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Biomedical subjects

J J Olalla

Publications and source records attributed to J J Olalla.

17 recordsLinked to original sources
PubMed1996

Repair of chordae tendineae for rheumatic mitral valve disease. A twenty-year experience.

Sixty-two patients with rheumatic mitral valve disease (mean age 42.2 +/- 10.2 years) underwent repair of chordae tendineae between June 1974 and May 1994. Chordal shortening was done in 38 patients, fenestration in 17, resection of secondary chordae in 3, replacement in 2, and transposition in 2. In 41 patients, mitral commissurotomy was also done. Ring annuloplasty was done in all patients. The mean follow-up was 10.2 years (range 2 months to 20 years). The completeness of follow-up during the closing interval (January to July 1994) was 100%. Hospital mortality occurred in four patients (6.5%) and nine patients died during the late follow-up. The actuarial survival curve at 20 years was 65.8% +/- 10%. Six patients with mitral valve dysfunction (restenosis 4, insufficiency 2) and one with aortic valve dysfunction (structural deterioration of bioprosthesis) underwent reoperation. The actuarial curve of freedom from reoperation at 20 years for mitral valve dysfunction was 73.1% +/- 10.5%. In the 49 surviving patients, a Doppler echographic study during the closing interval showed a mean mitral valve area of 1.9 +/- 0.3 cm2. In the 43 patients with a repaired native valve, absent or trivial mitral regurgitation was documented in 35 and mild or moderate regurgitation in 8. In conclusion, repair of chordae tendineae in rheumatic mitral valve disease when feasible is a stable and safe procedure with a low prevalence of reoperation. However, the type of reconstructive operation and experience of the surgical team are major considerations in successful repair of the mitral valve.

Adult↗
PubMed1994

[The estimation of the severity of tricuspid insufficiency by Doppler color: the effects of gain, pulse repetition frequency and the echographic view].

INTRODUCTION AND OBJECTIVES: Regurgitant jet area is to date the most widely accepted color Doppler parameter for quantitation of atrium-ventricular regurgitations. In experimental studies, it has been demonstrated that color regurgitant jet area is greatly influenced by technical settings. The present study was aimed to analyze the effect of gain setting, pulse repetition frequency and echocardiographic plane on color jet area in patients with tricuspid regurgitation. METHODS: We studied 64 patients with nontrivial (more than 1 cm2), rheumatic tricuspid regurgitation. Examinations were performed in apical four-chamber and right ventricle inflow-tract views, at two gain settings (subsaturation gain and 1/3 reduced gain) and at two pulse repetition frequencies (3.1 and 3.8 kHz). Therefore, every regurgitant jet was study under 8 different technical conditions. The remaining technical settings were held unchanged included throughout the studies. The traced area induced central varianced and aliased signals, as well as the immediately contiguous nonturbulent velocities that were moving in the same direction as the jet. Measurements were taken from 5 and 3 representative cycles in patients with atrial fibrillation and sinus rythm, respectively. RESULTS: Globally, reduction in gain setting produced a color area decrease by 50%. This reduction was of greater extent for small jets (less than 5 cm2, 45 +/- 17%) with respect to larger jets (more than 5 cm2, 61 +/- 30%, p = 0.0009). Results were similar for both apical four-chamber and right ventricle inflow views and for the two pulse repetition frequencies. At a given color gain level and echocardiographic view, pulse repetition frequency at 3.1 kHz produced greater color areas (by 3-11%) than frequency at 3.8 kHz, but the difference was not significant. Overall, color jet area was significantly greater in right ventricle inflow view than in apical four-chamber view, but substantial individual variability was observed. Difference between both views was greater than 40% in 28% of patients, with the largest color area in right ventricle inflow view in most, especially in those patients with eccentric jets. CONCLUSIONS: Gain setting and echocardiographic view greatly affect regurgitant jet area by color Doppler in patients with tricuspid regurgitation. Therefore, standardization of technical settings is mandatory in order to avoid diagnostic pitfalls.

Aged↗
PubMed1993

[Pulsed Doppler of the hepatic veins: a new test in the assessment of aortic insufficiency].

