PubMed Health⌕ Search

Biomedical subjects

T Pop

Publications and source records attributed to T Pop.

At least 37 records · Page 2Linked to original sources
PubMed1989

Emergency surgical revascularization following coronary angioplasty: evaluation of operative results by isoenzyme analysis and electrocardiography.

Seventeen patients underwent emergency coronary artery bypass grafting due to balloon catheter induced occlusion or dissection of a major coronary artery. Patients were revascularized within a maximum of 210 min from the onset of ischaemia and received an average of 1.6 distal anastomoses. A perioperative transmural or non-transmural myocardial infarction as diagnosed by CK-MB activity and electrocardiographic patterns occurred in 7 patients (41.2%). One early death resulted in an overall perioperative mortality of 5.9%. Successful preservation of myocardium was demonstrated in 10 patients by a rapid decline of CK-MB activity, no perioperative electrocardiographic changes and no requirement for inotropic support. The incidence of a perioperative myocardial infarction was independent of the anginal status before coronary angioplasty or the angiographic evidence of a complete occlusion versus a dissection. Major ischaemic myocardial complications associated with coronary angioplasty are rare but frequently catastrophic events. Fast surgical intervention is mandatory to prevent myocardial infarction or to limit the extent of injury. The operative outcome can be evaluated by careful analysis of time release curves and cumulative parameters of CK-MB activity.

Adult↗
PubMed1989

[Balloon dilatation and coronary vascular stent implantation].

To avoid acute complications and restenosis after percutaneous transluminal coronary angioplasty coronary stents were developed. For the first time three flexible Palmaz-Schatz stents were implanted after application and fixation by balloon inflation in two patients with severe lesions of the left anterior descending coronary artery. The vessels showed larger diameters with smoother surface and smaller gradients compared to balloon angioplasty as related to a blockade of the elastic properties of the vessel and suggested fixation of intima or media dissection. The implantation of the coronary stents was without complications. The control after 24 h showed an open vessel with unchanged diameter. The patients with the proximal lesion of the left anterior descending coronary artery six months later showed no restenosis and no luminal narrowing. The recanalized left anterior descending coronary artery, which was dilated, received two stents and was reoccluded after six months. Meanwhile, up to four stents were implanted successfully in an additional four patients with open vessels as the 24-h-control. Based on this and previous work the implantation of coronary stents seems to open a new dimension for percutaneous transluminal coronary angioplasty because vessel occlusions can be prevented. Whether or not the restenosis rate can be reduced has to be demonstrated in additional studies.

Adult↗
PubMed1988

Recombinant single-chain urokinase-type plasminogen activator during acute myocardial infarction.

Recombinant single-chain urokinase-type plasminogen activator was intravenously administered in 2 different doses in 24 patients with acute myocardial infarction and angiographically proved occlusion of the infarct-related artery. Patients with first infarction without contraindications of thrombolysis were treated within the first 4 hours after the onset of symptoms. Group A (12 patients) received 20 mg of rscu-PA as a bolus followed by 60 mg infused over 1 hour and group B received 10 mg as a bolus and 30 mg as infusion. The 2 groups showed no significant difference in age, sex, height, weight, time between onset of symptoms and start of therapy, peak values and course of infarct-related enzymes. Time to reperfusion was 43 minutes in group A versus 67 minutes in group B (p less than 0.005). The rate of reperfusion 90 minutes after start of treatment was 91% in group A and 50% in group B (p less than 0.001). Plasma levels of fibrinogen, plasminogen and alpha-2-antiplasmin did not differ significantly in both groups. Systemic lytic state (fibrinogen less than 100 mg/dl) occurred in 33% of group A and in 9% of group B. Intravenous infusion of 80 mg (but not 40 mg) of rscu-PA led to reperfusion of the occluded coronary artery in nearly all patients. Approximately one-third of the patients treated with this dose demonstrated systemic lysis.

Adult↗
PubMed1988

[Current complication rate of percutaneous transluminal coronary angioplasty in stable and unstable angina].

