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V Conraads

Publications and source records attributed to V Conraads.

At least 19 recordsLinked to original sources
PubMed2004

Heart transplantation: how to select patients? What are the alternatives?

The gap between the number of potential recipients of a cardiac graft and the availability of donor hearts is still growing. A proper selection of heart transplant candidates is mandatory to ensure that patients in critical need, who are likely to benefit from this procedure, are identified. The work-up of a patient with terminal chronic heart failure includes a comprehensive cardiac and systemic evaluation. Critical in the decision is the exclusion of irreversible pulmonary hypertension. Furthermore, underlying diseases that could compromise short- and long-term prognosis after transplantation should be carefully assessed. The mortality on the waiting list and the growing pool of patients with chronic heart failure that is excluded from transplantation has stimulated the search for alternative treatment modalities. Besides a pharmacologic approach, the last few years have witnessed a tremendous evolution in so-called mechanical devices, designed to improve both morbidity and mortality of these patients. Although several of these devices have only just entered the clinical phase, internal cardioverter defibrillators, left ventricular assist devices and biventricular pacemakers can no longer be viewed as experimental tools.

Chronic Disease↗
PubMed2001

Isolated non-compaction of the left ventricle: a rare indication for transplantation.

This report describes the diagnostic difficulty encountered in a young female patient presenting with neurologic symptoms, atrial fibrillation and severe left ventricular systolic dysfunction, eventually leading to cardiac transplantation. The scrutiny used in the evaluation of the particular aspect of the left ventricle, and the integration of the information obtained from echocardiography, angiography and magnetic resonance imaging, led to the diagnosis of a rare and mostly unknown cause of cardiac failure. The correct identification of this entity is mandatory because enhanced risk of thromboembolism and malignant arrhythmia should be anticipated. A review of the literature revealed only 6 patients in whom isolated non-compaction of the left ventricle was treated by heart transplantation.

Adult↗
PubMed2001

IgE-mediated anaphylaxis after first intravenous infusion of cyclosporine.

BACKGROUND: Intravenous administration of cyclosporine, which contains Cremophor EL (a polyethoxylated castor oil; BASF, Berlin, Germany), has occasionally resulted in an anaphylactic reaction. An apparent hypersensitivity reaction (bronchospasm and decrease in blood pressure) had occurred during heart transplantation in a 59-year-old woman after intravenous infusion of cyclosporine. Subsequent oral administration of cyclosporine precipitated no reaction. OBJECTIVE: The purpose of this study was to attempt to ascertain the mechanism responsible for the anaphylactic reaction. METHODS: Hypersensitivity investigations, including total serum IgE and allergen-specific IgE quantifications, skin testing, and basophil activation tests by flow cytometric determination of CD63 upregulation were undertaken in the study patient and in two healthy control subjects who were free of medication. RESULTS: The results of intradermal testing with Cremophor EL were positive after 15 minutes in the study patient only. Both cyclosporine and Cremophor EL induced considerable activation of the basophils from our study patient, with an upregulation of CD63 expression from 1% to 39% and 55%, respectively. In contrast, the expression of CD63 on basophils from the two control subjects remained essentially unchanged. CONCLUSIONS: The negative investigative findings in the control subjects, the patient's clinical manifestations in temporal relationship to the infusion, her positive results on intradermal testing with Cremophor, the basophil activation test results, and her uneventful course after oral administration of cyclosporine strongly support the presence of IgE antibodies to Cremophor EL in our patient.

Anaphylaxis↗
PubMed2001

Blurred vision, left bundle-branch block and cardiac failure.

We cared for a patient with progressive renal impairment who presented with blurred vision, QRS broadening and cardiac failure due to chronic cibenzoline intoxication. Treatment consisted of catecholamines and repetitive infusions of Ringer lactate. Cardiac function and symptoms recovered completely.

Aged↗
PubMed1999

Effect of stenting on coronary flow velocity reserve: comparison of coil and tubular stents.

OBJECTIVE: To determine whether coil stents are as effective as tubular stents in improving coronary flow velocity reserve (CFVR) after stent deployment. METHODS: Distal CFVR was measured with a 0. 014 inch Doppler guide wire before and after stenting in 33 patients. A coil stent was implanted in 16 patients and a tubular stent was used in 17 patients. Coronary flow velocity within the stent was also recorded during a slow pullback. RESULTS: Following placement of the stents, the percentage diameter stenosis was similar for both the tubular and coil stents (mean (SE) 11 (2)% v 13 (2)%, NS). However, distal CFVR was higher after stenting with a tubular stent compared with a coil stent (2.46 (0.13) v 1.96 (0.14), p < 0.05). Furthermore, pullback through the stent detected a major flow velocity increase within coil stents but not in tubular stents (83 (24)% v 5 (5)%, p < 0.05). CONCLUSIONS: In spite of similar angiographic improvement, placement of coil stents was associated with inferior functional results compared with tubular stents. The flow velocity acceleration within the coil stents suggests the presence of a residual narrowing within the stent, which is not appreciated on angiography.

Analysis of Variance↗
PubMed1998

Sudden death in hypertrophic cardiomyopathy: risk stratification and prevention.

Hypertrophic cardiomyopathy is an important cause of sudden death in young and asymptomatic patients. Young athletes and patients with unexplained sudden death, including their relatives, should be screened for its presence. Risk stratification identifies a high-risk group, in which preventive measures should be taken to reduce the risk for sudden death: moderate to heavy physical activity has to be avoided and arrhythmias with haemodynamic impact should be rigorously prevented.

Adolescent↗
PubMed1998

Cardiac graft vasculopathy: aetiologic factors and therapeutic approaches.

