Biomedical subjects

L Bernardes

Publications and source records attributed to L Bernardes.

9 recordsLinked to original sources

PubMed1992

[Pulmonary artery involvement in Takayasu arteritis. A case of right ventricular failure as presentation form].

Pulmonary involvement in Takayasu's artery disease has been reported since 1940 with an incidence of 14 to 56%. However, the development of severe pulmonary hypertension is an extremely rare event in the natural course of the disease. The authors report a case of a 62 year old male presenting with severe congestive heart failure of recent onset. The initial evaluation and routine exams suggested the presence of pulmonary hypertension of unknown etiology. The absence of left radial pulse in the physical examination led to the performance of a complete angiographic study which confirmed the diagnosis of Takayasu's arteritis with pulmonary involvement and severe pulmonary hypertension.

Heart Failure↗

PubMed1991

[Stenosis of the common trunk with and without ostium involvement: clinical and angiographic characteristics].

STUDY OBJECTIVE: To evaluate the clinical and angiographic profile of patients with left main coronary artery stenosis with (LM-OS) and without left coronary ostial stenosis (LM-NOS). DESIGN: Retrospective study of patients submitted to coronary angiography. SETTING: Laboratory of Hemodynamics and Interventional Cardiology at Bellvitge Hospital -Barcelona, Spain. PARTICIPANTS: 4663 consecutive patients (pts) with angiographically defined coronary artery disease. 139 pts had left main stenosis greater than or equal to 50%. Twelve pts were excluded because nonatheroesclerotic disease. Twenty two pts (17%), had LM-OS and 105 (83%) LM-NOS. INTERVENTIONS: Pts records were reviewed, to analyse the following clinical and angiographic variables: age, gender, risk factors to coronary artery disease, history of myocardial infarction, anginal class, presence of unstable angina, basal ECG ischemia, percentage and localization of left main stenosis, number and degree of vessels diseased, indexes of left ventricular function and coronary dominance. MAIN RESULTS: 1. Clinical characteristics--In the LM-OS group 18 pts were male and 4 female, while in the LM-NOS the numbers were respectively 90 and 15, p = ns. As for the gender the age showed also a similarity: 58 +/- 8 and 57 +/- 8 years, p = ns. A history of arterial hypertension was present in 73% of pts with LM-OS and 47% with LM-NOS, p greater than 0.05. With respect to the other clinical variables both groups were similar. The incidence of LM-OS was 0.4%. 2. Angiographic characteristics--The severity of left main stenosis was identical in the two groups: 80 +/- 15 in LM-OS and 75 +/- 16% in LM-NOS (p = NS). Four (18%) of the pts with LM-OS had no associated coronary disease versus 7 (7%) of the LM-NOS (p = 0.08). There were 1.3 +/- 1 diseased vessels in the LM-OS group and 2.1 +/- 1 in the LM-NOS (p greater than 0.01). CONCLUSIONS: In the present series, the clinical and hemodynamic profile of patients with left main disease suggest that the following characteristics are more frequently seen in patients with ostial stenosis: 1) history of arterial hypertension; 2) no associated coronary disease; 3) smaller number of diseased vessels; 4) less significant stenosis.

Aged↗

PubMed1991

[Exercise test parameters after acute myocardial infarction. Relationship with coronary angiography].