During a four-year period (1983-1986) percutaneous transluminal coronary angioplasty (PTCA) was performed on 930 patients with stable or unstable angina with a mortality rate of 0.4%. A transmural myocardial infarct developed in 1.1% and 1.0% of patients required an urgent aorto-coronary bypass. Thus the total rate of severe cardiac complications was 2.5%. Compared with the years 1983-1985, there was in 1986 a significant fall in the number of deaths and of myocardial infarcts from 2.2% to 0.5% (P less than 0.05), while there was a nonsignificant increase in emergency coronary bypass surgery from 0.7 to 1.3%. Patients with unstable angina compared with those with stable angina had a significantly higher mortality rate (1.0% vs. 0.2%; P less than 0.05), incidence of infarction (2.0% vs. 0.6%; P less than 0.05), and emergency operations (2.0% vs. 0.5%; P less than 0.05). The total risk of a severe cardiac complication was 1.2% for stable and 5.2% for unstable angina (P less than 0.001).

Aneurysm↗
PubMed1988

Combination of calcium channel blocker and thrombolytic therapy in acute myocardial infarction.

To evaluate the protective effect of nifedipine on ischemic myocardium, in addition to thrombolytic therapy, a total of 149 patients with acute myocardial infarction were included in a double-blind controlled study in which they received 20 mg sublingual nifedipine (74 patients in group 1) or placebo (75 patients in group 2) in the emergency ward, either intracoronary nifedipine, 0.2 mg before and 0.2 mg after reperfusion of the infarct-related vessel and 20 mg three times/day during the hospital stay, or placebo. Combined intravenous and intracoronary thrombolytic therapy was initiated by means of mechanical recanalization in nonreperfused vessels. There were no differences between group 1 and 2 with regard to age, sex, body weight, or location of infarct. Evolution of CK-MB release and cumulative CK-MB was higher in group 1 than in group 2. Changes with regard to regional and global left ventricular function and coronary anatomy were not significantly different (NS) between the two groups. Reocclusion occurred in 15 of 74 (20%) and 10 of 75 (13%) patients in groups 1 and 2, respectively. During the reperfusion period, second- and third-degree atrioventricular block occurred in 5.4% and 6.7% (NS), ventricular couplets in 17.6% and 24% (NS), ventricular tachycardia in 2.7% and 9.3%, and ventricular fibrillation in 2.7% and 8% of the patients, respectively. Mortality rates were 13% and 8%. The study demonstrates that even very early administration of nifedipine combined with intracoronary administration does not enhance the salvage of ischemic myocardium achieved by reperfusion.

Adult↗
PubMed1988

[Effect of oral long-term enoximone therapy on the arrhythmia profile in chronic heart failure].

The arrhythmogenic potential of long-term treatment with Enoximone in patients with severe chronic heart failure has not been determined. We analysed retrospectively 24 h Holter recordings in 31 patients with chronic heart failure, predominantly NYHA functional class III and IV, before and during chronic Enoximone therapy between 4 and 52 weeks. At baseline ventricular couplets and salvos were found in 68% of patients. Ventricular arrhythmia response was variable with no significant overall change. During a mean follow-up of 28 weeks, however, 3 (10%) patients showed a significant increase and 4 (16%) patients a more than 90% decrease of repetitive ventricular arrhythmias. In another 10 (32%) patients a more than 70% decrease of singular ventricular arrhythmias was observed. There was no correlation between the change of the patient's arrhythmia profile, the degree of functional impairment of the underlying heart disease, and the clinical response to long-term Enoximone therapy. Two patients died suddenly, one with a significant increase, the other with a significant reduction of ventricular arrhythmias. Two patients died of pump failure with no change of the arrhythmia profile. Enoximone appears to have a low arrhythmogenic profile during long-term treatment. However, careful monitoring of ventricular arrhythmias is mandatory as the occurrence of proarrhythmic drug effects cannot be predicted.

Administration, Oral↗
PubMed1988

[Results of PTCA following thrombolysis in acute myocardial infarct].

The mortality in acute transmural myocardial infarction can be reduced by thrombolytic therapy administered within 6 hours after onset of symptoms. In patients with coronary angiography proven stenosis of less than 70% conservative therapy is recommended. In patients with one vessel disease PTCA in patients with suitable lesions should be used. Further studies have to elucidate, if the angioplasty has to be performed in the acute stage or on an elective basis. PTCA is recommended in patients with occluded coronary vessels and in patients with high grade stenosis and limited coronary blood flow. In patients with multi vessel disease aortocoronary bypass surgery is recommended to reduce high mortality. Long-term results demonstrate, that patients in whom PTCA or coronary bypass surgery was performed demonstrated the highest survival rate.

