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Biomedical subjects

W Hueb

Publications and source records attributed to W Hueb.

14 recordsLinked to original sources
PubMed2006

Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty.

Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention. The objectives of the present study were to analyze variables and the power of exercise testing to predict restenosis or a new lesion, 6 months after the procedure. Eight-four coronary multi-artery diseased patients with preserved ventricular function were studied (66 males, mean age of all patients: 59 +/- 10 years). All underwent coronary angiography and exercise testing with the Bruce protocol, before and 6 months after percutaneous coronary intervention. The following parameters were measured: heart rate, blood pressure, rate-pressure product (heart rate x systolic blood pressure), presence of angina, maximal ST-segment depression, and exercise duration. On average, 2.33 lesions/patient were treated and restenosis or progression of disease occurred in 46 (55%) patients. Significant increases in systolic blood pressure (P = 0.022), rate-pressure product (P = 0.045) and exercise duration (P = 0.003) were detected after the procedure. Twenty-seven (32%) patients presented angina during the exercise test before the procedure and 16 (19%) after the procedure. The exercise test for the detection of restenosis or new lesion presented 61% sensitivity, 63% specificity, 62% accuracy, and 67 and 57% positive and negative predictive values, respectively. In patients without restenosis, the exercise duration after percutaneous coronary intervention was significantly longer (460 +/- 154 vs 381 +/- 145 s, P = 0.008). Only the exercise duration permitted us to identify patients with and without restenosis or a new lesion.

Angioplasty, Balloon, Coronary↗
PubMed1997

VATS for complete dissection of LIMA in minimally invasive coronary artery bypass grafting.

BACKGROUND: The aim of this work is to report our initial experience with minimally invasive coronary artery bypass grafting, using video-assisted thoracic surgery (VATS) to facilitate the operation and provide complete dissection of the left internal mammary artery (LIMA). METHODS: Of 44 scheduled patients, 43 patients, 30 (69.8%) male, ranging in age from 31 to 83 years (60.8 +/- 12.0 years), with a severe lesion in the anterior descending artery, were operated upon. An 8-cm left anterior minithoracotomy was performed at the fourth intercostal space. Through this incision the optical device for video-assisted thoracic surgery as well as the surgical instruments were placed to provide complete LIMA dissection. This permits dissection until the subclavian region, allowing for anastomosis without tension or distortion. Bypass circulation was not used, and the cardiac rate was decreased with the use of intravenous beta-blockers. For LIMA-to-anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was administered intravenously. RESULTS: Video-assisted thoracic surgery provided a complete dissection of LIMA. The 43 patients presented satisfactory postoperative progress, being released from the hospital between 2 and 12 days after their operation, with a mean of 4 days. The patients have remained asymptomatic during a period that ranged from 1 to 13 months (6.3 +/- 3.5 months). During the follow-up, there was one death as a result of stroke and pneumonia 2 months after the release from the hospital. CONCLUSIONS: The use of video-assisted thoracic surgery through thoracotomy allows the LIMA dissection without the necessity of other incisions. The procedure also permitted more ample dissection of LIMA when compared with minithoracotomy without video-assisted thoracic surgery.

Adult↗
PubMed1997

Pulmonary function after coronary artery bypass surgery.

