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Biomedical subjects

J Soler-Soler

Publications and source records attributed to J Soler-Soler.

At least 145 records · Page 8Linked to original sources
PubMed1992

Late prosthetic valve endocarditis. Immediate and long-term prognosis.

From 1975 to 1989, 307 consecutive episodes of infective endocarditis were diagnosed in our hospital. Of those, 35 were cases of late prosthetic valve endocarditis, defined as those occurring after 12 months of valvular replacement. Blood cultures grew streptococci in 15 patients (43 percent), staphylococci in seven (20 percent), enterococci in five (14 percent), Gram-negative bacilli of HACEK group in four (11.5 percent), and Candida in one. Blood cultures were negative in three cases (prosthetic infection was confirmed at surgery). Heart failure due to prosthetic dysfunction occurred in seven patients (20 percent) and emboli in 12 (34 percent). Early valvular replacement was performed in six patients (17 percent). Complications and mortality were dependent on the infective agent. Overall mortality was 23 percent, no death occurred from streptococcal infection, whereas mortality with endocarditis by organisms of the HACEK group and Staphylococcus was 50 percent and 43 percent, respectively. During a mean follow-up of five years, 11 patients (those with prosthetic leaks diagnosed during the active infection and patients with biologic prostheses) required surgery. There was one relapse in a patient with staphylococcal endocarditis and one recurrence, six years after the initial episode. We conclude that immediate prognosis of late prosthetic valve endocarditis depends on the infective agent. Although the immediate prognosis of streptococcal infections is good, the need for early reoperation during follow-up due to progressive perivalvular leak is high. Also, it appears that deterioration of bioprostheses proceeds swiftly after the cure of infection.

Adolescent↗
PubMed1992

[Clinical and angiographic course after coronary angioplasty. Analysis of predictor factors of restenosis].

In order to know the restenosis rate and its predictive factors and the short-term clinical outcome (6-12 months) after coronary angioplasty (PTCA), we prospectively followed 200 consecutive patients with 231 coronary stenoses successfully dilated (residual stenosis < 50%). Patients have been clinically and angiographically followed 6-9 months after the procedure. Forty-nine clinical, hemodynamic, angiographic and technical variables were analyzed. Restenosis (stenosis > or = 50% in late angiographic control) rate was 51.5%, and 61% of the study population was symptomless. Variables associated with restenosis in the univariate analysis were: pre-PTCA positive exercise test (p = 0.004); stenosis severity pre-PTCA (p = 0.04); eccentricity (p < 0.0001) and irregularity (p < 0.0001) of the pre-PTCA stenosis; total dilation time (p = 0.02) and post-PTCA dissection (p = 0.002). The multivariate analysis revealed the following variables as independent predictors of restenosis: presence of dissection after PTCA, eccentricity and irregularity of pre-PTCA stenosis, positive pre-PTCA stress test and duration of symptoms before the procedure. These data suggest that the probability of restenosis after PTCA is predominantly determined by the characteristics of the lesion being dilated and the degree of intimal injury produced during the procedure. These variables could define high and low risk populations and may modify PTCA indications and follow up strategies.

Angioplasty, Balloon, Coronary↗
PubMed1992

[The performance of transesophageal echocardiography in clinical cardiovascular practice].

The usefulness of transesophageal echocardiography (TEE) in cardiovascular clinical practice is assessed. Seven hundred transesophageal studies were performed between November 1989 and October 1991. One hundred and seventeen studies carried out during the follow-up of treated non-acute pathologies were excluded. The study could not be made in 6 patients. The most frequent indications of TEE were aortic pathology study, 120 (21%), infective endocarditis, 72 (13%), origin of systemic embolisms, 66 (11%), and mitral pre-valvuloplasty and intensive care, 64 (11%). The incidence of pathologic findings on TEE not diagnosed by conventional echocardiography was 32% (182/577). The incidence of pathologic findings with therapeutic implications was 15% (85/577). Indications showing a greater incidence of pathologic findings with therapeutic implications were: 1) thoracic aorta pathology, 42 (35%); 2) mitral prostheses disfunction, 8 (19%), and 3) mitral pre-valvuloplasty, 10 (16%). Infective endocarditis, intensive care studies and congenital cardiopathies had an incidence of 12%. TEE findings in the study of intracardiac masses, the origin of peripheral embolisms and mitral insufficiency had little influence (less than 5%) on the management of the patient.

