Angioplasty treatment for peripheral vascular disease.
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Biomedical subjects
Publications and source records attributed to L Iannone.
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One hundred fifty-six patients underwent emergency coronary revascularization during the early phases of evolving myocardial infarction (MI). There were six hospital deaths (3.8%) and two later deaths (1.3%). Thrombectomy of the MI artery was achieved in 79% of the patients, and 17% of the patients showed no observable lesion in the MI vessel on restudy. Graft patency was 99%. Late follow-up to 62 months disclosed 17 patients with residual limitations. Analysis of the data established criteria for recognizing patients with early MI who would benefit from surgical therapy. The criteria are derived by comparing preoperative and postoperative ventricular anatomy, creatine phosphokinase levels, and hemodynamics.
One hundred thirty-eight selected patients underwent emergency coronary artery revascularization as the treatment for early evolving myocardial infarction. Low early and late (3.6 and 2.9%) mortality and morbidity up to 54 months, with favorable post surgical hemodynamic improvement demonstrates the operability with beneficial results in selected patients with early evolving myocardial infarction.
The intra-aortic balloon pump has been proven to be an effective form of therapy in a variety of situations involving actual or potential ventricular power failure. An experience with 12 newly-designed percutaneous PERCOR-TM intra-aortic balloon pumps is discussed. Emphasis is made on the ease of insertion and removal, and on the fact that a trained surgical team in an operating room setting is not necessary. Effectiveness of the balloon in comparison to the traditional intra-aortic balloon pump is also discussed.
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Cardiac muscle death caused by coronary artery occlusion is a dynamic process that often takes hours or days. Emergency revascularization (saphenous vein bypass graft (SVBG) during acute myocardial infarction (MI) can interrupt myocardial necrosis, salvage ischemic myocardium and revascularize vessels with obstructive lesions not involved in the MI. In this report we describe a preliminary experimental study of 75 patients in which emergency SVBG was the therapy for acute MI. Group 1, 16 patients, required vasoactive medications and/or intraaortic balloon pumping to maintain their blood pressure preoperatively. There was one operative death and two late deaths. Group 2 consisted of 59 hemodynamically stable patients. There were no deaths. The average preop CPK in group 1 was 892 vs 504 in group 2 (p greater than 0.05). Surgical techniques were routine. The average time from the onset of chest pain that continued to surgery was 6.5 hours. Forty patients were restudied. Post- vs presurgical hemodynamics revealed ejection fraction increased by 34% (p greater than 0.05), left ventricular end-diastolic pressure reduced by 40% (p greater than 0.01). End-systolic and end-diastolic volume reduced by 30% (p greater than 0.05), and 15% (p greater than 0.01), and stroke volume improved 25% (p greater than 0.05). Operative mortality was 1.3% and late mortality 2.8%. These results suggest that cautious continued trial of emergency SVBG in patients with evolving MI is warranted.
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