Angioplasty, Balloon↗
PubMed1988

[Percutaneous angioplasty of the stenotic aortic valve: results, hemodynamic effects and complications].

UNLABELLED: In 24 patients with aortic stenosis (13 men and 11 women, aged 47 to 80 years; mean age 67 years) a percutaneous angioplasty of the aortic valve was performed. The NYHA functional class improved in 20 patients. There was also a significant (p less than 0.01) decrease of the mean aortic gradient from 75.1 +/- 21.8 mm Hg to 45.3 +/- 11.7 mm Hg as well as an increase of the aortic valve area from 0.61 +/- 0.12 cm2 to 0.96 +/- 0.3 cm2. The end diastolic volume index decreased from 121.3 +/- 37.4 ml/m2 to 99.6 +/- 24.8 ml/m2 to the end diastolic volume index from 49.1 +/- 26.6 ml/m2 to 34.6 +/- 13.4 ml/m2 (both significant: p less than 0.01). The ejection fraction increased from 61.3 +/- 11.8% to 65.8 +/- 7.8% (p less than 0.05). Four patients presented a transient left bundle branch block. The corrected QT interval increased significantly (p less than 0.01) from 388.9 +/- 29 ms to 401.4 +/- 42.6 ms. Complications occurred in eight patients, being severe in three of them (one death from intractable internal hemorrhage, two cases of right sided hemiparesis). CONCLUSIONS: Percutaneous aortic valve angioplasty represents an alternative to the surgical procedure. In our patients there was not only an increase in the aortic valve area, but also an improvement in the ejection fraction. Nevertheless, unforeseeable complications may occur which obscure the results. In the future, widened experience and improved technique will reduce complications.

Adult↗
PubMed1988

[Percutaneous transluminal coronary angioplasty following thrombolysis in acute myocardial infarct].

The technique of combined medical and mechanical recanalization in acute myocardial infarction increases the reperfusion rate of occluded coronary vessels from 50% to 75% up to 90%. According to retrospectively performed analysis the reocclusion rate can be reduced at the same time from 17%-25% to about 7%-14%. The duration of occlusion of the coronary artery and the residual coronary stenosis following reperfusion are the main determinants of infarct size. The mechanical recanalization achieved by PTCA following thrombolysis improves the coronary flow and thus reduces infarct size, as demonstrated in experimental studies. Similar results can be expected in man as well. Indirect evidence has been demonstrated by ventriculographic and scintigraphic analysis of global and regional ventricular function. The time interval between successful thrombolysis and PTCA should be short, at least not longer than 5 days, because of the implications of residual stenosis for coronary flow and resulting infarct size and the incidence of reocclusion of the coronary vessel in the first few days following thrombolysis. In order to reduce the risk of reocclusion due to residual stenosis or residual coronary thrombi sufficient heparinization and anticoagulation is necessary. Cardiogenic shock in acute myocardial infarction represents a serious complication which is lethal in about 70%-80%. In these cases the technique of PTCA combined with thrombolysis may reduce mortality considerably to about 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1988

[Aortic isthmus stenoses--dilatation in adulthood. A German cooperative study].

An analysis of percutaneous transluminal angioplasty of the coarctation of the aorta in adults was evaluated in a cooperative study of the German Working Group of Angioplasty of the German Society of Cardiology. Dilation was performed in 18 patients with a mean age of 26 years (14-49 years). The success rate (gradient less than or equal to 20 mm Hg) was 78% regarding peak to peak gradient, 89% regarding mean gradient. The peak-to-peak gradient decreased from 82 +/- 16 mm Hg to 18 +/- 11 mm Hg. The diameter of the aortic isthmus increased from 0.7 +/- 0.3 cm to 1.3 +/- 0.4 cm (p less than 0.01). After six months only one restenosis occurred. The peak-to-peak gradient measured 10 +/- 12 mm Hg, the diameter 1.4 +/- 0.5 cm. In two patients a balloon rupture occurred without rupture-related complications. No patients died, no cross paralysis or aortic rupture occurred. In three of seven patients with trans-esophageal echocardiographic monitoring a small intimal flap was found; in one patient a media dissection occurred leading to a 15-min period of chest pain and spontaneous healing. In another patient successful dilation was controlled by acute control aortography and computer tomography. After discharge severe chest pain developed. A subtraction angiography of the aorta was negative. Six months later a biplane aortography of the distal thoracic aorta confirmed the diagnosis of aortic dissection type III DeBakey, previously diagnosed by transesophageal echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Dilatation of supravalvular pulmonary stenosis in transesophageal echocardiographic monitoring--the kissing-balloon technic].

