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Biomedical subjects

M Rijlaarsdam

Publications and source records attributed to M Rijlaarsdam.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[Obstruction of the outflow tract of the left ventricle by accessory mitral valve tissue].

Among the causes of left ventricular outflow tract obstruction, accessory mitral valve tissue is one of the last described and least studied. At present echocardiography permits a complete exploration of the atrioventricular valves as well as left ventricular outflow tract. In this study we evaluate the information obtained in four patients with two-dimensional echocardiography and color-coded Doppler by both transthoracic and transesophageal approaches. The information was compared with catheterization results. In none of the three cases in which hemodynamic study was performed, diagnostic angiographic images of the anomaly were obtained. Transesophageal echocardiography gave additional information about the mitral valve and subvalvular apparatus, the site of accessory tissue implantation and associated lesions.

Adolescent↗
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[Interatrial aneurysm as a cause of supraventricular arrhythmia in a newborn infant].

Atrial septal aneurysm is a rare malformation that may occur as an isolated abnormality or in association with various cardiac defects or with connective tissue disease. The reported incidence in adults is 0.2% and in children 4.9% which suggests spontaneous regression with advancing age. Atrial septal aneurysm may be complicated by thromboembolism, valvular obstruction or arrhythmias. Supraventricular arrhythmias have been reported in as much as 16% of the cases, most commonly paroxysmal supraventricular tachycardia, supraventricular extrasystoles and atrial flutter. The relationship between the arrhythmias and the atrial septal aneurysm is still controversial. Two cases of atrial septal aneurysm in neonates are described, who presented with arrhythmias: supraventricular extrasystoles with aberrant conduction and atrial flutter with variable conduction, respectively. One of them required treatment with various anti-arrhythmia agents. During follow-up the arrhythmias remitted with spontaneous involution of the aneurysm. In the presence of the supraventricular arrhythmias in neonates, atrial septal aneurysm needs to be ruled out as a potential cause.

Age Factors↗
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[Valve prostheses and transesophageal echocardiography].

The aim of this paper is to inform about the experience of the Echocardiography Department of the National Institute of Cardiology Ignacio Chávez, in the assessment of prosthetic valves dysfunction by transesophageal echocardiography. Sixty patients with a total of 75 prosthetic valves: 19 bioprostheses and 56 mechanical valves were studied. Forty four were in mitral position, 27 in aortic position and 4 in tricuspid position. All patients were evaluated using 5 MHz monoplane or biplane transesophageal transducers. The 52% (39) of the studied prosthetic valves were found normally functioning. However, 48% (36) of these showed signs of dysfunction. The causes of dysfunction in the mechanical valves were: obstruction, pannus, infectious endocarditis and periprosthetic leak, and in relation with bioprostheses rupture of the leaflets, stenosis and calcification, partial dehiscence, infectious endocarditis and periprosthetic leak were identified. The obtained percentage and type of prosthetic valves dysfunction in our results agree with those reported in the literature and confirm the great utility of transesophageal research in the detection of the valvular prosthetic dysfunction.

Adolescent↗
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[Corrected transposition of the great arteries in patients over 65].

Three cases with corrected transposition of the great arteries in patients older than 65 years are described. Two had atrial situs solitus and one atrial situs inversus. One had pulmonary valvular stenosis with valvular calcification and a small ventricular septal defect in association with ischemic heart disease. This patient died due to cardiac failure at the age of 80 years. The second case was associated with ventricular septal defect, atrial septal defect and pulmonary hypertension. The third patient presented with mild tricuspid regurgitation. Although this congenital heart malformation is theoretically compatible with normal life, few patients have long survival because of associated congenital defects or the subsequent development of tricuspid regurgitation or atrioventricular block.

Aged↗
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[Adenosine for suppression of paroxysmal supraventricular tachycardia in a newborn infant. First case in Mexico].

We present the case of a 20-day old baby who was admitted with orthodromic supraventricular reentry tachycardia with a heart-rate of 300/minute. Suppression of the arrhythmia was tried with vagal maneuvers and digoxin. On failure to control the heart rate, a 0.05 mg/kg intravenous bolus of adenosine was given, with immediate response and subsequent normal heart rate and rhythm. In the following year he has been adequately controlled with oral digoxin. This is the first pediatric patient treated with adenosine in Mexico. Even though experience elsewhere in this age group is also limited, the properties of adenosine make it a valuable first-choice drug for the control of paroxysmal supraventricular tachycardia.

Adenosine↗
PubMedDate not supplied

[Usefulness of Doppler echocardiography in the analysis of left ventricular isometric relaxation time in an experimental model of myocardial reperfusion].

