Biomedical subjects

Luís Moura

Publications and source records attributed to Luís Moura.

3 recordsLinked to original sources

PubMed2004

Negative predictive value of dipyridamole vs. dobutamine stress echocardiography in the long-term follow-up of patients undergoing major vascular surgery.

INTRODUCTION: Perioperative cardiovascular complications are a significant cause of post-surgical morbidity and mortality in patients undergoing major vascular surgery (MVS). Dobutamine stress echocardiography is the most important method of detecting coronary artery disease in these patients. Although dipyridamole stress echocardiography (SE-DIP) and dobutamine stress echo (SE-DOB) have demonstrated similar negative predictive value (NPV) in the early postoperative period in patients undergoing MVS, there are few data concerning the negative predictive value of SE-DIP in the long-term follow-up of this subgroup of patients. OBJECTIVE: Our aim was to compare the long-term NPV of these two types of stress echocardiography and to compare it with perioperative NPV, based on the working assumption that they are similar. PATIENTS AND METHODS: A retrospective study was made of 157 patients based on preoperative evaluations for vascular surgery between February 1997 and February 2000. Clinical history and the results of consecutive stress exams were analyzed. We excluded patients with a positive stress echo and those that performed dobutamine stress echo which was considered inconclusive since they did not reach 85% of the maximum heart rate for their age. Therefore, 110 patients were included, 29 (26.4%) with dobutamine and 81 (73.6%) dipyridamole-atropine. The patients were followed after surgery for a period of 2.2 +/- 1 years. Cardiac events were defined as cardiac death, nonfatal acute myocardial infarction and hospitalization for unstable angina. The cumulative probability of event-free survival was compared. RESULTS: The patients' mean age was 65 +/- 10 years, and 108 (98.1%) were men. After 2.2 +/- 1 years of follow-up, 7 cardiac events occurred in the group with negative SE-DIP (8.6%) and 3 in patients with negative SE-DOB (10.3%). There were no statistically significant differences between the two groups concerning event-free survival (3.7 +/- 0.2 vs. 3.5 +/- 0.2 years for SE-DIP and SE-DOB respectively; p = 0.91). Negative predictive values for SE for perioperative and long-term cardiac events were 97.3% and 90.9% respectively. CONCLUSIONS: SE-DIP is a good alternative to SE-DOB in the preoperative evaluation of patients undergoing MVS, with the NPV of SE-DIP being similar to SE-DOB in the perioperative period and in long-term follow-up.

Aged↗

PubMed2004

Right atrial rupture.

Cardiac rupture is a rare complication of primary cardiac tumors. We present a very uncommon case of cardiac angiosarcoma presenting as a right atrial rupture. A 58-year-old patient presented progressive dyspnea, weight loss, anorexia and asthenia. A chest X-ray revealed global cardiac enlargement, mainly from the right atrium. Transthoracic echocardiography gave rise to the suspicion of right atrial pseudoaneurysm, which was confirmed by transesophageal echocardiography. The ruptured atrial wall was clearly seen using contrast echo. In addition, magnetic resonance imaging provided an excellent tool in the anatomic evaluation of this uncommon complication. The diagnosis of angiosarcoma was hystologically confirmed.

Female↗

PubMed2002

Perioperative mortality and long-term outcome of infective endocarditis.

INTRODUCTION AND OBJECTIVES: Infective endocarditis (IE) is a disease with a high morbidity and mortality during the active phase and a considerable risk of complications during follow-up. The aim of this study is to describe the clinical features of IE associated with perioperative mortality in patients undergoing surgery and the short- and long-term prognosis of this disease after surgical treatment. PATIENTS AND METHODS: The clinical files of 150 patients (pts) admitted to our institution between 1989 and 2001 and whose final diagnosis was IE (Duke criteria) were retrospectively reviewed. Thus all patients included underwent at least 1 transthoracic examination, and a transesophageal examination if indicated. The study population was 69 patients with IE, 62 of whom (90%) underwent prosthetic valve replacement and 7 (10%) underwent explanation of pacemaker electrocatheter. In the statistical analysis, quantitative variables are expressed as means +/- SD and qualitative variables as proportions (percentages). Differences in survival were determined using the Kaplan-Meier log rank method. Associations were considered statistically significant when the p value was < 0.05. RESULTS: The mean age was 56 +/- 15 years. Thirty-five cases (51%) had prosthetic valve endocarditis, 30 (39%) had native valve IE and 7 (10%) pacemaker electrocatheter IE. Fifty-two patients (75%) had positive blood cultures. The most frequent agents were S. epidermidis (14.5%), S. aureus (14.5%), Enterococci (13%) and S. viridans (10%). Total perioperative mortality was 17.4% (n = 12), and surgical mortality was 19.4%. Our study shows a statistical tendency for higher mortality in diabetic patients (50% vs. 14%, p = 0.052) and in women (29% vs. 11%, p = 0.065). In multivariate analysis, the presence of heart failure was an independent predictor of perioperative mortality (OR = 11.4; 95% CI: 2.0-215.2; p = 0.024). Accumulated mortality in the first year was 28% and 5-year mortality was 48%. CONCLUSIONS: Prosthetic valve replacement in patients with IE is associated with high perioperative mortality (17.4%). Despite good early postoperative results, the mortality rate increases during the first year as well as the need for reoperation.

Endocarditis, Bacterial↗