A successful dilatation of a supravalvular pulmonary stenosis after banding operation is described in a 19-year-old male. The dilatation was performed during transesophageal echocardiographic monitoring. Dilatation with a 15-mm and a 19-mm valvuloplasty catheter was not successful. Using the "kissing-balloon" technique with a 15 and 19 mm balloon together, the pressure gradient could be reduced from 59 mm Hg to 10 mm Hg (mean 41 and 8 mm Hg). Pulmonary artery diameter increased from 17 to 24 mm without intima damage or dissection. Thus pulmonary artery stenosis caused by banding operation can be dilated successfully. Monitoring during the procedure quickly demonstrates the changes in the dilated vessel. Angiography 6 months later showed slight restenosis of the dilated vessel with a maximum pressure gradient of 27 mm Hg (mean 17).

Adult↗
PubMed1987

[Cardiogenic shock].

Explore the source record for details and available documents.

Angioplasty, Balloon↗
PubMed1987

"Three-level shock" in ablation-refractory paroxysmal atrial fibrillation.

His-bundle ablation is a very effective method to control drug-refractory supraventricular arrhythmias. We present a 69-year-old woman with paroxysmal atrial fibrillation, in whom several attempts of unipolar and bipolar His-bundle ablation were ineffective. Ultimately a stable 2/1 atrioventricular block was induced when three successive shocks of 400 W were applied. The first shock was given in that position with the largest His-potential deflection. The other two shocks were applied at catheter positions more distal and more proximal from the first one, respectively. We suppose that the initial lack of success was due to an atypical atrioventricular junction anatomy.

Aged↗
PubMed1987

Outcome of primary coronary recanalization and arrhythmia profile in survivors of acute myocardial infarction.

The purpose of this study was to assess the arrhythmia profile in survivors of acute myocardial infarction in whom recanalization of the infarct-related vessel was attempted. 127 patients with acute myocardial infarction were randomized to intravenous and intracoronary thrombolysis with or without transluminal coronary angioplasty. 84 of them, aged 54 +/- 9 years, had angiographic control, 24-hour Holter electrocardiographic monitoring and programmed electrical stimulation 4 weeks after infarction. The study protocol of programmed electrical stimulation included single and double extrastimuli at 2 driving cycle lengths. The end point was the induction of ventricular tachycardia with 10 and more beats. During infarction 28 patients had occlusion of the left anterior descending, 12 of the circumflex and 44 of the right coronary artery. Holter monitoring revealed both frequent (greater than 100 ventricular premature complexes per 24 hours) and repetitive (Lown IVA, IVB) ventricular arrhythmias in 23 patients (27%). Inducible ventricular tachycardia (greater than 6 beats) was found in 25 patients (30%), which was sustained in 4 patients. According to the angiographic results two groups of patients could be identified: group A consisted of 64 patients who showed primary recanalization of the infarct-related vessel with persistent patency at control. Group B consisted of 20 patients who showed late reopening (n = 5) or a closed infarct-related vessel (n = 15) due to late reocclusion in 9 of them. Frequent ventricular premature contractions occurred in 18 group A and in 5 group B patients (n.s.). Repetitive ventricular premature contractions were found in 21 group A and in 2 group B patients (P less than 0.05). Inducible ventricular tachycardia was observed in 17 patients of group A (27%) and in 8 patients of group B (40%) (n.s.). The incidence of spontaneous and stimulus-induced ventricular arrhythmias was not influenced by the type of recanalization procedure. Furthermore no relation to the time interval between onset of preinfarct angina and angiographically demonstrated reperfusion of the infarct-related vessel was found. The patients in the two groups did not differ with respect to left ventricular ejection fraction, number of abnormal contracting wall segments or site of infarction. It is concluded that reperfusion infarction does not differ from infarction due to permanent occlusion with respect to inducible ventricular tachycardia but may favor repetitive ectopic activity.