OBJECTIVE: To analyze the relation between characteristics of symptom-limited treadmill exercise stress test, after acute myocardial infarction (MI) and coronariographic results (number of diseased vessels). Both tests were performed before hospital discharge. DESIGN: Retrospective study with comparative analysis between variable defined groups. POPULATION AND SETTING: From 232 patients interned in the department of Cardiology of Hospital de Santa Marta with a first acute MI, a population of 112 patients submitted to exercise stress test and coronary angiography before discharge were selected (aged 29 to 69 years). METHODS: Symptom-limited treadmill exercise stress tests were performed according to Bruce protocol, with no heart-rate limitation. The following parameters were analyzed: Stress test duration (DUR); Double product variation (varDP); Metabolic equivalent units (METS); Maximal heart rate (FCmax); Percentage of the maximal reached heart rate (% FCmax); Incidence of ST segment depression (InfST); Maximal ST segment depression (Max-InfST); Onset minute of ST segment depression (MinInfST); Heart rate at the onset of ST segment depression (FCInfST); Double product at the onset of ST segment depression (DPInfST); Recovery minute of ST segment depression (MinRInfST); Onset minute of angina (MinAng); Heart rate at the onset of angina (FCAng); Double product at the onset of angina (DPAng). RESULTS: Statistical significant differences were obtained between coronariographic groups concerning the following parameters: DUR: 1-vessel/3-vessel P = 0.02; VarDP: 1-vessel/3-vessel p = 0.008, 2-vessel/3-vessel p = 0.004; METS: 1-vessel/3-vessel p = 0.01. No differences were seen between anterior and inferior myocardial infarctions regarding all the stress test parameters. However in patients with anterior MI significant differences were obtained concerning the following variables: VarDP: 1-vessel/2-vessel p = 0.02; InfraST: 1-vessel/2-vessel p = 0.006, 1-vessel/3-vessel p = 0.03; MaxInfST: 1-vessel/2-vessel p = 0.01, 1-vessel/3-vessel p = 0.0006; Angina: 1-vessel/2-vessel p = 0.0005, 1-vessel/3-vessel p = .001. In inferior myocardial infarctions only the stress duration differed between 1-vessel and 3-vessel groups (p = 0.003). CONCLUSIONS: Symptom-limited treadmill exercise stress tests, safely performed in our institution, were an important method for post MI evaluation and allowed the diagnosis of a great number of patients with residual ischemia. Statistical significant differences were found in ergometric parameters, between coronariographic groups (defined by the number of diseased vessels), emphasising the importance of stress tolerance analysis.

Adult↗

PubMed1991

[Residual myocardial function in dilated myocardiopathy. Response to post-extrasystolic potentiation].

OBJECTIVE: to evaluate the effectiveness of post-extrasystolic potentiation (PESP) to detect latent residual contraction function in patients (pts) with idiopathic dilated cardiomyopathy. DESIGN: retrospective study in pts referred for cardiac catheterization. SETTING: Haemodynamic Laboratory of Cardiology Service, Bellvitge Hospital. Barcelona, Spain. PATIENTS: the criteria for including pts with sinus rhythm were (SR): 1-The appearance of an extra beat R' on the ventriculogram; 2-The location of R' in relation to the preceding sinus beat R1 and the following beat R2 being such that R1-R' less than R'-R2. In patients with atrial fibrillation (AF), the criteria were: 1-An early beat Re had to be identified; 2-R1-Re interval had to be at most half of the Re-R2 interval; 3-The length of the cardiac cycle preceding R, has to be equal to the mean cycle length. All the patients with an increase of the ejection fraction (EF) from R, to R2 less than 12% were included in group A: 12 patients (3 females, 9 males, mean age 51 years, 5 SR, FE 27 +/- 10%). In group B were included patients with an increase of the ejection fraction greater than or equal to 12%; 14 patients (4 females, 10 males, mean age 50 years, 7 SR, FE = 31 +/- 7%). MEASUREMENTS: In each ventriculogram we assessed the performance of left ventricle on R1 and R2 beats by determining: 1-Left ventricular end diastolic (EDV), end systolic (ESV), stroke (SV) volumes; 2-Volumes index (EDVI), (ESVI) (SVI); 3 - Ejection fraction (EF) - Change in ventricular contractility from R1 to R2, delta EF. RESULTS: in the sinus rhythm group the values of R1 and R2 were respectively: EDV: (184 +/- 48 ml/m2; 191 +/- 17 ml/m2; NS); SVI (53 +/- 19 ml/m2; 80 +/- 22 ml/m2; p less than 0.01) FE (29 +/- 7%; 42 +/- 10%; p less than 0.01), delta EF 13 +/- 6%. The change of the ejection fraction from R1 to R2 in pts with SR and AF were respectively: 13 +/- 6% and 11.5 +/- 6.4%; NS. Group A: Deterioration of the functional class and two deaths occurred. Group B: Improvement in functional class in all cases but one. CONCLUSION: our data suggest that augmented ventricular filling and consequent Starling's effect is not a significant contribute for PESP in pts with dilated cardiomyopathy. The analysis of post extrasystolic beat in SR pts and the beat following an early beat with a long diastole in AF, is a valuable method of determining the residual left ventricular function in this group of pts.

