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Biomedical subjects

Jorge Guardado

Publications and source records attributed to Jorge Guardado.

8 recordsLinked to original sources
PubMed2006

Left pulmonary artery evaluation through transesophageal echocardiography.

INTRODUCTION: Transesophageal echocardiography (TEE) has become increasingly useful in the study of patients with suspected pulmonary thromboembolism. OBJECTIVE: The aim of this study was to prospectively evaluate the usefulness of TEE in the study of the distal part of the left pulmonary artery (LPA) as well as the influence of this procedure on total echocardiographic exam duration. METHODOLOGY: A prospective study in two groups of consecutive patients referred for TEE with a one- year interval between evaluation of Group A: 33 patients, 17 male, mean age 54 +/- 24 years, and Group B: 42 patients, 20 male, mean age 48 +/- 27 years (p = NS). The procedure was considered long when it took more than 3 min to evaluate the distal part of the LPA. RESULTS: In group A we were able to visualize the distal part of the LPA in 24 patients (73%) without significant prolongation of total exam duration in 16 patients (48% of group A). In one of the patients with suspected pulmonary thromboembolism thrombi were only observed in the distal part of the LPA. In group B we were able to visualize the distal part of the LPA in 36 patients (86%) without significant prolongation of total exam duration in 26 patients (61% of group B). CONCLUSIONS: 1. Visualization of the distal part of the LPA was possible in more patients, and with TEE time prolongation in less patients, in group B. These differences can be accounted for by the training of the operator in this technique. 2. The importance of visualization of this part of the LPA in guiding treatment in the subset of patients with pulmonary thromboembolism confirms the usefulness of this specific procedure.

Adult↗
PubMed2006

Transient left ventricular apical ballooning.

We describe the case of an elderly woman patient referred for primary angioplasty for acute anterior myocardial infarction, which developed after intense emotional stress. The coronary angiogram was surprisingly normal, but left ventriculography showed severe apical dilatation and dyskinesia, confirmed by echocardiography. By this time we suspected a syndrome of transient apical ballooning without coronary stenosis, which mimics acute myocardial infarction. She underwent medical therapy and subsequent clinical evolution was favorable, with complete recovery of left ventricular systolic function. We discuss the clinical setting and the pathophysiologic mechanisms of this syndrome.

Aged↗
PubMed2005

Coronary-subclavian steal syndrome. A case report.

Coronary-subclavian steal is an unusual clinical syndrome after successful internal mammary-coronary artery bypass grafting. Proximal subclavian artery (SA) stenosis is present and atherosclerotic disease is the underlying pathophysiologic mechanism in the majority of cases. The authors report a case of a sixty-two-year old man with angina and ventricular fibrillation soon after myocardial revascularization with left internal mammary artery (LIMA) to left anterior descending coronary (LAD). Dobutamine stress echocardiography showed ischemia in the anterior myocardial territory with patent LIMA-LAD bypass in the angiographic evaluation. This procedure showed occlusion of the proximal SA with reversal of flow in the LIMA. The best therapeutic approach was discussed and a carotid-subclavian bypass was performed with restoration of antegrade blood flow and reversal of the clinical setting.

Humans↗
PubMed2004

Myocardial infarction in a patient with congenital coronary anomaly.

The authors describe the clinical case of a 38-year-old patient, with a history of smoking and hypercholesterolemia, who was admitted for non-Q wave acute myocardial infarction, and in whom coronary angiography revealed severe coronary disease and a congenital coronary anomaly. Unlike many congenital coronary anomalies that are manifested in ischemic disease, the nature of this patient's anomaly may have contributed to its benign clinical evolution, and influenced the therapeutic approach.

Adult↗
PubMedDate not supplied

Mortality among a cohort of banana plantation workers in Costa Rica.

The nematocide 1,2-dibromo-3-chloropropane (DBCP), widely used in Costa Rica during the late 1960s and 1970s, causes sterility in men and is a possible carcinogen. Mortality among a cohort of Costa Rican banana plantation workers was investigated. The cohort included 40,959 individuals who worked on banana plantations between 1972 and 1979. Employment records were linked with the Costa Rican Mortality Registry to determine outcomes through 1999. Standardized mortality ratios (SMRs) were calculated for all causes of death. Poisson regression was also used to calculate mortality risk estimates by duration of employment, but provided no additional insight. All-causes SMRs were 0.77 for men (95% CI 0.75-0.80) and 0.90 for women (95% CI 0.80-1.02) relative to national mortality rates. Mortality from septicemia was significantly higher than expected. Nonsignificant increases in mortality were also observed for testicular cancer, penile cancer, Hodgkin's disease, and Parkinson's disease in men, and for cervical cancer and lung cancer in women.

Agricultural Workers' Diseases↗
PubMedDate not supplied

Thrombosis and endocarditis in prosthetic heart valves, a case report.

The authors report the case of a 49-year-old female with a history of rheumatic valvular heart disease who underwent valve surgery in 1997, with implantation of St. Jude prosthetic valves in aortic and mitral position. She was asymptomatic until the end of July 2001, when she was admitted to Garcia de Orta Hospital emergency unit because of heart failure, fever and suspicion of endocarditis. Cardiologic evaluation was requested and the transthoracic (TTE) and transesophageal (TEE) echocardiograms revealed vegetations on the prosthetic mitral valve. Blood cultures were negative. She started empiric antibiotic therapy and the clinical course stabilized in the first week. After ten days of medical therapy her symptoms became worse and TTE and TEE were repeated. TTE showed significant left ventricular-aortic gradient, suggesting aortic valve obstruction. Decreased left ventricular function was now present with hypokinesia in the anterior descending coronary artery territory. In the TEE, a large thrombotic process on the mitral prosthesis valve was seen, with a prosthesis disk blocked. There were similar findings in the aortic valve. Cardiac fluoroscopic images were obtained at the mitral and aortic position confirming the TEE report. The coronary angiogram was normal. Promptly transferred to a cardiac surgery center, the patient underwent aortic and mitral prosthetic valve replacement. The intraoperative findings were compatible with those from echocardiography and cardiac fluoroscopy.

Aortic Valve↗