In order to analyze the angiographic characteristics associated with left ventricular hypertrophy in patients with coronary insufficiency, the left ventriculography was used to calculate the ventricular volumes, the ejection fraction (EF) and the ventricular mass (LVM) in 31 patients with clinical diagnosis of ischemic heart disease. Patients were divided into three groups: A) Those with normal coronaries and (EF), B) Those with coronary lesion and EF greater than 50% and C) Those with coronary lesions and EF less than 50%. The following results were obtained for the telediastolic volume (ml/m2), the EF (%) and the LUM (g/m2): Group A = 85 +/- 19, 73 +/- 7 and 41 +/- 13. Group B = 102 +/- 25, 61 +/- 8 and 50 +/- 9. Group C = 154 +/- 27, 39 /+- 7 and 74 +/- 17 respectively. Comparing the FEV with the LVM in the patients studied, a negative correlation was found with an r index of -0.7894 (p less than or equal to 0.001). The correlation index for the diastolic volume and the LVM was r = 0.6806; and -0.6991 for the EF and the telediastolic volume. These findings suggest that hemodinamic changes, especially an increase in the ventricular volume and subsequently in the tension of the ventricular wall, act as a stimulus in initiating a metabolic chain leading to ventricular hypertrophy. This process is compensatory in the initial phases of the disease (groups A and B) but insufficient in the advanced stage (group C).

Angiocardiography↗

PubMedDate not supplied

[Functional significance of collateral coronary circulation in univascular obstructions (1)].

The presence, degree and functional significance of the coronary collateral circulation was investigated in a group of 68 patients with angiographycally important (greater than 60%) univascular coronary obstruction. The following clinical parameters were reviewed. Smoking, hypertension, diabetes mellitus, functional class (NYHA), and degree of angina pectoris. In the ECG the presence of abnormal Q waves and the response to the stress test were analysed. To evaluate the functional significance of the collateral circulation the following angiographic and hemodynamic parameters were measured: ejection fraction (FE 100), mid sistolic ejection fraction (FE 50), percent of regional shortening of the left ventricular wall and finally the end diastolic pressure. According to the obstructed vessel (R, DA, Cx) the degree of obstruction (parcial or complete) and the degree of collateral circulation (O, I, II, III) several groups were formed. Statistical analysis of all the above mentioned clinical, electrocardiographic and angiographic findings were compared amongst the various groups. Coronary collateral circulation was demonstrated in 45 patients (68%) being present in 82% of those with complete coronary obstruction. In most of the patients (87%) an abundant collateral network was present (grade II or III). No statistical differences were demonstrated between the groups with abundant or poor collateral circulation in all the clinical, electrocardiographic or angiographic parameters. Finally we conclude that important collateral circulation usually develops in the presence of severe coronary obstruction; however its functional value is limited.

Adult↗

PubMedDate not supplied

[Collateral pathways in patients with univascular coronary obstruction (2)].

We found 10 coronary collateral pathways in patients with right coronary (RC) obstruction. The communication with the anterior descending (DA) through the septum was the most prevalent. 5 pathways were found in the presence of DA obstruction, again the communication with the RC through the apex was the most frequently observed. Only 2 pathways were found in the presence of circumflex (Cx) obstructions.

Collateral Circulation↗

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[Left ventricle function in isolated mitral stenosis. Regional angiographic study during the ejection phase].

Twenty two patients with rheumatic mitral stenosis and 12 healthy individuals were studied, using the following parameters: 1) Basal (B), Medial (M) and apical (A) mean velocity of circunferential shortening (VMAC); 2) Ejection fraction (EF); 3) Mid-systolic ejection fraction (FE 50); 4) Relative ejection fraction (REF = FE 50/FE). The student T comparing the patients with mitral stenosis to the control group showed statistical difference in all the parameters studied, but in the M and A, VMAC. In 13 patients (59%) the EF and the REF were found diminished, on the other hand, the EF 50 was definitively abnormal in 19 patients (86%). Twenty one patients (96%) showed abnormalities at least in two of the mentioned parameters and finally, only one had normal ventricular function. We conclude that the ejection ventricular function studied with "regional" indexes is almost always abnormal in patients with mitral stenosis.

Cardiac Output↗

PubMedDate not supplied

[Comparative study of coronariography and radiocoronariography in ischemic cardiopathy. Preliminary report].

25 patients with ischemic heart disease were studied by selective coronariography and radiocoronariograpy with 3mCi of human albumin macroaggregates labeled with 99mTc, injected selectively into each coronary artery. Gammagraphic images were then obtained. 17 cases (68%), had coronary obstructions and 8 patients (32%), had a normal coronary angiogram. Of all patients studied, 23 (92%), had areas of hypoperfusion. Patients with coronary obstructions had corresponding image defects. 6 cases with normal coronary angiography had areas of hypoperfusion and finally 2 cases had normal images in both studies. All patients wit EC6 necrosis had abnormal radiocoronariography. The macrocirculation is studied by coronary angiography, while the microcirculation is visualized by radiocoronariography. Both technique are complementary. We conclude that radiocoronariography should be performed routinely after coronary angiography in the study of ischemic heart disease, with special emphasis in cases with normal angiograms.