Cardiomyopathy, Dilated↗

PubMed1990

[Mitral prostheses with and without dysfunction: evaluation using 2-D Doppler echocardiography].

STUDY OBJECTIVE: To evaluate the flow characteristics of normal and abnormal functioning mechanical and bioprosthetic (B) mitral valves. DESIGN: Prospective study in patients submitted to mitral valve replacement. SETTING: Laboratory of Echocardiography at Santa Marta Hospital. PATIENTS: 61 consecutive and asymptomatic patients with normally functioning mitral prosthesis (prt)--37 Bjork-Shiley (B-S), 11 Carpentier-Edwards (C-E), 5 Hancok (HAN), 7 Ionescu-Shiley (I-S) and 1 Wessex--and 15 pts with abnormal prosthetic function (6 B-S, 5 Hall-Kaster, 2 C-E, 1 I-S and 1 HAN). INTERVENTION: Prosthetic mitral flow record, using 2D-Doppler echocardiography, to analyse: peak velocity (PV), peak gradient (PG), mean gradient (MG), pressure half time (PHT), area (A) and presence of regurgitation (R). RESULTS: Normally functioning prosthetic valves--PV ranged from 88 to 186 cm/s (134.6 +/- 24.3) in B-S prt and 133 to 198 cm/s (157.4 +/- 18.8) in B, p less than 0.0001. The prt B-S showed a greater PG (10.3 +/- 2.5 vs 7.6 +/- 2.6 mmHg), MG (3.1 +/- 1.1 vs 2.6 +/- 1 mmHg) and smaller area (2.3 +/- 0.4 vs 2.5 +/- 0.4 cm2) then Bioprosthetic ones, p less than 0.0001, p = 0.003, p = 0.003 respectively. There was a significant correlation between PG and MG: r = 0.84, r = 0.87, r = 0.84 respectively in B-S prt, Bioprosthesis and both, p less than 0.001. Mild regurgitation was present in 8 pts with prt B-S and 4 with B. Malfunctioning prosthetic valves--The mean of PV was 238.5 +/- 29.2 cm/s in prt B-S compared to 265.48.2 +/- 48.2 cm/s in B. Significant regurgitation, was detected by Doppler technic in 100% of B and 72% of mechanical prt. PV greater than 2 m/s has a 100% sensitivity and specificity to separate normal from abnormal prosthesis function. CONCLUSIONS: These data may be useful as reference values to the follow-up of pts with these types of prt. The prt B-S seems to have more optimal hemodynamics profile than B ones. Protodiastolic transprosthetic PV greater than 2 m/s suggest abnormal functioning valve. PG is a significant determinant of MG.

Adult↗

PubMed1990

[Non-invasive evaluation of systolic pressure of the pulmonary artery in patients with tricuspid regurgitation, using Doppler echocardiography].