Coronary artery bypass graft surgery (CABG) adversely affects pulmonary function tests (PFTs). Although several previous studies have addressed these changes, none has measured the forced vital capacity (FVC) on a daily basis. The purpose of the present study was to assess serial changes in the FVC following CABG and to identify factors that may influence these changes. The FVC was obtained pre- and daily postoperatively (1-10 days) in 120 patients. Fifty-one patients received saphenous vein grafts (SVG group) while 69 received at least one internal mammary artery graft in addition to SVG (IMA group). On the first postoperative day, the FVC decreased to 33% of the pre-operative value in the SVG group and to 29% in the IMA group. The spirometry gradually improved, but after 10 days, the FVC remained reduced (SVG, 70%; IMA, 60%). Although the decreases in FVC tended to be greater in the IMA group, there was no significant difference in the two groups (P = 0.27). The changes in FVC were not significantly related to age (P = 0.48), smoking history (P = 0.65), anesthesia (P = 0.38) or pump time (0.09). From this study, it is concluded that after CABG, there is a significant worsening of the pulmonary function. The nadir of FVC occurs immediately after surgery and improves gradually thereafter. However, on the tenth postoperative day, the FVC still remains more than 30% below pre-operative values. Since there is only a slight tendency for patients undergoing IMA grafting to have larger decreases in their pulmonary function, patients with ventilatory impairment should not be excluded from IMA grafting.

Analysis of Variance↗
PubMed1997

[Minimally invasive myocardial bypass surgery using video-assisted thoracoscopy].

PURPOSE: In order to associate the major benefits of the coronary artery bypass graft (CABG) with a less aggressive procedure minimally invasive coronary artery bypass graft (MICABG) has been utilized. The aim of the work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation. METHODS: Twenty-six patients, 19 males with ages from 44 to 83 years old, and having isolated lesion of the anterior descending artery were operated upon. Left anterior minithoracotomy of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate was decreased with the use of intravenous betablockers. For LIMA--anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered. RESULTS: All patients presented satisfactory postoperative evolution, being discharged from the hospital at 72 h after surgery in the majority of the cases. There were delay in two patients healing of incisions and 25 patients have remained asymptomatic, with a mean in postoperative follow-up of four months. One patient died in the second postoperative month due to stroke. CONCLUSION: MICABG makes the surgery possible with better esthetic effect, lower cost and enables faster recovery than the conventional one. The use of VATS through the thoracotomy itself, allows the LIMA dissection without other incisions. It also permitted more ample dissection of the LIMA when compared to minithoracotomy without VATS.

Adult↗
PubMed1995

Meta-analysis of randomised trials comparing coronary angioplasty with bypass surgery.

A patient with severe angina will often be eligible for either angioplasty (PTCA) or bypass surgery (CABG). Results from eight published randomised trials have been combined in a collaborative meta-analysis of 3371 patients (1661 CABG, 1710 PTCA) with a mean follow-up of 2.7 years. The total deaths in the CABG and PTCA groups were 73 and 79, respectively, with a relative risk (RR) of 1.08 (95% CI 0.79-1.50). The combined endpoint of cardiac death and non-fatal myocardial infarction occurred in 169 PTCA patients and 154 CABG patients (RR 1.10 [0.89-1.37]). Amongst patients randomised to PTCA 17.8% required additional CABG within a year, while in subsequent years the need for additional CABG was around 2% per annum. The rate of additional non-randomised interventions (PTCA and/or CABG) in the first year of follow-up was 33.7% and 3.3% in patients randomised to PTCA and CABG, respectively. The prevalence of angina after one year was considerably higher in the PTCA group (RR 1.56 [1.30-1.88]) but at 3 years this difference had attenuated (RR 1.22 [0.99-1.54]). Overall there was substantial similarity in outcome across the trials. Separate analyses for the 732 single-vessel and 2639 multivessel disease patients were largely compatible, though the rates of mortality, additional intervention, and prevalent angina were slightly lower in single vessel disease. The combined evidence comparing PTCA with CABG shows no difference in prognosis between these two initial revascularisation strategies. However, the treatments differ markedly in the subsequent requirement for additional revascularisation procedures and in the relief of angina. These results will influence the choice of revascularisation procedure in future patients with angina.

Angina Pectoris↗
PubMed1994

Relationship between pleural effusion and pericardial involvement after myocardial revascularization.