In order to determine the value of the analysis of the hepatic vein flow pattern in the gradation of aortic regurgitation, two-dimensional and Doppler studies were carried out in 13 healthy individuals (control group) and 36 patients with aortic regurgitation (study group), in a prospective fashion. By 2-D and Doppler Echocardiography, aortic regurgitation was graded as mild in 5 patients, moderate in 13 and severe in the remaining. In 25 patients of the study group, hemodynamic and angiographic studies were available. Moderate or severe pulmonary hypertension was detected in 11 patients. Peak and integral velocities of the systolic, diastolic and "A" waves were measured on pulsed Doppler hepatic veins flow tracings. Both peak and integral hepatic vein diastolic flow velocities in postexpiratory apnea were significant lower in patients with severe aortic regurgitation with respect to the remaining study group patients and control group patients. Sensitivity and specificity for the detection of severe aortic regurgitation were 100 and 67% respectively. An postexpiratory increase in the retrograde "A" wave was observed in 11 patients with severe and 6 with moderate aortic regurgitation. Sensitivity and specificity for the detection of severe aortic regurgitation were 58 and 67% respectively. In this study, characteristic pulsed Doppler hepatic vein flow patterns are defined for patients with aortic regurgitation. Sensitivity and specificity of the findings allows the identification of severe AR. This results could have diagnostic and therapeutic implications.

Adolescent↗
PubMed1992

[Changes in the flow patterns of the hepatic veins obtained by pulsed Doppler during the postoperative follow-up of a patient with acute aortic insufficiency].

Blood flow pattern recording of hepatic veins using pulsed Doppler technique is a valid method for the assessment of hemodynamic changes in right atrium. We describe a patient with severe aortic regurgitation secondary to acute infective endocarditis who underwent surgical repair. Before surgery and during the postoperative period, several evolutive studies (including conventional echo and hepatic veins pulsed Doppler recordings) were performed. The different central blood flow patterns were correlated with changing hemodynamic conditions during follow-up of the patient. These central flow velocities reflect changes in right atrial pressure contours, and are easily obtained non-invasively with pulsed wave Doppler ultrasound of the hepatic veins. They could be an useful method for assessing right heart filling dynamics, reporting characteristic patterns in other cardiac disease states.

Acute Disease↗
PubMed1991

[Severe disorders of auriculoventricular conduction after aortic valve replacement. A postoperative electrophysiological study in 36 patients and the long-term follow-up].

Cardiac conduction defects (CD) are common in patients with aortic valve diseases. Several studies have suggested that the occurrence of complete heart block at the time of valve replacement is related with preoperative conduction defects and with other factors like calcium deposits, aortic gradient or poor left ventricular function. We evaluated 36 patients undergoing isolated aortic valve replacement in 29 of them, combined mitroaortic in four, isolated mitral valve replacement in two and subvalvular myectomy in one. In all of them an electrophysiologic study was done at the postoperative period. In group 2 (with preoperative CD) patients were older (mean age +/- SEM; 56.57 +/- 8.90) than in group 1 (without CD) (45.64 +/- 14.79) (p less than 0.02). Surgical times were higher in group 1 than in group 2 (p less than 0.01 and p less than 0.005). The site of block was distal to the His bundle in 59% of patients in group 1 and in 47% in group 2 (p-NS). Complete AV block occurred in 70.5% of patients in group 1 while was of 36.8% in group 2 (p less than 0.05). Severity of conduction defects was unrelated with the type of valve disease, aortic valve calcification or gradient or with poor left ventricular function. Preoperative conduction defects were not responsible of more severe postoperative conduction defects. On late follow-up permanent pacemakers were unnecessary in 33% of patients in group 1 and in 75% in group 2 (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[The importance of the echocardiographic diagnosis of a mycotic aneurysm of the mitral septal leaflet in infectious endocarditis of the aortic valve: the surgical implications].

Mycotic aneurysm of the septal leaflet of the mitral valve is an infrequent complication associated with aortic infective endocarditis. The most probable mechanisms implicated on its formation are two: the lesion induced by regurgitant jet striking on septal mitral leaflet and the direct spreading of infection through the fibrosa inter-valvular. We describe the preoperative diagnosis of mycotic aneurysms of the septal mitral leaflet by two-dimensional echocardiography and color flow mapping in 2 patients. Surgical management will depend on the anatomic characteristics of the aneurysm and its hemodynamic repercussion. Careful echocardiographic search for mycotic mitral aneurysms should be performed in cases of aortic valve endocarditis, in view of its important prognostic implications.

