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J Goicolea

Publications and source records attributed to J Goicolea.

At least 73 records · Page 4Linked to original sources
PubMed1992

Comparison of results of percutaneous mitral valvuloplasty in patients with large (greater than 6 cm) versus those with smaller left atria.

To determine whether the presence of an aneurysmatic (severely enlarged) left atrium (greater than 60 mm on echocardiography) influences results of percutaneous mitral valvuloplasty (PMV), the clinical, echocardiographic and hemodynamic characteristics and the results of this technique were compared in 46 consecutive patients with aneurysmatic left atrium (group I) and 125 consecutive patients without such echocardiographic finding (group II). Left atrial size was 70.5 +/- 8 vs 50.1 +/- 6 mm (p less than 0.005) in groups I and II, respectively. Patients in group I were older (57 +/- 12 vs 48 +/- 12 years, p less than 0.025), more symptomatic (New York Heart Association functional class greater than or equal to III or IV: 67 vs 42%, p less than 0.05), and had atrial fibrillation more frequently (91 vs 44%, p less than 0.001). The echocardiographic score (8.9 +/- 1.9 vs 7.5 +/- 2, p less than 0.005) and the incidence of mild mitral regurgitation on angiography before PMV (54 vs 30%, p less than 0.01) was also higher in group I patients. Hemodynamic parameters before PMV were similar in both groups, but after the procedure, final mitral valve area (1.61 +/- 0.5 vs 1.95 +/- 0.4 cm2, p less than 0.05) and the absolute increase in mitral area (0.81 +/- 0.3 vs 1.02 +/- 0.3 cm2, p less than 0.05) were lower and mean pulmonary artery pressure (35 +/- 10 vs 28 +/- 9 mm Hg, p less than 0.025) was higher in group I.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Midterm outcome of patients with asymptomatic restenosis after coronary balloon angioplasty.

Although many patients with restenosis after balloon coronary angioplasty have recurrence of angina, others remain asymptomatic. To assess the clinical implications of asymptomatic coronary restenosis, we analyzed clinical and angiographic characteristics of 277 consecutive patients with restenosis, 133 (48%) of whom were asymptomatic (group I) and 144 (52%) symptomatic (group II). Restenosis was documented 6 to 9 months after the index procedure, or earlier if angina recurred, and was defined as a greater than 50% lumen narrowing (visual estimation). Group I (asymptomatic group) included fewer female (9% vs. 18%, p less than 0.05) and hypertensive patients (38% vs. 56%, p less than 0.005) and more patients with a previous myocardial infarction (48% vs. 28%, p less than 0.05) and single-vessel disease (67% vs. 55%, p less than 0.05). Before angioplasty, symptoms had lasted for a shorter period (10 +/- 25 vs. 23 +/- 42 months, p less than 0.001), ischemia after a recent infarction was a more frequent indication (21% vs. 10%, p less than 0.05) and total revascularization more frequently obtained (74% vs. 63%, p less than 0.05) in group I than in group II patients. Only a normal blood pressure, previous myocardial infarction, single-vessel disease and a shorter duration of symptoms were independent correlates of asymptomatic restenosis. No differences were found in stenosis severity before angioplasty (90% in both groups) or after angioplasty (22% +/- 12% vs. 24% +/- 16%).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1992

[The correlation between measurements performed by intravascular echography and quantitative digital angiography in large- and small-caliber arteries].

Intravascular ultrasound is a new promising technique that appears as a very useful complement to standard angiography in the study of atherosclerosis. Specifically, intravascular ultrasound provides by itself, information of great value concerning vessel wall characteristics. Nevertheless, before taking any decision with the results provided by this new technique, we must validate this information with that provided by other more conventional techniques like standard angiography. Accordingly, we have analyzed in 25 patients, 50 images of the abdominal aorta and 77 images of the coronary arteries taken from arterial segments free of atherosclerotic involvement. With the use of a calibrated small grid located over the patient's thorax, we have analyzed "in the same points" the images obtained with intravascular ultrasound and those provided by contrast angiography using a quantitative angiographic analysis. In the abdominal aorta the vessel diameter measured by intravascular ultrasound and angiography was 17.8 +/- 0.39 mm vs 18.6 +/- 0.42 mm (NS), whereas in the coronary arteries it was 2.76 +/- 0.39 mm vs 2.98 +/- 0.37 mm (NS), respectively. The correlation between both techniques was good for both types of arteries (r = 0.93 in the abdominal aorta and r = 0.87 in the coronary arteries). We conclude, that in our experience and with the methodology used, there is a good correlation between the measurements of the vessel diameters obtained by both intravascular ultrasound and digital angiography in arteries of different sizes, being the correlation even better in large arteries.