Heart transplantation has become an accepted and successful treatment for end-stage heart disease with survival rates of 80-90% after one year and 70% after 5 years. During the early posttransplant period (6-12 months), patients are subject to two major complications: rejection and infection. Fortunately, a certain degree of graft tolerance develops, allowing the immunosuppressive therapy to be progressively tapered off with a concomitant decrease in infectious problems. Long-term survival, however, is largely dependent on the development of an accelerated atherosclerosis in the graft, which is believed to represent some kind of chronic rejection. This transplant vasculopathy is documented by means of coronary angiography with an incidence of approximately 5 to 10% per year. It is not surprising therefore that major interest has risen concerning risk factors promoting this pathology.

Graft Occlusion, Vascular↗
PubMed1996

Comparative study of rest technetium-99m sestamibi SPET and low-dose dobutamine stress echocardiography for the early assessment of myocardial viability after acute myocardial infarction: importance of the severity of the infarct-related stenosis.

Rest technetium-99m sestamibi single-photon emission tomography (SPET) has been shown to underestimate viability in some patients with chronic ischaemic myocardial dysfunction. The present study was designed to appraise the value of 99mTc-sestamibi as a viability tracer in patients with a recent myocardial infarction and to determine factors that might influence its accuracy in assessing infarct size. Therefore, rest 99mTc-sestamibi SPET, low-dose dobutamines stress echocardiography and quantitative coronary angiography were performed in 51 patients with a recent myocardial infarction. Perfusion activity and regional wall motion were scored semi-quantitatively using the same segmental division of the left ventricle. Assessment of 99mTc-sestamibi uptake as a marker of viability was performed by comparing a binary uptake score (viable=>50% vs necrotic =</=50% of the maximal tracer activity) with a binary wall motion classification during low-dose dobutamine infusion (viable=normal/hypokinetic vs necrotic=akinetic/dyskinetic). Infarct size, expressed as the number of segments with evidence of necrotic tissue, was significantly greater in the scintigraphic study than in the echocardiographic study (2.8+/-1.5 vs 2.2+/-1.3, P=0.006). This overestimation of infarct size by 99mTc-sestamibi was present only in patients with a severe infarct-related stenosis (% diameter stenosis >/=65%-100%) and particularly those with "late" reperfusion therapy (time delay >/=180 min). In patients without a severe infarct-related stenosis, 99mTc-sestamibi was able to accurately distinguish viable from necrotic segments. Thus, rest 99mTc-sestamibi scintigraphy early after acute myocardial infarction may underestimate residual viability within the infarct region, particularly in patients with low flow state coronary anatomy, as a result of a severe infarct-related stenosis and/or late reperfusion therapy.

Cardiotonic Agents↗
PubMed1996

Clinical outcome of patients with an uncomplicated myocardial infarction: effect of revascularization.

In 80 patients (pts) with an uncomplicated myocardial infarction (MI) the rate of major cardiac events (MACE) including cardiac death, non-fatal myocardial infarction and recurrent ischemia requiring hospitalization was prospectively assessed over a mean follow-up period of 17 +/- 9 months and related to clinical, angiographic and scintigraphic findings, the latter obtained from adenosine Tc-99m sestamibi SPECT imaging. Decision for revascularization was mainly based on angiographic data and was carried out in a total of 50 patients (angioplasty in 34 pts and cardiac surgery in 16 pts). The overall MACE rate was 24% with a mortality and myocardial infarction rate of 4% and 5%, respectively. Early (< 2 months) revascularization seemed to have a beneficial effect on clinical outcome as was suggested by the following findings: 1) Cardiac events (MACE) were not significantly different in patients with versus without revascularization (MACE 24% versus 23%) although the former constituted a subgroup at higher risk for ischemic events because of a more extensive coronary artery disease state. 2) In the subset of patients with at least one significant coronary artery stenosis the clinical outcome was significantly better in those who were revascularized than in those who underwent no revascularization (MACE 24% vs 47%, p < 0.05. Among a variety of factors, including the scintigraphic and angiographic extent of coronary artery disease and post-MI treatment strategy, multivariate analysis selected hypercholesterolemia (> 240 mg%) as the only independent predictor of MACE with a more than fourfold increase in risk for development of MACE. These data suggest that the natural history, especially the rate of recurrent ischemic events, can be favourably changed by an elective and early revascularization, strategically oriented by the results of the angio-graphic study. Furthermore, our data emphasized the deleterious role of hypercholesterolemia on clinical outcome in patients with a recent MI.

Angioplasty, Balloon, Coronary↗
PubMed1994

Cacogeusia in amyloidosis associated with plasma cell dyscrasia.

Cacogeusia, being the patients' main complaint, is reported as a new symptom of amyloidosis, probably caused by a peripheral sensory neuropathy. A case is presented of a patient with weight loss, dysphagia, macroglossia and taste disturbances, due to amyloidosis associated with a plasma cell dyscrasia. The importance of oral manifestations in amyloidosis is discussed.

Aged↗
PubMed1993

Apical hypertrophic cardiomyopathy.

Illustrated by a case report, which was rather suggestive of coronary ischemic heart disease, the principle characteristics of apical hypertrophic cardiomyopathy are outlined. Outside East Asia, it remains a very uncommon variant of hypertrophic cardiomyopathy. The electrocardiogram in basal conditions showed giant negative T-waves (-14 mm) in the precordial leads, while the ventriculogram in RAO projection revealed the typical, so called "ace of spades" configuration. Based on the present literature and the follow-up of these patients a review of apical hypertrophic cardiomyopathy is presented. One of the most important consequences of the identification of this variant seems to be the rather good prognosis when compared to other forms of hypertrophic cardiomyopathy.

Biopsy↗