Adolescent↗
PubMed1991

Percutaneous right brachial artery approach with 5F catheters for studying coronary artery disease.

We prospectively studied 60 ischemic patients with 5F catheters (Pigtail and Amplatz) using the percutaneous right brachial artery approach (group I), in order to compare this technique with two groups of 100 patients each randomly studied by the femoral route with either 5F (group II) or 8F (group III) catheters (Pigtail and Judkins). The following parameters were analyzed: need to change the initially elected catheter diameter or/and artery approach; technical difficulty for obtaining LV, LCA, and RCA angiograms; total time of X-ray exposure; quality image of LV, LCA, and RCA angiograms; incidence of arterial puncture related hematomas or total arterial occlusion; and duration of local compression after sheath removal. There were no differences between 5F brachial and femoral approaches except for the arterial compression time (p less than 0.01) and the X-ray exposure time (p = 0.03) which were longer with the brachial approach. Whatever the route used, 5F showed a mild increase difficulty (brachial p = 0.001; femoral p = 0.01) and a mild decreased quality image for LCA (branchial p = 0.006; femoral p less than 0.05). Mild hematomas were more frequent with 8F catheters (p less than 0.05). The procedure could be completed by the elected first artery and type of catheter (5F or 8F) in 57/60 patients in group I, in 95/100 in group II, and in 96/100 in group III (nonsignificant differences). Thus, the percutaneous right brachial artery approach using 5F catheters is similar to the femoral artery approach with the same catheters. Although both of them showed a mild increased technical difficulty and a mild decreased quality image compared to 8F, mainly for LCA angiograms, they allowed complete and reliable angiograms reading and analysis.

Angiography↗
PubMed1991

Effect of drugs on a noninvasive index of arterial compliance in healthy and heart failure patients.

Ten healthy (aged 28 to 39) and ten heart failure NYHA II (aged 19 to 49) male subjects were prospectively studied under no drugs, under furosemide (40 mg/day), under captopril (150 mg/day) and under their association. Arterial compliance (ml/mmHg) was measured in all subjects at rest and supine. Heart failure etiology was dilated cardiomyopathy or ischemic heart disease without significant regurgitation. Arterial compliance was significantly higher in healthy than in heart failure patients in all studied conditions (p less than 0.001) (healthy = 2.2 + 0.29 vs. heart failure = 0.79 + 0.14). Neither single drug nor their association induced any change in healthy subjects. Arterial compliance progressively increased in heart failure with furosemide, captopril, and their association (no drug = 0.79 + 0.14; furosemide = 0.87 + 0.15; captopril = 0.94 + 0.15 and furosemide + captopril = 0.99 + 0.14). Captopril induced a higher increment than furosemide (p less than 0.001) and their association even a higher increment (p less than 0.001) than any single drug. Thus captopril and/or furosemide increased arterial compliance in heart failure but not in healthy subjects, possibly through changes in arterial wall edema and smooth muscle contraction.

Adult↗
PubMed1991

Comparison of perceived health status and conventional functional evaluation in stable patients with coronary artery disease.

A cross-sectional study of stable coronary hospital patients was carried out to compare perceived health assessment with conventional clinical measures; 93 consecutive patients were studied, 45 of whom had undergone bypass surgery. Exercise tests and clinical functional classification were obtained together with blind concurrent self-responses to the Nottingham Health Profile (NHP), a measure of distress. Coronary arteriography was available for all patients. Patients with negative exercise tests had lower NHP scores (lower levels of distress) than those with positive or inconclusive tests, especially in the energy, pain and physical mobility NHP dimensions (p less than 0.01). High Spearman correlation coefficients were found between exercise performance and energy (rs = -0.51) and pain (rs = -0.36) scores. This correlation was closer than that found with clinical functional class. In these patients, exercise performance closely correlated with perceived distress. Self-perceived health status measures may improve the evaluation of coronary patients based on clinical assessment alone.