Adult↗
PubMed1992

[Transluminal percutaneous coronary angioplasty of the left coronary artery].

This paper describes our preliminary experience with left main coronary angioplasty in 8 patients (9 procedures). In 6 patients the left main coronary artery was "protected" either by previous by-pass surgery (4 patients) or by collateral vessels from the right coronary artery (2 patients). Three patients had a total occlusion of the left main coronary artery and 2 of them had a recent or acute myocardial infarction and the coronary angiogram suggested a thrombotic occlusion of the infarct-related artery. Three patients were not considered surgical candidates and an additional patient, who was in cardiogenic shock, required an emergency coronary angioplasty as "rescue" procedure. A successful dilatation was achieved in 6 patients (including a patient with successful deployment of a Palmaz-Schatz stent) but, unfortunately, one them eventually died 7 days later from a femoral sepsis related to the procedure. However in the 2 remaining patients--with a total occlusion of the left main coronary artery in relation with a myocardial infarction--the dilatation procedures were unsuccessful. One patient underwent a successful repeat coronary angioplasty for restenosis of left main coronary artery. Our preliminary experience confirms previous reports suggesting the value of coronary angioplasty in patients with left main coronary artery disease providing a careful selection of possible candidates is performed prior to the procedure.

Adult↗
PubMed1990

[Transesophageal Doppler color echocardiography in the evaluation of patients after percutaneous mitral valvuloplasty].

To determine the value of transesophageal ultrasound in the assessment of patients after percutaneous mitral valvuloplasty, 42 patients were studied by transthoracic (TTE) and transesophageal (TEE) two-dimensional and color Doppler echocardiography. All of them were studied as out-patients and without complications. We describe the technique, planes of examination and the advantages that this new acoustic window offers in patients after balloon valvuloplasty regarding to: detection of thrombus in the left atrium (LA), visualization of spontaneous echo contrast in the LA, evaluation of mitral regurgitation (MR), detection of small atrial septal defects (ASD) and evaluation of the stage of the commissures of the mitral valve. We detected thrombus by TEE, in 5/42 vs 1/42 by TTE approach. Spontaneous echo contrast was found in 35/42 by TEE and none by TTE. Small ASDs were visualized in 10/42 patients vs 2/42 by TTE. No differences were found in the evaluation of MR and mitral valve commissures either by TEE or TTE. We conclude that transesophageal echocardiography is a well-tolerated technique in outpatients which complements and improves the information obtained by the transthoracic approach in patients after balloon mitral valvuloplasty.

Adult↗
PubMed1989

Combined percutaneous mitral and aortic balloon valvuloplasty.

Between August 1987 and November 1988, combined mitral and aortic balloon valvuloplasty was performed in 10 patients (mean age 42 +/- 9 years), all of whom had symptomatic mitral and aortic stenosis. The procedure was performed using a transarterial approach with a multiballoon catheter and an exteriorized intracardiac long guidewire circuit. The procedure could be considered successful in 9 patients where significant increases in the mean mitral (0.97 +/- 0.19 to 1.80 +/- 0.26 cm2) and aortic (0.63 +/- 0.18 to 1.15 +/- 0.32 cm2) areas were achieved. Severe mitral regurgitation that required surgery developed in 1 patient in the following 24 hours. Femoral vascular surgery was necessary in 1 patient. Mid-term follow-up was available in 8 patients for a period averaging 8 +/- 3 months. The 9 patients in whom the procedure was successful showed persistent clinical improvement in functional class, Doppler echocardiography showed 2 cases of aortic restenosis and none of mitral restenosis. Combined mitral and aortic balloon valvuloplasty could be a valid alternative treatment in selected patients with both mitral and aortic rheumatic stenosis. Further experience and long-term hemodynamic follow-up are necessary to define the role of this mode of treatment.

