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Biomedical subjects

P R Cipriano

Publications and source records attributed to P R Cipriano.

At least 19 recordsLinked to original sources
PubMed1988

Transluminal atherectomy for occlusive peripheral vascular disease.

Sixty-one patients with occlusive peripheral vascular disease were treated with transluminal atherectomy, a catheter-mediated technique for removal of atheroma. The technique was performed using 7Fr, 9Fr or 11Fr atherectomy catheters. Mean percent diameter stenosis was reduced from 71 to 23%, by removal of 831 atheromatous specimens in 949 passes of the cutting element through 136 stenoses in 61 patients. All specimens removed were sent for histopathologic examination to determine the components of the atheroma removed, which differed for specimens removed from original vs restenotic lesions. Percent stenosis was reduced to less than 45% in 118 of 136 stenoses (87%). Complications included 1 thrombus, which resolved after intraarterial infusion of streptokinase and 1 probable distal embolization without sequelae. Three angiographic dissections occurred without impairment of blood flow. There were no instances of acute occlusion, vascular spasm or vessel perforation. Six-month follow-up angiography was performed showing that patients who had a residual stenosis less than 30% after initial atherectomy had a lower restenosis rate (18%) than patients with initial residual stenoses greater than 30% (52%); this result demonstrated the importance of performing more complete atherectomy. Transluminal atherectomy appears to be an effective, predictable and safe method for removing occlusive atheromatous deposits from peripheral arteries.

Angioplasty, Balloon↗
PubMed1986

Balloon embolectomy catheter used percutaneously.

Percutaneous arterial embolectomy was performed following percutaneous transluminal angioplasty in three patients using Fogarty balloon embolectomy catheters. This technique is effective for the treatment of arterial embolism resulting from angioplasty in selected situations.

Angioplasty, Balloon↗
PubMed1984

Calcification of aortic versus mitral porcine bioprosthetic heart valves: a radiographic study comparing amounts of calcific deposits in valves explanted from the same patient.

Calcium detected by radiography was compared in 10 pairs of aortic and mitral glutaraldehyde-treated porcine bioprosthetic heart valves explanted from 10 patients (7 men and 3 women), aged 19 to 68 years (mean 43). Both valves of 6 pairs of valves had undergone primary tissue failure (revealed by cardiac catheterization and angiography) and 1 valve of the other 4 pairs of valves had undergone primary tissue failure. These porcine valves had been implanted from 2 1/4 to 9 years (mean 5 3/4). All 20 explanted valves contained calcium. The grade of calcium was the same in 4 pairs of valves (grade 2+ or 3+), and 1 grade different in 4 pairs of valves (grade 1+ to 4+), with the greater calcium evenly divided between the 2 valve positions. There was more than 1 grade greater mitral valve calcium in 2 pairs of valves (grade 3+ and 4+ mitral vs 1+ and 2+ aortic, respectively). Thus, calcium is usually present in both aortic and mitral valve positions when bioprosthetic valves of this type in either valve position fail as a result of primary tissue failure, and radiographic calcium in porcine bioprosthetic valves is usually similar in grade in both the aortic and mitral valve positions.

Adult↗
PubMed1983

Myocardial infarction in patients with coronary artery spasm demonstrated by angiography.

Twelve cases of myocardial infarction (MI) were documented in 11 of 39 patients who had coronary artery spasm (CAS) that was observed by angiography either before MI (3 patients), after MI (5 patients), or both before and after MI (3 patients). MI corresponded in location to sites of ECG changes of myocardial ischemia during spontaneous angina pectoris in 7 of 7 patients and to the region of myocardium supplied by the vessel in which CAS was observed by angiography in each patient. MI occurred in the distribution of the right coronary artery in 8 patients and of the left coronary artery in 4 patients. Of 12 vessels that supplied infarcted regions of myocardium, 7 vessels had greater than or equal to 50% diameter fixed coronary artery narrowing (CAN), but the remaining 5 vessels had minimal (10%) or no fixed CAN. In those patients who were studied after MI, coronary angiography demonstrated that only 3 of 9 vessels in the distribution of infarcted regions of myocardium were completely occluded. Clinical follow-up for an average of 1.3 years after MI showed that 7 patients continued to have chest pain, 2 patients were asymptomatic, and 2 patients died suddenly 9 weeks and 1 year, respectively, after MI. Therefore, among our patients with CAS demonstrated by angiography, MIs (1) were frequent (28%), (2) occurred in the distribution of observed coronary spasm, (3) were frequently (5 of 12 arteries) in the distribution of vessels having minimal or no fixed narrowing, and (4) were often (6 of 9 arteries) in the distribution of vessels that were demonstrated to be patient after MI.

Adult↗
PubMed1982

Calcification of porcine prosthetic heart valves: a radiographic and light microscopy study.