Adult↗
PubMed1991

Induced ventricular arrhythmias in regionally denervated porcine heart with healed myocardial infarction.

STUDY OBJECTIVE: The aim was to test the hypothesis that chronic sympathetic denervation of the boundaries of a healed myocardial infarction may modify the arrhythmogenic response to programmed electrical stimulation. DESIGN: Electrical induction of ventricular arrhythmias and infarct size were evaluated in a control group of pigs with a one month old myocardial infarction induced by ligature of the left anterior descending coronary artery below the first diagonal branch. These were compared with a group of similarly infarcted pigs subjected to regional denervation of the peri-infarction area induced by topical pericoronary application of phenol. Denervation was verified by the absence of adrenergic histofluorescent reaction to glyoxylic acid in myocardial samples. EXPERIMENTAL MATERIAL: 24 pigs (weight 15-20 kg) with myocardial infarction were studied, 13 of which were subjected to regional peri-infarction denervation, and 11 acted as controls. MEASUREMENTS AND MAIN RESULTS: Programmed ventricular stimulation with one to four extrastimuli at 500 and 400 ms basic cycle length at the left and right ventricles induced fewer episodes of ventricular fibrillation in the denervated than in the non-denervated group (five episodes in three pigs v 14 in nine pigs, p less than 0.005), but more episodes of sustained ventricular tachycardia (79 in eight pigs v 23 in two, p less than 0.001). Unlike fibrillation, induction of ventricular tachycardia increased with multiple extrastimuli and with short basic cycle length. The denervated preparations tended to develop smaller infarcts but this difference was not statistically significant: infarct weight (g) relative to total ventricular mass (g) = 7.2 (SD 2.4)% v 10.5(4.5)%. CONCLUSIONS: Neural integrity of the non-ischaemic myocardium bordering a healed infarction modulates inducibility of ventricular tachycardia and fibrillation during programmed ventricular stimulation.

Animals↗
PubMed1990

Clinical evaluation of a prospective protocol for the timing of surgery in chronic aortic regurgitation.

Out of 160 prospectively followed patients with aortic regurgitation, the clinical courses of 53 patients with pure, severe, and chronic aortic regurgitation and without coronary artery disease who were selected for surgery on the basis of predefined criteria is discussed. Surgical criteria were either unequivocal symptoms or documentation of impaired left ventricular dysfunction (defined as angiographic ejection fraction of less than 50% plus and end-systolic volume index greater than 60 ml/m2). According to preoperative status, patients were divided as follows: 11 asymptomatic patients (group A), 30 patients with moderate (classes II to III) symptoms (group B), and 12 patients with dyspnea at rest and pulmonary edema when first seen (group C). Surgical mortality was one patient (from group C). Late death occurred in four patients (one from group B, three from group C). At the end of follow-up (minimum 1 year, mean 3.6 years) 41 patients were in functional class I, four patients in class II, and one patient in class III. All patients except one in functional classes II and III belonged to group C. Before surgery, patients from groups A and B had similar ventricular dimensions and ejection fractions, whereas patients from group C had larger end-systolic diameters and volumes and lower ejection fractions. End-diastolic and end-systolic diameters decreased significantly at 1 and 2 years after surgery. Patients from group C continued to have dilated hearts as did those patients from groups A and B who had preoperative end-systolic diameters greater than 55 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Diagnostic accuracy of radionuclide techniques in patients with equivocal electrocardiographic exercise testing.