STUDY OBJECTIVE: To quantify the systolic pulmonary artery pressure (SPAP) by continuous wave Doppler echocardiography and record the prevalence of tricuspid regurgitation (TR). DESIGN: Prospective analysis of 42 patients (pts), submitted to right heart catheterization (RHC). SETTING: Pts referred to the Echocardiographic Laboratory at Sta. Marta Hospital - H.C.L. PATIENTS: Sequential sample of 42 pts with several cardiac pathologies, subjected to RHC and 2D Doppler Echocardiography. INTERVENTIONS: The right ventricular and SPAP were recorded in the hemodynamic exam. We considered pulmonary hypertension (PH) if SPAP was greater than 35 mmHg or mean pressure greater than 20 mmHg. The pts were divided into two groups: I-pts without PH and II-pts with PH. The 2D Doppler echocardiography was made within 24 H of the hemodynamic one. Peak gradient (pg) of TR and the correlation with catheterization data were analysed. RESULTS: Hemodynamic--The mean SPAP in the sample was 46 +/- 21.5 mmHg (27 +/- 4.6 in group I and 55 +/- 20.2 mmHg in II). In 35 pts with TR the mean SPAP was 50.3 +/- 21.2 mmHg. Doppler--The pressure gradient was 40 +/- 18.7 mmHg. 57% pts of the group I and 96% II had TR p less than 0.001. The correlation between Doppler gradient and SPAP was r = 0.95, and no change was noted when 7 is used as a constant. CONCLUSION: Continuous wave Doppler echocardiography is a non invasive technic useful to the quantitative analysis of SPAP.

Adult↗

PubMed1989

[Flow patterns of a normally functioning monocuspid aortic prosthesis evaluated using Doppler echocardiography].

STUDY OBJECTIVE: Flow analysis in normally functioning eccentric monocuspid aortic prosthetic valves, to obtain a reference data list. DESIGN: To analyse, using 2D-Doppler Echocardiography, aortic flow velocity and systolic time intervals in clinically normal patients (pts), by physical examination. SETTING: Referred pts to the Echocardiographic Laboratory at Santa Marta Hospital--HCL. PATIENTS: Sequential sample of 61 pts with aortic prosthesis (41 Bjork-Shiley and 20 Hall-Kaster) without clinical evidence of either cardiac failure or significant aortic regurgitation. Patients with bad quality record were also excluded. INTERVENTIONS: Doppler Echocardiography was used to record transaortic flow, and the following indexes were analysed: instantaneous peak velocity (pv) and gradient (pg), presence of regurgitation, systolic time intervals and both preejection period/ejection time (PEP/ET) and acceleration time/ejection time (AT/ET). RESULTS: Pv ranged from 1.1 to 4 m/sec (mean 2.4 +/- 0.2. The prosthesis size 19 and 21 showed a greater pg compared to the larger ones: 46.3 +/- 14.4 mmHg against 12.6 +/- 6.4 mmHg (p less than 0.001). Occasionally a pg over 50 mmHg was found in the prosthesis size 19 and 21. The correlation between prosthesis size and pg was also significant (r = -0.62; p less than 0.001). PEP interval was 60 +/- 10 milisec in prosthesis no. 19 and 90 +/- 13 milisec in no. 27 (p less than 0.01). AT ranged from 77 +/- 14 to 88 +/- 14 milisec (mean 82 +/- 13). ET was 294 +/- 5.4 milisec in valves size 19 and 257 +/- 34 millisec in no. 25 (p less than 0.05); there was also a significant difference between prosthesis size 19 and 27 (p less than 0.05). Mild regurgitation was detected in 32.7% of cases. CONCLUSIONS: These data may be particularly useful as reference values to the follow-up of pts these types of prosthesis. Significant differences were found in pg between different valve sizes and this should be remembered when proceeding to standard evaluation by 2D-Doppler Echocardiography. Regurgitation is frequently detected in normally functioning prosthesis, not deeper than 2 cm in the left ventricle.

Adult↗

PubMed1989

[Movement of the mitral valve in patients with ischemic cardiopathy].