Angioplasty, Balloon↗
PubMed1987

What is the need for further intracoronary treatment?

Intracoronary treatment in acute myocardial infarction seems to be useful in order (1) to reach the maximum rate of reperfusion, (2) to reduce rate of reocclusion and reinfarction, and (3) to improve coronary blood flow necessary to maximize salvage of myocardium. Particularly in patients with cardiogenic shock and right ventricular infarction, PTCA in addition to thrombolytic therapy seems to be a major improvement of therapy. Whether intracoronary therapy including PTCA is superior to intravenous thrombolytic therapy with elective PTCA will hopefully be answered in cooperative studies.

Angioplasty, Balloon↗
PubMed1987

[Incidence and kind of reperfusion arrhythmias in thrombolytic therapy of acute myocardial infarct].

UNLABELLED: In 200 consecutive patients with acute myocardial infarction combined medical-mechanical recanalization was attempted. Coronary angiography revealed an occluded vessel in 150 patients. This vessel could be opened in 127 patients. There were 112 men and 15 women, aged 32 to 72 years (mean age 61.2 years); 60 patients had an anterior and 67 patients presented with an inferior myocardial infarction. 103 from 127 patients presented with arrhythmias during the ischemic phase and 112 from 127 patients during the reperfusion phase. The following arrhythmias had a significantly higher incidence in the reperfusion phase compared to the ischemic phase: sinus bradycardia (29 pts. - 22.8% - vs. 15 pts. - 11.8%; p less than 0.05), ventricular bigeminy (28 pts. - 29.9% - vs. 5 pts. - 3.9%; p less than 0.01), ventricular couplets (34 pts. - 26.8% - vs. 20 pts. - 15.7%; p less than 0.05) and accelerated idioventricular rhythm (32 pts. - 25.2% - vs. 5 pts. - 3.9%; p less than 0.01). Ventricular fibrillation occurred during the ischemic phase in 9 patients and during the reperfusion phase in 7 patients (n.s.). None of the patients presented with sustained ventricular tachycardia, neither in the ischemic, nor in the reperfusion phase. CONCLUSIONS: The following rhythm disturbances can be called reperfusion arrhythmias: sinus bradycardia, ventricular bigeminy, ventricular couplets and accelerated idioventricular rhythm. The observed reperfusion arrhythmias were short-living and did not need special therapeutic measures.

Adult↗
PubMed1987

[Relation between spontaneous and electrically inducible ventricular arrhythmias in patients with coronary heart disease].

In a prospective study, 267 patients with invasively diagnosed coronary artery disease were studied by programmed electrical stimulation (PES) and induced ventricular arrhythmias were compared to spontaneous arrhythmias occurring during 24 h Holter registration. In 89 patients (33%) no evidence of myocardial infarction was present, 61 patients (23%) were studied for 6 weeks to 3 months, 36 patients (13%) for 3-6 months and 81 patients (31%) for more than 6 months after myocardial infarction. PES was performed in the right ventricular apex with 1 and 2 extrastimuli during pacing with 100, 120 and 140 beats/min. Endpoint of the study was defined by the induction of 4 repetitive ventricular responses (RVR). Within 72 hours after PES a 24 h Holter registration was performed in all patients. During PES, 15 patients (6%) were not inducible for any RVR. Single RVR (1-2) were induced in 146 patients (55%) and 3-5 RVR in 68 patients (25%). Ventricular tachycardia and ventricular fibrillation were induced in 38 patients (14%); 6 patients showed a sustained, monomorphic tachycardia. Altogether, the incidence of RVR was higher when a history of myocardial infarction was present. With increasing time after infarction the incidence of inducible 3-5 RVR remained stable; however, the number of greater than 6 RVR decreased. During Holter registration, 54/255 patients (21%) showed no spontaneous ventricular arrhythmias, 70 patients (28%) had arrhythmias of Lown-class I/II, 84 patients (33%) of Lown-class III. Complex arrhythmias were observed in 47 patients (18%) (Lown-class IVA: 33 patients, IVB: 14 patients).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