The aim of the present study was to evaluate the yield of radionuclide studies for the diagnosis of coronary artery disease (coronary artery narrowing greater than 50%) in a prospective series of 73 patients with thoracic pain and equivocal electrocardiographic stress testing. In the study population, the prevalence of coronary artery disease was 51%. The sensitivity, specificity, diagnostic accuracy and the post-test probability difference curves according to the Bayes' theorem were calculated for 201-thallium exercise testing and radionuclide exercise equilibrium ventriculography. For the latter study the following criteria were considered: (1) increase in left ventricular ejection fraction less than 5%; (2) the criterion proposed by Rozanski; (3) decrease in regional ejection fraction; and (4) abnormalities in phase and amplitude analysis (Fourier). 201-thallium exercise testing was the most sensitive (97%) and accurate (86%) study. Radionuclide ventriculography sensitivity was always lower for any criterion, although its best result was for evaluation of regional ejection fraction (85%). The most specific study was Fourier analysis (97%), although its sensitivity was low (42%). The application of Bayes' theorem to these results shows that the highest post-test probability difference values were achieved with 201-thallium exercise testing for prevalences higher than 40% and with Fourier analysis for lower prevalences.

Adult↗
PubMed1990

Circadian variations of electrical properties of the heart.

Cardiac refractoriness and electrical inducibility of supraventricular tachycardia (SVT) were assessed at intervals of 1 to 2 hours over a period of 22 hours in 38 patients (25 with paroxysmal SVT). Daily variability of effective refractory period (ERP) had a mean range of 35 +/- 14 mseconds for the atria, 79 +/- 65 mseconds for the AV node, 24 +/- 10 m seconds for the ventricles, 51 +/- 27 mseconds for the retrograde Kent bundle, and 35 +/- 17 mseconds for the antegrade Kent bundle. Between 11 PM and 8 AM there was a significant prolongation of the ERP of the atria (ANOVA, p less than 0.001), AV node (p = 0.002), right ventricle (p less than 0.001), and retrograde Kent bundle (p = 0.005), and a reduction in electrical induction of SVT from 75% to 42% (p less than 0.05) with respect to the first electrophysiologic study. This nocturnal prolongation was preceded by ERP shortening of all explored cardiac sites and by increased tachycardia inducibility between 8 and 10 PM. Six patients with dual AV nodal pathways showed a prolongation of the fast pathway ERP at midnight, whereas conduction through the slow pathway followed an unpredictable daily variability. These data indicate a circadian influence on refractoriness of normal cardiac tissues and accessory pathways that exerted a midnight protection against electrical inducibility of reciprocating tachycardia but a transient arrhythmia facilitation at the evening.

Adolescent↗
PubMed1990

A systematic diagnostic approach to primary acute pericardial disease. The Barcelona experience.

Acute pericarditis and cardiac tamponade without a definite cause at the time of the initial hospital evaluation are defined as primary acute pericardial disease. In immunologically competent patients from the Western World, most cases (more than 80%) are idiopathic. However, severe specific diseases may be present in the remaining cases, the clinical features often providing insufficient clues to the etiologic diagnosis. A systematic approach to these patients is therefore needed. It is relevant to this approach that pericardiocentesis and pericardial biopsy have a much higher diagnostic yield when performed in patients with cardiac tamponade than when they are performed for purely diagnostic purposes. Strategies to increase this yield might be devised on the basis of noninvasive findings.

Acute Disease↗
PubMed1989

Prognostic value of segmental contractility assessed by cross-sectional echocardiography in first acute myocardial infarction.

We prospectively studied 110 patients with a first acute myocardial infarction with cross-sectional echocardiography, between 7-10 days post-infarction, to assess the value of semiquantitative segmental contractility score for the first year post-AMI risk stratification. 87 patients had acceptable recordings (40 anterior and 47 inferior infarction). Twelve patients had severe complications (severe angina or heart failure, reinfarction or death) and 40 had non-severe complications. The total segmental score was higher in complicated than in non-complicated patients. The score also differentiated angina from heart failure. The score of necrotic area was more discriminating than that of non-necrotic area. Discriminating power was higher in anterior than in inferior acute myocardial infarction. Thus we conclude that the semiquantitative assessment of segmental contractility by cross-sectional echocardiography is useful for risk stratification following acute infarction identifying severe complications, particularly heart failure, with better discrimination in anterior acute myocardial infarction.