UNLABELLED: Modifications of left ventricular isometric relaxation time (LVIRT) were analyzed in an experimental model of myocardial reperfusion (MR). In a prospective study, 19 mongrel dogs were studied with open chest, mechanical ventilation and hemodynamic monitoring. A catheter was inserted in the middle third of the anterior descending artery (ADA) for registry of its pressure. The ADA was ligated distal to the first diagonal branch for 15 min and subsequently untied. Epicardial Echo/Doppler registries were obtained in basal conditions, at 5 and 15 min of ischemia and at 5, 15, 30 and 60 min after MR. Mobility and changes in thickness of the interventricular septum (IVS) were analyzed, and LVIRT was measured in all of the periods mentioned. There were no significant changes in the thickness of IVS. LVIRT increased in comparison to the basal registry at 5 and 15 min of ischemia (p < 0.0001) and returned to basal values with MR (p < 0.05). CONCLUSIONS: Acute myocardial ischemia prolongs LVIRT, in this model, during MRLVIRT returned to normal. In the experimental model, measurement of LVIRT may be used as criterion for reperfusion.

Animals↗
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[Diagnosis of thoracic aorta dissection using transesophageal echocardiography].

During a 36 month period there were 20 patients in our hospital with aortic dissection suspected clinically. All of them were examined with transesophageal echocardiography (TEE); 17 were examined with transthoracic echocardiography (TTE); six with computed tomography (CT) and seven with aortography. Twelve patients required surgery: eight with proximal aortic dissection (Type-A), two with distal dissection (Type-B) and two with aortic aneurysm without dissection. With the goal of investigating the utility of TEE for the diagnosis of aortic dissection in our hospital, we compared this and other available methods to the surgery findings. The sensitivity to TEE was 100% and the specificity 92%, with test accuracy at 92%. The sensitivity of the other tests was low: 66% with TTE; 50% with TAC; 57%, with aortography. The specificity was 90% with TTE, and higher with CT and aortography (100%). The ultrasound tests reveal additional information about complications like aortic regurgitation. Transesophageal echocardiography is the best test to examine patients with aortic dissection in our hospital. Computed tomography, aortography and magnetic resonance imaging have indication only to answer specific doubts.

Adult↗
PubMedDate not supplied

[The transcatheter closure of patent ductus arteriosus. The initial experience].

Percutaneous closure of the patent ductus arteriosus (PDA) has been recently reported to be an effective alternative in the treatment of patients with ductal shunting. We report the initial experience and results during follow-up of percutaneous ductal occlusion with the Rashkind occluder (USCI) in six patients with isolated PDA. Ages ranged from 3 to 23 years. Diagnosis was corroborated with two dimensional and Doppler echocardiography in all patients. During cardiac catheterization systolic pulmonary artery pressure oscillated between 22 and 64 mmHg and Qp/Qs ratio between 1.3 and 4.1. In two patients prosthesis of 12 mm were used and in the remaining prosthesis of 17 mm. Only one patient demonstrated total occlusion during immediate control aortography, the other patients presented central residual shunting over the occluder. In the three patients occlusion with balloon-catheter was added to the procedure, resulting in total occlusion in two and significant reduction of the shunt magnitude in one. Two technical problems were resolved satisfactorily. None of the cases presented device embolization. Mean follow-up was 23.8 months with control echocardiograms at 24 hours, 1, 4, 12 and 24 months. In all patients immediate reduction of the left atrial dimension was demonstrated. Three patients presented residual shunts in the first 24 hours. In two of them total occlusion had occurred after one month and the other patient persisted with a small residual shunt until one year after the procedure. In conclusion, in this small study group good results were obtained with percutaneous ductal closure.

Adult↗
PubMedDate not supplied

[The usefulness of transesophageal echocardiography in the diagnosis of intracardiac and extracardiac tumors].

We studied 18 patients with suspected intrathoracic mass from january 1990 to august 1993. In all patients electrocardiogram, X-ray, transthoracic and transesophageal echocardiography were performed. Accordingly, the patients were divided into two groups: I) 8 patients with intracardiac myxoma, and II) 10 patients with no myxomatous tumor. The histopathologic identification of the intracardiac or extracardiac tumor was corroborated in all patients of group I and in only 8 patients of group II. In group I the mean age was 39 years and the female sex was more frequently (75%); with transthoracic and transesophageal approaches the myxoma was found in right atrium in four patients, in left atrium in three, and in the last patient the four chambers were occupied. In group II the mean age was 36 years, and the male sex was predominant (60%). In three patients cardiac tumors were detected by echocardiography, two of them were found in the right cavities (leiomyoma and leiomyosarcoma), in the rest the histologic lineage of the left atrial tumors was not possible to recognize. In the other seven patients with mediastinal tumor the heart was not infiltrated. On the basis of the obtained results we conclude that transthoracic echocardiography permits the identification of the intracardiac tumor; in these patients transesophageal studies give us an additional valuable information about the valves, the site of tumoral implantation and the wall infiltration. Transesophageal approach provides more information about its potential cardiac compression.