Adult↗
PubMed1991

[The double-orifice mitral valve. An evaluation by two-dimensional echocardiography and color echo-Doppler].

Double-orifice mitral valve is an uncommon congenital heart defect. The isolated occurrence of this anomaly is exceptional and, more often, is encountered in association with other congenital cardiac abnormalities. Principal among these are the partial and complete forms of the atrioventricular canal. In this paper, we present two cases of double-orifice mitral valve. Our first case is associated with subaortic stenosis and coarctation of aorta. The second case is an isolated one resembling a severe mitral stenosis. As we know, the diagnosis of this rare anomaly by color-Doppler technique has not been previously reported. We believe this technique provides definite anatomical and functional information about double-orifice mitral valve.

Adolescent↗
PubMed1989

Mitral valve rupture during percutaneous dilation of aortic valve stenosis.

A 62-year-old patient underwent catheter balloon valvuloplasty for aortic valve stenosis. During the procedure, iatrogenic severe mitral regurgitation was induced, requiring emergency surgery. At operation, extensive laceration of the septal mitral leaflet was found; chordae tendinae were intact. Retrospective examination of the cineangiogram revealed the presence of balloon indentation at the chordal level during inflation, which disappeared at full inflation. Mitral valve rupture was probably related to balloon entrapment in chordae tendinae, severe chordal stretching at inflation, and subsequent valve laceration. This severe complication or aortic valvuloplasty in adults has not been reported previously and probably could be avoided by careful observation of guidewire and balloon position before inflation.

Aortic Valve Insufficiency↗
PubMed1989

[Traumatic tricuspid insufficiency].

Isolated tricuspid valve regurgitation is a rare finding after nonpenetrating chest trauma. The clinical course is usually benign and the time of surgery can be delayed for many years. Two-dimensional Doppler echocardiography is an essential procedure in the diagnosis of chordae tendineae or papillary muscle traumatic injury. We present two cases of traumatic tricuspid regurgitation with mild symptoms undiagnosed for sixteen and forty-three years, respectively.

Adult↗
PubMed1989

[Dysfunction in a Hancock mitral valve bioprosthesis caused by thrombosis and resolved with heparin].

Thrombotic malfunction is a rare and shortly documented complication of cardiac bioprostheses. Surgical treatment is usually needed. We report a patient with thrombotic occlusion of a Hancock mitral prosthesis which was resolved with heparin. Clinical and therapeutic features are discussed. To our knowledge, this is the first case of a bioprosthetic thrombotic obstruction successfully managed with heparin therapy.

Bioprosthesis↗
PubMed1988

Color Doppler diagnosis of left ventricular pseudoaneurysm.

A patient underwent mitral valve replacement because of mitral insufficiency secondary to bacterial endocarditis. Early postoperatively, routine examination with "color Doppler" correctly identified the presence of a left ventricular pseudoaneurysm. To our knowledge, this is the first case of left ventricular pseudoaneurysm diagnosed by this new technique.

Echocardiography↗
PubMedDate not supplied

[The transcutaneous treatment of superficial thrombophlebitis with the exogenous nitric oxide donor: nitroglycerin].

Nitroglycerin (glyceryl trinitrate) is a substance that is metabolized to nitric oxide in the cell. Its action is not dependent of the endothelium derived nitric oxide, but imitates those of this biological mediator. We thought that nitroglycerin should have the same in vivo actions as the endogenous nitric oxide in vitro has. We report and discuss the first patient with superficial thrombophlebitis successfully treated with transdermal nitroglycerin.

Acute Disease↗
PubMedDate not supplied

Cyclosporine neurotoxicity in heart transplantation.

The neurotoxic potential of cyclosporine in previous clinical experience has not been considered a significant problem. Recently a significant incidence of severe neurotoxicity has been related to cyclosporine therapy in liver transplant recipients. In our heart transplant program we have observed an unexpectedly high incidence of serious neurologic toxicity, presumably caused by use of cyclosporine. Coma, cerebral hemorrhage, hemiparesis and dysphasia, confusion, and visual hallucinations were reported in four patients. Cyclosporine discontinuation or dose reduction eliminated the neurologic effects in all but one patient. Cyclosporine neurotoxic effects should be suspected in heart transplant recipients with central nervous system syndromes.

Adult↗