nature of the lesion and avoid unnecessary surgery.

Adult↗
PubMed1978

Pulmonary steal syndrome: an unusual case of coronary-bronchial pulmonary artery communication.

The authors report a patient with angina pectoris in whom selective left coronary angiography demonstrated that the pulmonary artery branch to an apical lung segment was supplied by a bronchial collateral vessel which arose from the left circumflex artery. The anatomic and physiological developmental mechanisms, and the clinical implications, are discussed. Relief of the patient's angina following ligation of the pulmonary artery branch indicated the development of a form of pulmonary steal syndrome.

Angina Pectoris↗
PubMed1978

Pseudoaneurysm of the left ventricle. Radiographic and angiocardiographic diagnosis.

Left ventricular pseudoaneurysms represent intrapericardial ruptures contained by adherent pericardium and fibrous tissue, forming an avascular wall; in contrast, the wall of a true aneurysm is formed of fibrous elements of the infarcted myocardium and contains coronary vessels. Prior myocardial infarction and/or aneurysmectomy may predispose to pseudoaneurysm formation. Plain radiographs, echocardiography, gated cardiac blood pool imaging, and left ventriculography are helpful, and the combination of left ventriculography and selective coronary arteriography is diagnostic. A uni- or multiloculated chamber communicating with the left ventricle by a relatively small orifice without draping of coronary vessels is diagnostic of pseudoaneurysm.

Aged↗
PubMed1975

Comparison of observer performance with 16 mm cinefluorography and 70 mm camera fluorography in coronary arteriography.

Clinical 16 mm cinefluorography and 70 mm camera fluorography were compared in 30 unselected patients undergoing coronary arteriography. Accuracy in detecting coronary arterial stenosis and collateral vessels and in assessing the degree of stenosis was similar with the two techniques. With both methods, there were significant inter- and intraobserver differences in estimating the degree of stenosis. These differences indicate that coronary arteriography is only a semiquantitative method for making decisions about treatment, prognosis and follow-up of patients. The use of more than one observer increases the likelihood that stenotic lesions will be detected. Interobserver variation in detecting collateral circulation is small.

Adult↗
PubMed1975

Migration of epicardial pacemaker leads.

The implantation of permanent pacemakers often gives rise to complications. Migration of leads, an unusual complication, occurred in two of our patients with epicardial pacemakers. In one case lead fracture and sussequent displacement due to heart action occurred after an automobile accident. In the second case looping and migration of the wire occurred within a day after implantation although the lead continued to function properly for six months. The probable cause of migration in this patient was excess slack.

Accidents, Traffic↗
PubMed1975

Coronary vascular patterns during occlusion arteriography.

The arteriograms from 18 studies in which the catheter accidentally occluded the right coronary artery were analyzed and compared with successful studies in 25 patients with normal coronary arteries and 20 patients with coronary artery stenosis. The occlusion arteriograms showed distinct early filling of the anterior cardiac veins and occasionally retrograde filling of the left circumflex artery. Although there were no serious complications due to occlusion arteriography in our patients, the potential for producing ventricular tachycardia, ventricular fibrillation or cardiac arrest must be borne in mind. Angiographers should be aware of these filling patterns in order to recognize them as artifacts of the technique and not as manifestations of disease.

Angiography↗