The explanation for the high incidence of pleural effusion after cardiac surgery is unclear. There is a high incidence of left pleural effusion with inflammatory pericardial disease. We hypothesized that after coronary artery bypass grafting (CABG) there would be a higher incidence of pleural effusions in patients with pericardial involvement. We prospectively studied 47 patients undergoing elective CABG; 17 had only saphenous vein grafts (SVG group) and 30 received at least one internal mammary artery graft (IMA group) in addition to SVG. Patients had a chest radiograph, chest ultrasound, and an echocardiogram on the 7th, 14th, and 30th postoperative days. Seven days after the surgery, 42 to 47 patients (89.4 percent) had a pleural effusion and 36 (76.6 76.6 percent) pericardial involvement. No relationship was found between the presence of a pleural effusion and a pericardial effusion (p > 0.05). On the 14th postoperative day, 36 patients (76.6 percent) had a pleural effusion while 33 patients (70.2 percent) had a pericardial effusion. There was a significant relationship between the presence of a pleural effusion and a pericardial effusion (p < 0.05). On the 30th postoperative day, 27 patients (57.4 percent) had a pleural effusion and 25 (53.2 percent) had a pericardial effusion. Again, there was a significant relationship between a pleural effusion and a pericardial effusion (p < 0.05). Finally, there was no relationship between the ejection fraction and the presence of pleural effusion at any time (p > 0.05). From this study, we conclude that there is a high prevalence of both pleural and pericardial effusion postoperatively in patients undergoing CABG. Both types of effusions tend to be asymptomatic, gradually disappear, and are more common in the IMA group. Patients who have a persistent pericardial effusion are more likely to have a persistent pleural effusion.

Coronary Artery Bypass↗
PubMed1993

Influence of atelectasis on pulmonary function after coronary artery bypass grafting.

The purpose of this study was to determine the influence of atelectasis on pulmonary function 6 days following coronary artery bypass grafting (CABG). After 6 days, 30 patients had normal chest radiographs, 38 had atelectasis, and 57 had pleural changes. In 11 patients, atelectasis only was observed in the radiograph, and in 27 it was in combination with pleural changes. The decrease in FVC and FEV1 in the patients with atelectasis was 33.4 and 33.5 percent in the SVG group and 34.8 and 34.3 percent in the IMA group, while in those patients with a normal radiograph, the decrements were 26.3 and 26.9 percent in SVG group and 26.1 and 26.9 percent in IMA group, respectively. Thus, patients with atelectasis on the 6th postoperative day have a larger decrement in pulmonary function post CABG than the patients with normal chest radiograph and this reduction reflects a higher degree of thoracic trauma.

Coronary Artery Bypass↗
PubMed1993

[Hemodynamic effects of low doses of chlorthalidone in patients with mild systemic arterial hypertension].

PURPOSE: To evaluate the hemodynamic effects of low doses of chlorthalidone (CHT) in patients with systemic arterial hypertension (SAH). METHODS: Eight patients with mild SAH, mean age of 52 +/- 8.9 years, 7 men, were studied. Clinical evaluation, systolic (SBP) and diastolic (DBP) blood pressure and heart rate (HR), in supine and standing positions, were obtained before and every two weeks, first two in placebo, during 12 weeks. Laboratory data, hemogram, sodium, potassium, urea, creatinine, glucose, hepatic aminotransferases and urinalysis, were done and at end of study. Hemodynamic monitorization was performed by Swan-Ganz catheter in pulmonary artery to obtain RAP and PAWP, in mmHg. Cardiac output (CO) was obtained by thermodilution method. Systemic vascular resistance (SVR) arose from variables above. Hemodynamic variables were measured at 2nd and 12th weeks during treatment with 50mg of chlorthalidone each 48 h. RESULTS: A significant reduction of SBP (p = 0.005 and p = 0.003), DBP (p < 0.0001 and p < 0.0001), respectively in supine and standing positions. HR did not show statistical difference. At hemodynamic monitoring was observed a significative reduction of SVR (p < 0.02), but not with CO. CONCLUSION: Chlorthalidone in low dosis was effective to treat mild SAH, basically by lowering SVR.