Adult↗
PubMed1989

[Coronary transluminal angioplasty and determination of the intracoronary gradient with a new monorail system].

STUDY OBJECTIVE: To evaluate the results obtained in coronary angioplasty using the new very low profile monorail catheter. DESIGN: A retrospective study to define the causes and frequency of successful and unsuccessful coronary angioplasty on proximal and distal lesions located in the three coronary vessels. SETTING: Patients referred to the Hemodynamic Unit for coronary angioplasty. PATIENTS: Coronary angioplasty was performed in 106 patients with cardiac ischemic disease (stable angina, unstable angina and myocardial infarction after thrombolytic therapy). INTERVENTIONS: To perform coronary angioplasty using a monorail system, including dilatation of vessels (angioplasty) and to measure the intracoronary gradient. RESULTS: A high success rate was achieved (92%) independent of vessel dilated or of the position of the stenosis. There was a lower success rate in complex lesions. CONCLUSION: In this study, this newly modified system for coronary angioplasty with balloon catheter and monorail pressure catheter gave a very high performance.

Aged↗
PubMed1989

[Aortic valvuloplasty using the transatrial route in aortic valve stenosis].

We describe a new technique for aortic valvuloplasty in four patients. The balloon catheter was inserted percutaneously from the right femoral vein over a long guidewire introduced into the right femoral vein and advanced transseptally to the left atrium and left ventricle and drawn out of the body through the left femoral artery using an intravascular retriever set. With both ends of the long guidewire under manual control outside the body, the balloon could be easily fixed during inflation. The procedure was easy to perform and caused no complications.

Adolescent↗
PubMed1984

Relation of midwall circumferential systolic stress to equatorial midwall fibre shortening in chronic aortic regurgitation. Value as a predictor of postoperative outcome.

Nineteen patients with chronic aortic regurgitation and a large increase in heart size were studied before aortic valve replacement. By relating midwall circumferential systolic stress to midwall circumferential fibre shortening (Cs/Cd) before operation the patients could be divided into two well defined groups. Twelve patients (group 1) had a pronounced decrease in heart size as measured by the cardiothoracic ratio and an excellent clinical outcome six months after operation. Seven patients (group 2) had no significant decrease in heart size and a less good clinical outcome. The ratio of midwall circumferential systolic stress to end systolic volume index was significantly higher in group 1 than in group 2. Group 2 had more severe left ventricular hypertrophy determined by the ratio of the wall thickness to the minor internal radius of the left ventricle (h:r ratio), total left ventricular mass, and left ventricular mass to end diastolic volume ratio. There were no significant differences in any other haemodynamic or angiographic indices between the two groups. Thus the relation of midwall circumferential systolic stress to fibre shortening is useful in determining the prognosis in individual patients with chronic aortic regurgitation undergoing aortic valve replacement.

Adult↗
PubMed1983

Early in vivo hemodynamic evaluation of the mitral Medtronic-Hall cardiac valve.

We studied the hemodynamics of 14 patients with a Medtronic-Hall prosthesis in mitral position 6 months after valve implantation. The usual hemodynamic parameters showed a striking improvement after surgery. The mean pulmonary arterial pressure decreased from (mean +/- SD) 37 +/- 10.7 mmHg to 20 +/- 6.5 mmHg (p less than 0.005). Mean pulmonary capillary pressure decreased from 24 +/- 7.1 mmHg to 10 +/- 3.0 mmHg (p less than 0.001). Cardiac output increased slightly from 3.7 +/- 0.8 L/min to 4.2 +/- 0.45 L/min, the difference not being significant. Valvular area at rest was 1.82 +/- 0.25 cm2 and increased significantly during exercise to 2.47 +/- 0.45 cm2 (p less than 0.001). The opening angle of the disk occluder reached a mean value of 64 +/- 4.6 degrees, that is 91% of the maximal theoretical opening angle. We fitted a hydraulic function gradient = Ax (Flow)n (mean r = 0.9176), to the paired data of gradient and flow obtained during progressive exercise. This procedure permitted us to establish the actual hemodynamic behavior of the prostheses which did not concur with the behavior predicted by the Gorlin formula. We conclude that the Medtronic-Hall mitral prosthesis is an acceptable alternative when mitral valve replacement is considered.