Angiocardiography↗

PubMedDate not supplied

[The DDD pacemaker implanted intravenously].

Retrospectively, we studied 66 consecutive patients in whom we implanted an intravenous DDD pacemaker. The indications were: AV block in 52 patients (79%), sick sinus syndrome in 5 patients (7.5%), both AV block and sick sinus syndrome in 4 patients (6%), and other causes in 5 (7.5%). The venous access route was by subclavian punction in 38 cases (57.5%) and by cephalic vein dissection in 28 (42.5%). With a mean follow-up of 16 months, there were complications in 11 patients (17%), in 9 of them, it was necessary a change in pacing mode different to DDD, and was possible to maintain a DDD pacing mode in 2 patients with a minimal reprogramming. The complications were: A) lost of sense and/or atrial capture in 10 patients (3 of them, had also loss of ventricular capture, one had pacemaker-mediated tachycardia, other had diaphragmatic stimulation and other had a severe infection of the pocket), B) atrial fibrillation appeared in another patient. At the implantation time there were significant differences between patients with and without complications on follow-up, the P wave amplitude was 1.86 +/- 0.75 mV in the first group vs. 3.06 +/- 1.52 mV in the latter group, p < 0.005, and the atrial pacing threshold was 1.10 +/- 1.17 microJ in the first group vs. 0.65 +/- 0.66 microJ in the latter group, p < 0.005. We consider that dual chamber stimulation is a well established form of therapy, although, it requires a more laborious implantation and specialized personal for its follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[The implant of a pacemaker cardioverter-defibrillator with a system of endocardial electrodes without thoracotomy].

This article describes the first case in Mexico of an implantable pacer-cardioverter-defibrillator in a 44-year-old man with coronary artery disease and recurrent ventricular tachycardia without the need for a thoracotomy and epicardial electrodes. The patient underwent electrophysiological evaluation that revealed drug-refractory ventricular tachycardia. Endocardial catheter ablation with radiofrequency was considered and rejected due to an unstable hemodynamic state during the tachycardia. A triple electrode system using two transvenous catheter electrodes and a subcutaneous chest patch were employed. Two monophasic unsynchronized shocks were delivered with a 18 J sequential pulse technique over two distinct current pathways. The automatic pacer-cardioverter-defibrillator was implanted in the abdominal wall and demonstrated reproducible termination of ventricular fibrillation.

Adult↗

PubMedDate not supplied

[Clinico-angiographic correlations in ischemic cardiopathy].

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Angiocardiography↗

PubMedDate not supplied

[Angiocardiographic observations in 20 patients with unstable angina pectoris].

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Angina Pectoris↗

PubMedDate not supplied

[Determination of the real value of the ventricular volume using angiographic methods].

The developing of cuantitative angiographic procedures for evaluating the left ventricular efficiency have displaced most of the simple hemodynamic methods. The calculation of the left ventricular volume by usual ventriculography yields, as a rule, magnified values. The purpose of this paper is to determine the equation of the regression line means of which the real left ventricular volume can be calculated. A series of 12 normal hearts obtained from accidentaly deceased adult individuals (this necropsy material was afforded by the Forensic Medicine Department of México City). Previously measured amounts of a contrast substance were injected into the left ventricular cavity. The heart was filmed in a position equivalent to the chest RAO. The volume of the left ventricle was calculated using monoplane Sandler and Dodge cineventriculographic method. The results were submitted to statistic analysis. Confrontation of calculated and real values rendered a significative "r" (0.7374) and a non-significant "p" (0.001) the regression equation obteined was: y=36.97 + (0.39 x) in which: y=real left ventricular volume. x=calculated left ventricular volume.

Angiocardiography↗

PubMedDate not supplied

[Pre-excitation syndrome in monozygotic twins].

A family group of seven members is presented, two of which have pre-excitation syndrome. These subjects are identical twin brothers. One of them has the W-P-W syndrome tipe B, and the other has L-G-L syndrome. The latter had an associated atrial-septal defect, and the other twin had no associated cardiovascular lesions. Both underwent electrocardiographic and vectorcardiographic studies, as well as His bundle electrograms. In the case with W-P-W, the diagnosis was made by electrocardiography, and was confirmed by vertocardiography. The His bundle electrogram showed the habitual findings in this type of pre-excitation. The His bundle potential was preceded by the beginning of the delta wave. The patient with W-P-W had episodes of supraventricular paroxysmal tachycardia, some of these with antegrade conduction through the normal pathway, and others with conduction through the anomalous pathway. The other had a L-G-L syndrome, demonstrated by electrocardiography and vectorcardiography. During the register of the His bundle electrogram, he did not present pre-excitation, the tracings in basal conditions as well as during atrial stimulation were normal. The conclusion is that many factors exist which back up the hypothesis that the pre-excitation syndromes occur because of anomalous pathways, and that this type of alteration might have a sex linked genetic basis. This presumption appears to be confirmed by the presence of pre-excitation in identical twin brothers. Other possibilities are also discussed.

Child↗