Adult↗
PubMed1992

Ventricular arrhythmias induced by programmed ventricular stimulation after uncomplicated myocardial infarction.

The aim of this study was to correlate the occurrence of ventricular dysrhythmias induced by programmed ventricular stimulation and sudden cardiac death (SCD) after a first episode of acute myocardial infarction (AMI). Twenty-seven consecutive male patients aged fifty-four +/- six (forty-seven to seventy) years were studied prospectively. Thirty days after AMI, patients were submitted to coronary arteriography and programmed ventricular stimulation with the S2-S3-S4 protocol. Noninvasive assessments, including Holter monitoring, ECG stress test, and radionuclide ejection fraction, were also repeated six and twelve months after AMI. Ventricular dysrhythmias were induced in all patients. According to such response, patients were divided into three groups: (1) repetitive ventricular response (n = 9); (2) nonsustained ventricular tachycardia (n = 8); and (3) sustained ventricular tachycardia (n = 10). All patients consistently developed complex ventricular dysrhythmias at Holter monitoring and ECG stress test. One patient from group 2 suffered SCD and another presented a syncope. Similarly, in group 3, 2 patients suffered SCD, 1 during a documented episode of recurrent AMI. Except for 1 patient, radionuclide ejection fraction remained unchanged throughout the study in all cases. SCD was also unrelated to the presence and type of dysrhythmias at noninvasive evaluation. Therefore, the type of ventricular dysrhythmia induced by the S2-S3-S4 protocol has no correlation with late SCD in patients with a first AMI and preserved ejection fraction.

Adult↗
PubMed1992

Relationship between pleural changes after myocardial revascularization and pulmonary mechanics.

It is known that coronary artery bypass grafting (CABG) results in impairment of postoperative pulmonary function. There is also a high incidence of pleural changes (pleural effusion or pleural thickening) after CABG. We hypothesized that those patients with pleural changes in the postoperative period would have a greater decrease in pulmonary function test (PFTs) results. The present study reports the results of 110 male patients who underwent CABG. The chest films and the PFT results obtained preoperatively and on the sixth postoperative day were reviewed. The relationship between pleural changes and PFTs was analyzed in patients who received saphenous vein graft alone (SVG group: 50 patients) or in combination with internal mammary artery grafting (IMA group: 60 patients). In the IMA group, the patients who had pleural changes had significantly greater decreases in their pulmonary function than did the patients without pleural changes. The decrease in the FVC, TLC and FEV1 in the patients with pleural effusions (37.6, 27.8 and 36.8 percent) was similar to that in patients with pleural thickening (34.6, 28.3 and 35.0 percent) and both were significantly greater (p < 0.05) than the changes in the patients with a normal radiograph (26.1, 17.6 and 26.9 percent). In the SVG group, the presence of pleural changes was not significantly related to the decrement in pulmonary function. The values of RV, FRC, Cst, and blood gases were not affected in the SVG or IMA group by the presence of pleural changes. We conclude that the presence of pleural changes on the chest radiograph is associated with a larger decrement of pulmonary function after CABG in the IMA group. This larger decrease probably reflects added thoracic trauma and is not due to the presence of pleural changes per se.

Coronary Artery Bypass↗
PubMed1990

[Predictive value of programmed ventricular stimulation after myocardial infarction].

