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Biomedical subjects

P Giudice

Publications and source records attributed to P Giudice.

9 recordsLinked to original sources
PubMed1981

His bundle electrogram recording using a multipolar electrode catheter via the arm veins.

In eighteen patients with atrioventricular conduction disturbance, His bundle electrograms were studied via the arm vein. A 6F Berkovits-Castellanos USCI hexapolar electrode catheter was introduced into the right atrium and looped across the tricuspid valve in a "golf club" shape. The main aim was to leave the two distal electrodes in contact with the atrial endocardium to perform atrial pacing, while displaying the other four electrodes along the superior angle of the tricuspid valve for proximal and distal His bundle recordings. His bundle electrograms were successfully obtained in all cases. The arm approach provides an alternate route whenever the femoral approach is not feasible. Moreover, the use of an hexapolar electrode catheter provides some practical advantages: 1) it enables atrial pacing to be performed, as well as proximal and distal His bundle recording to be obtained, by using the same multipolar electrode catheter; and 2) it allows long-term monitoring of His bundle potentials, in view of the stability of His bundle recordings. Finally, the arm approach could be the method of choice for the study of His bundle electrograms during leg supine exercise in selected patients.

Arm↗
PubMed1981

Clinical hemodynamic and angiographic findings in 94 patients with old myocardial infarction. Comparison with 79 patients with coronary artery disease and no myocardial infarction.

Clinical, hemodynamic, coronary arteriographic, and ventriculographic findings of 94 patients (pts) with coronary artery disease (CAD) and old myocardial infarction (MI) have been described and compared with those of 70 pts with CAD and no previous MI. Pts with old MI presented a more compromised functional and hemodynamic status, with a higher incidence of NYHA class III-IV pts (40%), symptoms of left ventricular (LV) failure (31%), cardiomegaly (70%), higher left ventricular end-diastolic pressure (LVEDP) (19.6 +/- 9.6 mmHg, p less than 0.05), compared with 32%, 22%, 54% and 16.0 +/- 6.8 mmHg respectively in CAD pts with no MI. MI pts presented more severe CAD, higher incidences of three vessel disease (56%, p less than .005) and of left anterior descending (LAD) (34%) and right coronary artery (RCA) (36%) occlusions, compared with 34%, 6%, and 9% respectively in pts with no MI. Furthermore, pts with old MI showed more diffused and severe LV segmental wall contraction abnormalities, with higher frequencies of LV aneurysm (31%) and of pts with asynergy of more than 2 LV segments (26%), compared with 1% and 3% respectively in pts with no MI. Within the group with old MI, LVEDP was higher in pts with anterior (A) (22.0 +/- 11 mmHg, p less than .02) and anterior ł diaphragmatic (AłD) (21.5+/- 7.9 mmHg, p less than .05) MI, compared with pts with diaphragmatic (D) MI (16.6 +/- 7.1 mmHg); furthermore, LVEDP increase was significantly correlated with the severity and the extent of LV asynergy. In A and D MI, LAD and RCA stenoses or occlusions were prevalent respectively; pts with AłD MI showed larger numbers of coronary stenosis (3.05) and occlusions (1.05) per patient. The coronary artery supplying the infarcted area showed stenosis (greater than 75%) in 95.6% and was normal in 2.2% of cases. Thus, pts with CAD and old MI, and particularly of AłD and A MI, show a more compromised hemodynamic status and more severe degrees of CAD and of LV segmental wall contraction abnormality, which are responsible for their poor prognosis, compared to pts with CAD but no old MI.

Adult↗
PubMed1980

[Diagnostic availability of R wave changes during effort test for a diagnosis of coronary artery disease (author's transl)].

New ecgraphic criteria has been proposed to improve diagnostic availability of R wave changes (delta R) and algebra summation of delta R and ST segment depression (delta RST) in comparison to the criterion of ST depression (ST). The AA. considered as a positive test for a diagnosis of coronary artery disease (CAD): delta R and delta RST values greater than or equal to 0. In 69 patients with stenosis, 75% of at least one major coronary vessel, delta RST showed correct diagnosis in 87% of cases, R in 81% and ST in 73%. RST sensitivity was better than that of ST (P = 0,02). In 44 patients with normal coronaries delta RST was able to correct diagnosis in 52% of cases, delta R in 57% and ST in 73%. ST specificity was better than that of delta RST (P = 0,04). Predictive accuracy was comparable for the three criteria. In normal healthy subjects everyone with an exercise test negative for CAD, with ST analysis, delta R and delta RST was 0 in 16% of cases. New ecgraphic criteria, also showing a better sensitivity in comparison with ST segment analysis, have a worsened specificity. The Authors do not consider these methods a significant improvement in ecgrahic evaluation of exercise test.

Adult↗
PubMed1979

Hemodynamic response to exercise after propranolol in patients with mitral stenosis.

Hemodynamic response to exercise before and 10 minutes after propranolol (5 mg intravenously) was studied in 10 young patients with pure mitral stenosis who had normal sinus rhythm and no cardiac failure. After propranolol the mean heart rate and cardiac index at rest were lower than during the control state (respectively, 95 +/- 4 versus 82 +/- 3 beats/min, P less than 0.005; 3.4 +/- 0.2 versus 2.8 +/- 0.1 liters/min per m2, P less than 0.025). As a result, the mean pulmonary wedge pressure and mean mitral valve gradient at rest were lower (respectively, 22 +/- 2 versus 18 +/- 2 mm Hg, P less than 0.005; 24 +/- 2 versus 17 +/- 2 mm Hg, P less than 0.001). During exercise after propranolol the values of pulmonary wedge pressure and mitral valve gradient were lower than control values during exercise (respectively, 39 +/- 3 versus 30 +/- 2 mm Hg, P less than 0.005; 44 +/- 3 versus 32 +/- 3 mm Hg, P less than 0.005), again because of the lower heart rate and cardiac index (130 +/- 6 versus 104 +/- 6 beats/min, P less than 0.001; 4.6 +/- 3 versus 3.7 +/- 2 liters/min per m2, P less than 0.01). Left ventricular end-diastolic pressure and stroke index showed no significant changes. Thus, propranolol may benefit patients with pure mitral stenosis with sinus rhythm and no cardiac failure whose symptoms occur during those reversible conditions characterized by an increase in heart rate or cardiac output, or both.

Adult↗
PubMed1979

[Iatrogenic ostial stenosis of the left coronary artery. Report of a case with Starr-Edwards aortic prosthesis (author's transl)].

A case of a 41 years-old-man, who had undergone surgical intervention ten years previously for aortic valve replacement in ECC with the coronary perfusion technique, is reported. This patient was studied because of the appearance of angina pectoris three months after the intervention and its progressive development. Selective left coronary angiography showed an ostial subocclusive stenosis; the run-off from the right coronary artery provided distal blood supply to the left coronary artery. A venous bypass was implanted between the aorta and the left anterior descending branch; the prosthesis was substituted because it was altered and caused hemolysis' problems. In accordance with most Authors late ostial coronary stenosis is a complication of the coronary perfusion technique, which is adopted for myocardial protection during surgical interventions for aortic valve replacement.

Adult↗