Biomedical subjects

P Rábago

Publications and source records attributed to P Rábago.

10 recordsLinked to original sources

PubMed1994

[The potential usefulness of MIBI-99mTc SPECT at rest in identifying viable myocardium after a myocardial infarct].

We present a 65 years-old female with a silent anterior myocardial infarction. A coronary angiogram showed a left ventricle with akinesia of segments anterior, lateral and apex. Left anterior descending artery showed a unique 95% lesion. The patient was discharged with medical treatment. Two months later the patient was readmitted with atypical angina. She was submitted to tomographic study (SPECT), with 99mTc-hexakis-2-methoxy-isobutyl-isonitrile (MIBI-99mTc) at rest. The images showed a wide area of hypocaptation in the territory of the left anterior descending artery but with differences among the different segments. This image was interpreted as suggestive of necrotic and viable myocardium. A second coronary angiogram yielded the same findings as in the first study. It was performed a successful PTCA on the left anterior descending artery lesion. A new SPECT study was performed 9 days later that showed a significant improvement of perfusion in some of the myocardial segments and a significant decrease of the internal left ventricular diameter. Isotopic left ventricular ejection fraction showed an increase from 25 to 35%. The present case suggests that the study with SPECT and MIBI-99mTc at rest may be potentially useful in the identification of viable myocardium after a myocardial infarction and assesses the importance of revascularization of the culprit artery with severe residual narrowing.

Aged↗

PubMed1991

Diagnostic value of two-dimensional echocardiography in cardiac hydatid disease.

Echinococcal infection of the heart is rare. The preoperative findings, with special attention to two-dimensional echocardiography (2DE), of six patients with cardiac echinococcosis and their surgical and pathological correlations are reported. Cardiac hydatid cysts (HCs) were located in the cardiac apex in three patients, in the upper part of the interventricular septum extending towards the anterior aspect of the heart in one and in the postero-superior right atrial wall in another patient. The remaining patient had multiple intrapericardial cysts. In three patients the cysts presented as well defined, rounded, echolucent masses within the myocardial wall bulging into the cardiac chambers. In two patients, the cysts had ruptured into a cardiac chamber with loss of the characteristic 'cystic' appearance; these cysts presented as an echogenic or solid mass protruding into a cardiac chamber. Finally, another patient had one HC with echolucent appearance and another HC in a different location with echogenic appearance; this last cyst corresponded to a degenerated HC. In two cases the cyst showed a loculated internal aspect. In one patient the myocardial segment involved by the cyst had a dyskinetic movement. In all six patients, 2DE accurately demonstrated the location and morphological details of the cardiac cysts, permitted recognition of the ruptured and/or degenerated cysts and was superior to thoracic computed tomography and angiography in the preoperative assessment of these patients. Nuclear magnetic resonance imaging (one patient) gave no further information to that obtained by 2DE. We conclude that 2DE is the technique of choice for an early diagnosis of this rare entity.

Adult↗

PubMed1987

Arrhythmogenic effects of antiarrhythmic drugs in patients with an old myocardial infarction and asymptomatic ventricular ectopic activity as studied by programmed electrical stimulation.

In 22 patients with a previous myocardial infarction and documented Lown class II to IV asymptomatic ventricular arrhythmias, the arrhythmogenic effect of mexiletine (18 patients) and propafenone (10 patients) has been assessed by programmed electrical stimulation. Ventricular arrhythmias induced during the basal study were: repetitive ventricular responses (RVR) (11/22, 50%), nonsustained ventricular tachycardia (VT) (3/22, 14%), sustained VT (7/22, 32%) and ventricular fibrillation (VF) (1/22, 4%). The induction of sustained VT or VF increased to 50% after mexiletine and to 80% following propafenone. An arrhythmogenic effect was found in 7/11 patients (64%) without VT at the control study (P = 0.004). One patient of this group spontaneously developed sustained VT both after mexiletine and propafenone. Only 1/8 patients (13%) with sustained VT/VF at the basal study had RVR after drug administration. The R-R interval of sustained VT at the basal state tended to be faster than that after the drugs (260 +/- 60 ms vs 293 +/- 56 and 332 +/- 77 ms for mexiletine and propafenone, respectively) (P = 0.052). Statistical significance was only reached in the propafenone group (P = 0.03). Facilitation of VT induction after antiarrhythmic drugs is most likely due to a modest lengthening of refractoriness in contrast with a more evident reduction in conduction velocity within the reentry pathway. Our study illustrates that treating asymptomatic ventricular ectopic activity in patients with an old myocardial infarction may be dangerous and that antiarrhythmic drugs show a significant arrhythmogenic potential at least in the laboratory setting.

Adult↗

PubMed1984

Relation of midwall circumferential systolic stress to equatorial midwall fibre shortening in chronic aortic regurgitation. Value as a predictor of postoperative outcome.

Nineteen patients with chronic aortic regurgitation and a large increase in heart size were studied before aortic valve replacement. By relating midwall circumferential systolic stress to midwall circumferential fibre shortening (Cs/Cd) before operation the patients could be divided into two well defined groups. Twelve patients (group 1) had a pronounced decrease in heart size as measured by the cardiothoracic ratio and an excellent clinical outcome six months after operation. Seven patients (group 2) had no significant decrease in heart size and a less good clinical outcome. The ratio of midwall circumferential systolic stress to end systolic volume index was significantly higher in group 1 than in group 2. Group 2 had more severe left ventricular hypertrophy determined by the ratio of the wall thickness to the minor internal radius of the left ventricle (h:r ratio), total left ventricular mass, and left ventricular mass to end diastolic volume ratio. There were no significant differences in any other haemodynamic or angiographic indices between the two groups. Thus the relation of midwall circumferential systolic stress to fibre shortening is useful in determining the prognosis in individual patients with chronic aortic regurgitation undergoing aortic valve replacement.

Adult↗

PubMed1975

Thrombotic obstruction of Bjork-Shiley tricuspid valve prosthesis. Report of three cases reoperated with success.

Three patients presented subacute right heart failure, 6, 12 and 22 months after replacement of the tricuspid valve with a Björk-Shiley prosthesis. The principal finding encountered on clinical examination was a tricuspid filling murmur with inspiratory accentuation. The mean prosthetic gradient found at cardiac catheterization was 7, 8 and 10 mm Hg. At surgery, the three prostheses were thrombosed on their ventricular aspect and all the three were replaced with new ones of the same model. The patients are alive and in good condition, 21, 17 and 8 months after the operation. Problems which relate to the surgical management of tricuspid valve disease are discussed.

Adult↗

PubMed1967