Adult↗
PubMedDate not supplied

Intraoperative balloon valvuloplasty in pulmonary valve stenosis.

Balloon valvuloplasty was used in the operating room on 7 patients to visually assess the valvular changes induced by inflation of a balloon catheter. All patients had typical pulmonary valve stenosis and an associated cardiac condition which necessitated surgery. Of 23 fused commissures present, 21 were successfully opened with a single balloon inflation. In 2 patients, damage to the leaflets was observed. In 1 patient there was partial detachment and in the other a small tear was noted at the margin of one leaflet. These intraoperative results may be similar to the results obtained with percutaneous balloon valvuloplasty.

Adolescent↗
PubMedDate not supplied

A new type of adjustable vascular introducer for balloon valvuloplasty: technical note.

To minimize vascular damage in percutaneous balloon valvuloplasty, a new type of dynamic adjustable vascular introducer has been developed which is capable of both expanding and contracting on the passage of a balloon catheter. This ability greatly reduces damage to the vessel and limits blood loss at the site of entry during the procedure. It has been used in both mitral and aortic balloon valvuloplasty.

Catheterization↗
PubMedDate not supplied

[Color-coded Doppler in the diagnosis of vascular complications following heart catheterization].

To determine the value of color Doppler in the diagnosis of vascular complications resulting from cardiac catheterization 5 consecutive patients, with the clinical suspicious of vascular iatrogenesis potentially requiring surgical repair, were analyzed. In 2 patients a femoral mass developed after a diagnostic catheterization but 3 patients underwent previously an interventional catheterization technique. In 3 patients color Doppler readily visualized a systolic jet originated in the femoral artery entering an anterior echo-free cavity, and a reversal flow in diastole, suggesting a femoral pseudoaneurysm. In 1 patient the clinical diagnosis of arteriovenous fistulae was confirmed by color Doppler which demonstrated a continuous turbulent flow within the femoral vein. In the remaining patient a diagnosis of simple femoral haematoma was made after the demonstration of a relatively echogenic structure overlying the femoral artery and vein but not interfering with their flows. In the 3 patients with femoral pseudoaneurysms and in the patient with arteriovenous fistulae the diagnosis was confirmed by angiography and during surgery. Our preliminary findings underscore the value of color Doppler, using the technology currently available in echocardiographic laboratories, in the differential diagnosis of vascular complications after cardiac catheterization.

Aged↗
PubMedDate not supplied

[Coronary angioplasty with a rotary atherotome].

Several new coronary dilatation systems, including those using laser energy, atherectomy devices and stent implantation, are being developed as alternative or complementary procedures to coronary artery balloon angioplasty. We report our initial experience performing coronary angioplasty with a new rotational atherectomy device, the transluminal extraction catheter, which simultaneously cut and aspirate fragments from the atherosclerotic plaque. The components of the whole system are a special guidewire to cross the stenosis, the atherectomy catheter and the conduction-control unit. This unit, connected when the atherectomy catheter is positioned across the lesion, produces rotation of the conical bladder located in the catheter distal tip and simultaneous aspiration of residual particles. The procedure was performed in 11 patients in whom 13 lesions were dilated. All patients were male (mean age 55 +/- 23 years, range 45-77). The reason for the angioplasty was stable angina in 2 patients and unstable angina in the remaining seven. Initial success (residual stenosis less than 50% of vessel diameter) was obtained in 10 of 13 lesions. In two, conventional balloon angioplasty was required to improve atherectomy result. The only unsuccessful procedure was in a proximal right coronary artery venous graft, in which a large dissection occurred. Patient had angina but no myocardial infarction. Pathologic examination of aspirated material revealed fibrous tissue in 12 cases and cholesterol crystals in four. We conclude, with the limitation of a preliminary study, that rotational atherectomy with the transluminal extraction catheter is a useful procedure to relief coronary stenosis of the coronary arteries.

Aged↗