To determine the incidence and extent of calcification of implanted glutaraldehyde-treated porcine prosthetic heart valves, 82 valves explanted from 73 patients were examined for calcium by radiography and light microscopy. At the time of valve implantation, the patients were 2 1/4-76 years old. The included 15 children (patients younger than 15 years of age, mean age at time of valve implantation 8.7 +/- 4.1 years) and 58 adults (patients older than 15 years, mean age at time of valve implantation 53.5 +/- 15.1 years). Valves explanted from children (average time implanted 4.6 +/- 1.7 years) included four aortic, five mitral, as well as six right ventricle-pulmonary artery conduits and one left ventricle-abdominal aorta conduit. Valves explanted from adults (average time implanted 3.2 +/- 2.5 years) included 32 aortic and 32 mitral, as well as one tricuspid valve and one valve from a right ventricle-pulmonary artery conduit. Calcification of explanted valves was graded from 0 to 4+ based on radiographs. All 16 valves from children were calcified, with grade 3+ or 4+ calcification in each of the aortic and mitral valves. In adult patients, calcification was present in 10 of 33 valves (30%) implanted for less than 3 years (average time implanted 1.0 year), in nine of 11 valves (82%) implanted for 3-5 years (average time implanted 3.7 years) and in 21 of 22 valves (96%) implanted for 5 years or longer (average time implanted 6.2 years). Analysis of variance demonstrated that calcification was strongly related to the duration that valves were implanted (p less than 0.001). Age at the time of valve implantation also had a strong effect (p less than 0.001) on the amount of valvular calcium. Valves from children showed the most calcification, and the amount did not change when valves were implanted in patients 30 years of age or older. Patient sex and valve position had no effect on the amount of calcification. Calcification occurred at each right- and left-heart valve position, most frequently at sites of commissural attachments.

Adolescent↗
PubMed1981

Clinical course of patients following the demonstration of coronary artery spasm by angiography.

The clinical course of 25 patients was determined during an average of 2.7 years following the angiographic demonstration of coronary artery spasm (CAS). Seventeen patients received medical treatment after the demonstration of coronary spasm and six patients had cardiac surgery. Twenty-three patients were living and two patients had died at the time of follow-up. Twenty-one of the 23 surviving patients has either no chest pain or markedly reduced symptoms. However, the demonstration of CAS by angiography was associated with a high incidence of subsequent cardiac complications, which included myocardial infarct (four patients), cardiac arrest (four patients), and death (two patients). We concluded from this study that after the demonstration of CAS by angiography: (1) the clinical course was variable, with most patients (21 of 25 patients, 84%) having improvement of symptoms at the time of follow-up; (2) major cardiac complications were frequent (11 out of 25 patients, 44%) and; (3) although clinical and coronary angiographic features were of limited use in predicting major cardiac complications, most of the patients who had an uncomplicated course (11 of 14 patients, 79%) had either less than 50% fixed coronary artery luminal diameter narrowing (CAN) or coronary artery bypass graft operations, the majority of patients with less than 50% CAN (8 of 11 patients, 73%) had no major cardiac complications, and myocardial infarction or death usually occurred during periods of increased angina pectoris.

Adult↗
PubMed1981

Coronary artery spasm in the denervated transplanted human heart: a clue to underlying mechanisms.

The mechanism of coronary artery spasm has been poorly understood but there has been some suggestion that cardiac autonomic innervation may play an important role. We report coronary artery spasm in a 43 year old man two years after he had received a transplant. Provocative pharmacologic testing suggested functional denervation of the patient's heart. Thus, coronary artery spasm can occur in the transplanted, denervated human heart. Autonomic innervation of the heart is not essential in all cases of coronary spasm, and circulating catecholamines and/or metabolic of hormonal products may play an important role.

Adolescent↗
PubMed1981

Acute myocardial ischemia detected in vivo by computed tomography.

Normal and acutely ischemic myocardium was imaged by dynamic computed transmission tomography (CT) in dogs during injection of contrast material. The rotary fan-beam CT scanner used could obtain 16 sequential, ungated, 3.0-second scans at 13-20-second intervals. Time-attenuation curves of myocardial enhancement, which were constructed from serial CT images of normally functioning anterior and lateral left ventricular myocardium, demonstrated mean +/- SEM baseline values: 37 +/- 3.3 and 32 +/- 4.0 CT#s; mean +/- SEM peak enhancement: 72 +/- 4.1 and 73 +/- 3.9 CT#s; and decay in enhancement having mean +/- SD time constants: 3.12 +/- 0.27 and 3.17 +/- 0.22 minutes. Regions of acutely ischemic myocardium demonstrated lower but not significantly different baseline values (mean +/- SEM = 25 +/- 4.3 CT#s) from normal (mean +/- sEM = 37 +/- 3.3 CT#s), without a peak and decay in enhancement. The authors conclude that regions of experimentally-produced acute ischemia are readily detected in vivo by dynamic CT imaging as absent or markedly reduced myocardial contrast enhancement.