PURPOSE: To find out whether is there a relation between electrophysiology laboratory ventricular arrhythmias through programmed ventricular stimulation, and the occurrence of relevant clinical events, particularly, sudden death, in patients victims of first episode of myocardial infarction. PATIENTS AND METHODS: Twenty-seven patients (all males) who suffered non-complicated first myocardial infarction, with age varying from 47 to 70 (mean 54 +/- 6) years were prospectively and consecutively studied. Upon consent, patients were at first submitted to conventional cinecoronaryography and to programmed ventricular stimulation utilizing the S2, S3, S4 protocol, 30 days after infarction. Moreover, patients were submitted to continuous electrocardiographic (Holter system), exercise test, and radioisotopic studies for left ventricle ejection fraction (phase I). The last three studies were subsequently repeated at 6 and 12 months (phases II and III), respectively. RESULTS: All patients had ventricular arrhythmia induced, and according to the kind of response, patients were grouped into: group I--repetitive ventricular response, RVR, nine (33.5%) patients; group II--non sustained ventricular tachycardia. NSVT, eight (29.5%) patients; group III--sustained ventricular tachycardia SVT, ten (37%) patients. The patients of three groups, when submitted to electrocardiographic exercise test and Holter system studies, revealed complex arrhythmias in all phases. One patient of group II suddenly died at home, and another was injured with syncope, whereas in group III, two suddenly died, one at home and the other at the admission to the hospital, after an acute myocardial infarction. All patients but one of group I, who had a non-fatal reinfarction, showed preserved ventricular function. CONCLUSION: Holter system and electrocardiographic exercises test revealed complex dysrhythmia in the tree phases of the study, independently of the induced response; C--Holter system and electrocardiographic exercise test studies revealed no relation. between sudden death and the kind of ventricular induced response or complex arrhythmia. Ventricular arrhythmia induced with S2, S3 and S4 protocol in patients with preserved ventricular function seems to indicate results without predictive value for cardiac sudden death.

Aged↗
PubMed1989

Two- to eight-year survival rates in patients who refused coronary artery bypass grafting.

One hundred and fifty patients with coronary artery disease (CAD) who refused bypass grafting were followed prospectively from 2 to 8 years. Mean age was 57 +/- 8 (standard deviation) years. Ejection fraction averaged 70 +/- 14%. Eight percent of patients had 1-vessel CAD and 92% had multiple-vessel CAD. Medical treatment included propranolol, nifedipine, isosorbide dinitrate, dipyridamole and aspirin. Annual mortality was 0% for 1- and 2-vessel CAD and 1.3% for left main equivalent disease, 3-vessel and left main CAD. Treatment significantly reduced the incidence of stable and unstable angina. Fifty-two patients (34%) had a second hemodynamic study 4.2 +/- 1.3 years after initial evaluation. Stenosis progression or new significant obstructions (greater than or equal to 70%) in previously normal coronary arteries occurred in 61% of 123 arteries studied, whereas new occlusions were observed in 12% of the arteries. Nonfatal acute myocardial infarction incidence was 8%. No significant changes occurred in ejection fraction. In conclusion, proper medical treatment in selected patients with advanced CAD but preserved ventricular function is associated with good long-term survival and remission of symptoms, although progression of coronary atherosclerosis does occur in some patients.

Aged↗
PubMed1989

[Acute pulmonary edema due to dysfunction and/or rupture of the papillary muscles in patients with coronary insufficiency. Surgical results].

Acute mitral regurgitation due to severe papillary muscle dysfunction or rupture has a poor clinical outcome and often requires an emergency surgical procedure. Pulmonary venous congestion generally occurs as an end-stage event and in these patients surgery is often postponed or even not considered. We studied 14 consecutive patients with coronary artery disease that suffered acute pulmonary edema soon after mitral regurgitation was diagnosed; they were 8 (57%) male and 6 (43%) female with mean age 60-8 years (49 to 69 years). Five patients had an acute myocardial infarction and 9 had an old infarction or stable angina. Surgical treatment was indicated to all patients: mitral valve replacement or reconstructive procedure (annuloplasty) was the only procedure in 2 patients and was associated to coronary artery revascularization in the other 12. Two patients (14.3%) with acute myocardial infarction died in hospital; the remaining 12 (85.7%) had hospital discharge and did well in the late follow-up period. We concluded that this high-risk group of patients is particularly suitable for surgical management since medical treatment carries a very poor prognosis.

Acute Disease↗