Adolescent↗
PubMedDate not supplied

[Usefulness of the measurement of the left-ventricular isometric relaxation time by echo-Doppler during the administration of dipyridamole or dobutamine as a method of inducing myocardial ischemia].

Myocardial isquemia prolongs ventricular relaxation. The purpose of this study was to assess the isovolumetric relaxation time of the left ventricle (IVRT) as a parameter of global ventricular relaxation, during the administration of Dipyridamol or Dobutamine intravenously. We studied 58 patients with ischemic heart disease uncovered by the administration of pharmacological agents. They were divided in two groups: 22 patients in the group of Dipyridamole, which was administered intravenously at a dose of 0.84 mg/kg during 10 minutes and 36 patients in the group of Dobutamine administered at a dose of 5, 10, 20, 30 and 40 mcg/kg/min in stepping fashion every three minutes. Coronariography was performed in all patients. The measurements of the maximal velocities of the E and A waves, as well as the deceleration time of the E wave and the pressure half time of the mitral flow did not show significant changes in both groups. If the study was positive by criterion of alteration of the wall motion, the IVRT corrected from the heart rate (IVRT/C) had an increase in 54% (p < 0.01) with respect to baseline values in the same patient in the Dipyridamole group and in the Dobutamine group the increment of the IVRT/C was 26% (p < 0.20). The sensibility (Sen), specificity (Sp) and positive predictive value (PPV) of the IVRT/C increments in detecting proximal significant obstruction of the left anterior descending coronary artery of trivascular disease in the Dipyridamole group was of 50%, 100% and 100% respectively. In the Dobutamine group the Sen was of 74%, the Sp of 60% and the PPV of 89%. Nor Dipyridamol neither Dobutamine produced a significant prolongation of IVRT/C when alterations of wall motion were absent or when the existing alterations were not exacerbated. On the basis of these results we concluded that the measurement of the IVRT/C in studies of myocardial ischemia with pharmacological provocative maneuvers is an additional useful parameter together with segmental alterations of wall motion to differentiate positive from negative studies.

Cardiotonic Agents↗
PubMedDate not supplied

[Transthoracic and transesophageal echo Doppler in the detection of mitral prosthesis dysfunction due to insufficiency].

UNLABELLED: Severe mitral regurgitation is accompanied by increment of left atrial pressure. The objective of this work was to compare Doppler parameters related to transvalvular peak-pressure gradient in patients with normally functioning and patients with malfunctioning mitral prosthetic valve, secondary to insufficiency, in order to analyze if the presence of high protodiastolic pressure gradient and normal prosthetic valve area could correlate with severe mitral regurgitation (MR). Fourty-two patients were studied. Group I: twenty-two normally functioning prosthesis (15 mechanical, 7 biological). Group II: twenty malfunctioning mitral prosthetic valves secondary to severe insufficiency (11 mechanical and 9 biological), 12 patients with acute MR and 8 with chronic MR. All of the patients were evaluated though transthoracic (TTE) and transesophageal (TEE) Doppler-echocardiography. Diastolic peak velocity prosthetic flow (DVP), protodiastolic gradient (PDG), mean gradient (MG) and prosthetic area (PA) by pressure halftime (PHT) were measured. DVP in Group I was 1.56 +/- 0.29 m/s and 2.49 +/- 0.30 m/s in Group II (p = 0.001). PGD measured 10.36 +/- 3.79 mmHg in Group I and 15.95 +/- 7.48 mmHg in Group II (p = 0.001). MG 4.86 +/- 1.90 mmHg in Group I and 10.38 +/- 4.8 mmHg in Group II (p = 0.001). PA was 2.01 +/- 0.54 cm2 in Group I and 2.10 +/- 0.43 cm2 in Group II (NS). PHT was 115.59 +/- 31.99 mseg in Group I and 108.3 +/- 19.1 mseg in Group II (NS). CONCLUSION: In patients with high PDG (greater than 20 mmHg) and normal prosthetic mitral area assessed by TTE could be suspicious of malfunctioning prosthesis secondary to severe insufficiency. Due to the higher sensitivity and specificity in the diagnosis of malfunctioning mitral prosthesis and the ability to determine the magnitude and severity of prosthetic regurgitation assessment should be completed with TTE.