STUDY OBJECTIVE: 1. Determination of the clinical value of the mitral-septal angle (MSA), a new two-dimensional echocardiographic (2DE) index, in the evaluation of left ventricular function; 2. Assessment of the relation of incomplete mitral leaflet closure (IMLC) with the presence of mitral regurgitation (MR) or elevated end-diastolic left ventricular pressure (EDLVP). DESIGN: Prospective study involving subjects without heart disease and patients with coronary artery disease. SETTING: Cardiology Department of the Hospitais Civis de Lisboa--Hospital de S. Marta. PARTICIPANTS: We studied: A - 30 normal volunteers; B - 43 patients (pt) with coronary artery disease documented by coronary angiography. METHODS: Two-Dimensional Echocardiography was performed in all subjects. MSA was measured in early diastole using the apical four-chamber view. Using the same view IMLC was assessed. Echo pulsed Doppler was used to detect the presence of MR. All patients in group B were submitted to cardiac catheterization. EDLVP was measured and left ventriculography and coronary arteriography were performed. Presence of MR was assessed and ejection fraction (EF) calculated. According to EF patients were divided: Group B1 (EF greater than 50 - 23 pt); Group B2 (EF 35-50% - 11 pt); Group B3 (EF less than 35% - 9 pt). MEASUREMENTS AND MAIN RESULTS: In group A MSA was always less than 30 degrees and IMLC was never observed. In group B pt with EF greater than 50% had MSA less than 30 degrees in all but one case. Patients with EF less than 50% had MSA superior to 30 degrees in all but two cases. MSA superior to 45 degrees was found in 2 pt with EF 35-50% and in 5 pt with EF less than 35%. IMLC was detected in 11 pt. Only 2 pt had MR and 7 had EDLVP greater than 18 mmHg - 15 pt had an elevated EDLVP in the whole group. IMLC was frequent in group B3 - 7 pt. Correlation between MSA and EF was good (r = -0.81). Sensitivity and specificity of MSA in the separation of pt with EF superior and inferior to 50% was 90% and 95%, respectively: they dropped when we tried to separate pt with EF superior and inferior to 35% (sensitivity 55%, specificity 77%). CONCLUSIONS: IMLC didn't correlate with the existence of MR or elevated EDLVP; it appears, however, to be associated with poor left ventricular function (EF less than 35%). MSA is a good echocardiographic index of left ventricular in patients with coronary artery disease. It is easily measured and it can be a good alternative to mitral E point septal separation in patients in which left sternal views are difficult or impossible.

Adult↗

PubMedDate not supplied

[Exercise 2D-Doppler echocardiography, for the evaluation of aortic valve prostheses].

STUDY OBJECTIVE: Exercise evaluation of eccentric monocuspid aortic prosthetic valves. DESIGN: Prospective study, using 2D Doppler echocardiography to analyse resting and exercise aortic flow patterns. SETTING: Laboratory of Echocardiography at Santa Marta Hospital. PATIENTS: Sequential sample of 28 patients with aortic prosthesis (19 Bjork-Shiley and 9 Hall-Kaster), without evidence of either cardiac failure, coronary artery disease, prosthesis dysfunction or stress test contraindication. INTERVENTIONS: Transaortic basal and exercise flow record, using Doppler echocardiography to analyse: instantaneous peak velocity (pv) and gradient (pg), systolic time intervals, heart rate (hr) and stress test time (stt). The patients were divided in two groups A (prosthesis valve size 19 and 21) and B (greater than 21). RESULTS: Technical success: 84%. basal pv ranged from 1.6 to 4.5 m/s in group A and 1.7 to 3 m/s in B. Rest pg was 35 +/- 1% mmHg--Group A--and 20 +/- 8 mmHg in B (p less than 0.01), increasing with stress test respectively to 62 +/- 26 (p less than 0.01) and 36 +/- 12 mmHg (p less than 0.001). 73% of group A patients had exercise pg greater than 50 mmHg. The correlation between basal and exercise pg was significant (r = 0.91 p less than 0.001). At rest the systolic time intervals revealed a significant difference between the two groups (p less than 0.05), while only the ejection time was significant with stress test (p less than 0.01). Exercise hr and stt were greater in group B-p = NS. CONCLUSIONS: These exercise Doppler echocardiography data suggest that mechanical moncuspid aortic prosthesis 19, 21 and same 23, result in left ventricular outflow obstruction mainly during exercise; these facts should be taken into account when aortic prosthesis insertion is considered. Given the good correlation between resting and exercise peak gradient, Doppler stress test is not routinely recommended in clinical practice.

Adult↗