Adult↗
PubMed1989

[Evaluation of small branch occlusion and myocardial damage related to angioplasty. Usefulness of determining serum CK-MB].

In 65 consecutive cases of PTCA we prospectively looked for the appearance of myocardial necrosis during PTCA and for the presence of occlusion of collateral branches arising from the inflation area. Premedication was oral in 44 and intramuscular in 21 cases. CK-MB was abnormally increased in 6 cases: 3 with total occlusion of the dilated artery, 1 with transient coronary occlusion, and 1 with occlusion of a collateral branch greater than 1 mm diameter; in the sixth case the increased CK-MB peak was attributed to repeated defibrillations. Only 1 collateral branch less than 1 mm was occluded during PTCA though myocardial necrosis was not detected. Only collateral branches arising from the dilated stenosis were affected (occlusion and/or appearance of new stenosis) by PTCA (4/24 vs 0/162; p less than 0.01). There were no significant differences in CK-MB peak between both types of premedication. Thus we conclude that: 1) in PTCA myocardial necrosis is only induced by occlusion of coronary arteries greater than 1 mm diameter; 2) only collateral branches arising from the dilated stenosis are at risk of occlusion; 3) estimation of CK-MB pre-PTCA and 8 hours post-PTCA are sufficient for detection of myocardial necrosis.

Adult↗
PubMed1988

Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus.

We performed echocardiography prospectively 4.9 +/- 0.7 years apart (mean +/- SD), in 74 patients with systemic lupus erythematosus. On the basis of the first study, the patients were distributed in four groups according to the type of valvular involvement: 7 patients had vegetations (Libman-Sacks endocarditis; group 1); 6 patients had rigid and thickened valves with stenosis, regurgitation, or both (group 2); 5 patients had miscellaneous forms of valvular involvement without valvular dysfunction (group 3), as did the 60 controls; and 56 patients had no valvular disease (group 4). The overall prevalence of clinically important valvular disease (groups 1 and 2) was 18 percent. Patients in group 1 were younger than those in group 2 (33.5 +/- 16.7 vs. 47.8 +/- 17.6 years; P less than 0.05), had a shorter mean duration of lupus (4.8 +/- 2.2 vs. 10.7 +/- 6.4 years; P less than 0.001), and had received a smaller cumulative dose of steroids (21.5 +/- 13.1 vs. 79.5 +/- 63.4 g of methylprednisolone or its equivalent; P less than 0.05). During the five-year follow-up, one patient in group 1 and five in group 2 required valve surgery, no patient in group 3 had valvular dysfunction, and five patients in group 4 had mild valvular lesions. We conclude that clinically important valvular involvement in systemic lupus is relatively frequent and sometimes requires surgery. Echocardiography can identify a subset of lesions (valvular thickening and dysfunction), other than verrucous (Libman-Sacks) endocarditis, that are prone to hemodynamic deterioration.

Adolescent↗
PubMed1988

Five French versus eight French catheters and the Judkins technique. Advantages and limitations for studying coronary artery disease.

In order to compare 5 French versus 8 French catheters for assessing ischemic heart disease, we prospectively studied 2 groups of 100 patients each, one with 5 French (group I) and the other with 8 French (group II) catheters by the Judkins technique. Significant differences were found in the greater easiness to catheterize LV (p less than 0.05) and LCA (p = 0.01) in group II and in better quality image for LCA in group II (p less than 0.05), although all patients in both groups had acceptable image quality. Pressure curves quality was better in group II (p less than 0.01); X-ray exposure time was longer in group I (p less than 0.001) and arterial compression time in group II (p less than 0.0001). Group I showed 3 and group II 10 mild hematomas (p less than 0.05). The procedure could be completed by the elected first artery and type of catheter in 95 patients in group I and in 96 in group II. Thus, the Judkins technique with 5 French catheters is as valid as with 8 French for assessing ischemic patients, reducing arterial morbidity, although mildly increasing technical difficulty and mildly decreasing quality image.

Adult↗