Bioprosthesis↗
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[Oral enalapril in patients with symptomatic ventricular septal defects].

Experimental and clinical studies have demonstrated that the inhibitors of angiotensin-converting enzyme may reduce the left-to-right shunt over a ventricular septal defect (VSD). The objective of the study is to evaluate the effects of enalapril on short and medium follow-up in patients with symptomatic VSD and Qp/Qs ratio > 1.5 and compare the results with conventional anti-congestive treatment in children. Twenty-four patients with ages from 3 months to 8 years were studied, dividing them in 3 groups of 8 patients each. Group I received treatment with enalapril, group II with furosemide an digoxin, and group III was treated with a combination of the three medicaments. Patients were evaluated after one, three and six months. Evaluation considered clinical signs of congestive failure, weight, heart rate, blood pressure, cardiothoracic index, and with echocardiography the dimensions of the cardiac chambers, size of the VSD and hemodynamic parameters as Qp/Qs, pulmonary artery pressure (PAP), systolic pressure gradient over the VSD, EF and SF. Statistic analysis was done for each group and was compared the three groups. The results demonstrated significant weight gain (p > 0.05) in the three groups. A decrease in heart rate, Qp/Qs and PAP was observed in group III, however without statistic significance. No side effects were observed. The use of enalapril in combination with furosemide and digoxin may have beneficial effects in patients with symptomatic VSD, awaiting surgery.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

[Fontan surgery in tricuspid atresia. Experience at the National Institute of Cardiology "Ignacio Chávez"].

A retrospective analysis is presented of all patients under 18 years of age with tricuspid atresia and concordant ventriculo-arterial connection who underwent a Fontan procedure in the National Cardiology Institute "Ignacio Chávez", México-City, between January 1989 and December 1995. In this period Fontan procedure was performed in 22 patients with a mean age of 6.52 +/- 1.4 years. 14 of them were females. Thirteen patients had previous palliative procedure. Age of palliation was 10 +/- 12 months with period of 5 +/- 2 years between palliative and Fontan procedure. Overall mortality was 31% (7 patients); with a mortality of 42% between 1989 and 1992, of 22% between 1992 and 1995 and of 17% since 1994 with all 5 patients operated in 1995 surviving. Mean pulmonary pressure was 13.9 +/- 4.15 mmHg, mean pulmonary vascular resistance 1.66 +/- 0.57 U.W/m2, left ventricular end diastolic pressure 7.5 +/- 2.46 mmHg, ejection fraction 58 +/- 11% and Nakata and McGoon indexes 219 +/- 56 mm2/m2 and 2 +/- 0.1 respectively. No significant differences were found survivors and non-survivors, with exception of the left ventricular end-diastolic pressure (p < 0.05). Causes of death were multiple organ failure in 2, ventricular fibrillation in 3 and septic shock in 2.

Child↗
PubMedDate not supplied

[Tetralogy of Fallot in adults].

We present the clinical and hemodynamic profile of 33 patients, older than the 18 year with tetralogy of Fallot. Cardiac catheterization and selective angiocardiography were performed in all cases. We excluded patients with valvular pulmonary atresia associated with tetralogy of Fallot. Most of the patients were in functional class II or IV of the New York Heart Association and all presented with cyanosis. In the electrocardiogram of 23 patients we found right bundle branch block. None had significant cardiomegaly, 19 of 20 cases had reduced pulmonary blood flow and reticular pattern in the lung fields as observed in the chest X-ray. We did not find correlation between the age and the degree of cyanosis, but the level of arterial desaturation correlated with the functional class. The right ventricular systolic pressure was elevated in all patients. In all cases but one the pulmonary arterial systolic pressure were normal of slightly increased. One case with mild pulmonary infundibular stenosis had pulmonary systolic pressure similar to the systemic pressure. Multivariate analysis for functional class showed significant value for cyanosis. Systemic-pulmonary shunt was performed in 10 patients with hypoplastic pulmonary arteries plus reduced pulmonary blood flow, with one postoperative death. We did not find postoperative mortality in patients who underwent corrective surgery. The anatomic and functional behavior of patients who underwent surgery, allowed better tolerance to their heart defects.

Adolescent↗
PubMedDate not supplied

[The echocardiographic aspects of infectious endocarditis].

Infective endocarditis is a severe disease observed frequently in cardiologic centers. The importance of echocardiography in the diagnosis, the morphological criteria of vegetations, abscesses and periaortic complications were analyzed. The use of transesophageal echocardiography in patients with surgical indication is assessed. The significance of clinical symptoms of infective endocarditis in the echocardiographic interpretation must be always taken into consideration.

Abscess↗