Acute Disease↗
PubMed1981

Dynamics of myocardial contrast enhancement: an in vivo computed-tomographic study.

Enhancement of normal functioning myocardium was quantitated in 15 dogs by serial computed transmission tomographic (CT) images during the bolus (10 ml/sec.) or slow (1 ml/sec.) intravenous injection of diatrizoate contrast media (1 ml/kg body weight) in concentrations of 37, 18.5, or 9.25 g iodine (I)/dl. Homogenous images of myocardial enhancement were obtained. However, major streak artifacts were observed frequently when contrast material was injected as a bolus, and myocardial edges were not defined clearly when contrast material with a concentration of 9.25 g I/dl was injected slowly. Time-attenuation curves of normal myocardial enhancement constructed from serial CT images demonstrated a peak in contrast enhancement (delta Hounsfield units, 22-45) followed by a period of deterioration that lasted two to three minutes. These results can be applied to make optimal use of both single (static) and serial (dynamic) myocardial CT images.

Animals↗
PubMed1980

Coronary hemodynamic effects of ergonovine maleate in human subjects.

The coronary hemodynamic effects of ergonovine maleate were examined in 15 patients with a chest pain syndrome not thought to be variant angina. Ergonovine was given intravenously in sequential doses of 0.05, 0.1 and 0.25 mg while measurements were made of systemic hemodynamic variables, coronary sinus blood flow and coronary arteriovenous oxygen difference at intervals during the protocol. Coronary arterial diameters were measured from the 35 mm cineangiogram. Despite an increase in myocardial metabolic demand, as estimated with the heart-rate-blood pressure product, there was no apparent increase in coronary vascular resistance. In addition, there was a significant widening of the coronary arteriovenous oxygen difference in five of the seven patients in whom it could be measured. However, neither chest pain nor ischemic electrocardiographic changes were evoked. Although ergonovine also produced a diminution in epicardial coronary arterial diameters, this effect was not sufficient to explain the absence of appropriate coronary vasodilation. These results suggest that ergonovine may limit the normal vasodilatory response of the arteriolar bed to increases in myocardial metabolic demand.

Adult↗
PubMed1980

The effect of stenosis of bypass grafts on coronary blood flow. A mechanical model study.

A mechanical model of a branched coronary artery with a graft bypassing an 80% stenosis of one branch was used to study the reduction in coronary flow due to stenosis of the bypass graft. Flow Reynolds number and ratio of aortic pressure to dynamic pressure were matched to the living system. Changes in coronary flow were measured for a range of stenoses (0-100%) of bypass grafts with graft-to-coronary-diameter ratios of 4:1, 3:1, 2:1 and 1:1 for conditions that simulated rest and exercise. The results of these studies indicate that: 1) marked stenosis of bypass grafts is needed to decrease coronary flow in the resting state, and even moderate stenosis will decrease flow during exercise when the diameter of the bypass is large relative to the coronary artery; 2) coronary flow is decreased with mild stenosis for bypass grafts of the same diameter as the coronary artery; and 3) a marked decrease in flow due to stenosis of a bypass graft occurs only when the diameter of a stenosis in a graft is less than the diameter of the coronary artery.

Arterial Occlusive Diseases↗
PubMed1979

Altered adrenergic activity in coronary arterial spasm: insight into mechanism based on study of coronary hemodynamics and the electrocardiogram.

To elucidate the pathophysiologic mechanism of coronary arterial spasm, the hypothesis was examined that underlying alterations in sympathetic activity may account for this syndrome in some patients. Observations were directed to alterations in coronary arterial hemodynamics and the electrocardiogram. Spasm of the left anterior descending coronary artery produced a mean increase in coronary vascular resistance of 107 percent (P less than 0.05) in four patients in whom coronary sinus blood flow was measured with the thermodilution technique. The alpha adrenergic blocking agent phentolamine, given intravenously, acutely reversed coronary spasm and its clinical manifestations in eight patients and reduced coronary resistance. In four patients, administration of the long-acting oral alpha blocking agent phenoxybenzamine (20 to 80 mg/day) caused disappearance of symptoms during a follow-up period of 3 to 12 months. Transient prolongation of the corrected Q-T interval preceded spontaneous or ergonovine maleate-provoked coronary spasm in 11 patients with variant angina pectoris, whereas no significant change in the Q-T interval followed ergonovine administration in 27 control patients with atypical chest pain who did not have coronary spasm. T wave inversions in the resting electrocardiogram were normalized by isoproterenol infusion in one patient and by long-term phenoxybenzamine treatment in four patients with variant angina pectoris. These Q-T and T wave changes are analogous to those described with unilateral or asymmetric stellate ganglion stimulation in animals. These observations suggest that alterations in the sympathetic nervous system that are consistent with asymmetric stellate ganglion activity and transient alpha adrenergic receptor stimulation can presage the development of coronary arterial spasm in some patients with variant angina pectoris.

Adult↗