Biomedical subjects

W Pitscheider

Publications and source records attributed to W Pitscheider.

At least 19 recordsLinked to original sources

PubMed2003

Left ventricular remodelling, and systolic and diastolic function in young adults with beta thalassaemia major: a Doppler echocardiographic assessment and correlation with haematological data.

OBJECTIVE: To evaluate left ventricular morphology and function in a large population of patients with beta thalassaemia. DESIGN: Echo Doppler assessment of left ventricular function and correlation of cardiovascular data with haematological data. SETTING: Thalassaemia unit in a tertiary referral centre. PATIENTS: 197 young adults with beta thalassaemia, following an adequate transfusional and chelation treatment regimen, without clinical signs of cardiopulmonary involvement. The control group consisted of 213 healthy subjects. RESULTS: Left ventricular volumes, mass index, and mass/volume ratio were increased. Diastolic and systolic shapes were different, the left ventricle maintaining an ellipsoidal shape. The ejection fraction was reduced, and was < 50% in 33 patients. Stroke volume and cardiac index were increased, and systemic vascular resistance was decreased. Fractional shortening and mean velocity of circumferential shortening were decreased. Meridional end systolic and peak systolic stress were increased, as was circumferential end systolic stress. The contractile state was reduced while the functional preload index did not differ. Left ventricular diastolic function, evaluated from the mitral inflow, showed a slightly prolonged isovolumic relaxation time, increased flow velocity integrals, and an increased E/A ratio. Among the haematological data, only serum ferritin showed a weak negative correlation with left ventricular ejection fraction. The patients with the highest serum ferritin (> 2500 ng/ml) had the lowest ejection fraction. CONCLUSIONS: Patients with beta thalassaemia on an adequate transfusion and chelation treatment regimen show abnormal left ventricular remodelling with increased volumes, mass, and mass/volume ratio. Systolic chamber function and contractile state are reduced, with a slightly increased afterload. These findings seem mainly to be related to the increased cardiac output caused by chronic anaemia. Left ventricular performance is better preserved when chelation treatment is adjusted to maintain the serum ferritin concentration at < 1000 ng/ml.

Adolescent↗

PubMed2001

Cardiac performance in Turner's syndrome patients on growth hormone therapy.

OBJECTIVES: To investigate possible cardiac morphofunctional alterations observed in 26 Turner's syndrome (TS) patients on prolonged high-dose growth hormone (GH) therapy. STUDY DESIGN: We examined 26 TS subjects treated with rhGH (1 U/kg/week) for a mean period of 4.9 years (range 1-7.8) and 37 age-, weight- and height-matched healthy girls. Left ventricular volume, mass, systolic function, cardiac index, systemic vascular resistance and diastolic function were evaluated by two-dimensional and Doppler echocardiography. RESULTS: Heart rate and systolic blood pressure (BP) were higher in TS patients than in controls, while diastolic BP was lower. Left ventricular volumes, ejection fraction, mass index, M/V ratio and cardiac index did not differ significantly; systemic vascular resistance was slightly decreased. Left ventricular fractional shortening and mean velocity of circumferential shortening were slightly increased while end-systolic meridional stress was decreased in TS. Contractile state was normal in TS. Diastolic function assessment showed a shortening of isovolumetric relaxation and diastolic filling times with an increased atrial contribution and a normal pulmonary venous flow. CONCLUSION: Cardiac morphology in TS patients on GH therapy is similar to controls. The observed changes in left ventricular systolic and diastolic function should be interpreted as an adaptation to the higher heart rate and reduced peripheral vascular resistance induced by GH therapy.

Adolescent↗

PubMed1999

Medium-term cardiovascular effects of high-dose growth hormone treatment in growth hormone-deficient children.

AIM: To investigate the possible cardiac morphofunctional alterations inducd by prolonged and high-dose GH therapy in a group of 14 children with isolated GH deficiency. PATIENTS AND METHODS: Patients were evaluated at phase 1, after 1.1 +/- 0.6 years of treatment with GH 0.93 +/- 0.13 U/kg/week, and at phase 2, after 5.5 +/- 2.1 years of therapy 0.89 +/- 0.11 U/kg/week. At each phase left ventricular volume, mass and systolic function were evaluated by two-dimensional guided M-mode echocardiography; left ventricular diastolic function was assessed by PW-Doppler sampling of transmitral flow. RESULTS: Phase 1: diastolic blood pressure was lower (p < 0.05) and fractional shortening was not adequate for the level of afterload (stress shortening index p < 0.05) in patients compared to controls. Phase 2: diastolic blood pressure was lower (p < 0.01) and mass and mass/volume ratio were increased (mass index p < 0.05, mass/ volume ratio p < 0.05) in patients compared to controls. The increased mass/volume ratio, together with the normal systolic blood pressure, explains the reduction in peak systolic stress (p < 0.005). Among the parameters of left ventricular diastolic function, the peak E velocity/total area under mitral valve tracing and the area under E velocity/total area under mitral value tracing ratios were significantly decreased (p < 0.05). CONCLUSION: After a mean period of 5 years on high-dose GH treatment in GH-deficient children, subclinical morphofunctional alterations in the left ventricle were found.

Adolescent↗

PubMed1998

[Developmental changes of cardiac mechanics during fetal and postnatal life. Diagnostic role of Doppler echocardiography].

The advent of fetal echocardiography combined with Doppler technology gave the clinicians the possibility to evaluate and clarify the main aspects of fetal and postnatal circulatory physiology. From the end of cardiogenesis to the end of gestation the developmental changes of the fetal myocardial structure, ventricular function and circulatory physiology have all been studied. Also the physiological features of the transitional circulation in the first postnatal period, as well as the developmental changes in the morphology and function of the neonatal ventricles can be assessed by Doppler echocardiography. This review is divided in two parts. In the first one we will briefly discuss the contractile properties of the fetal myocardium, the cardiac performance and dynamics of the fetal circulation; in the second one we will consider the physiological aspects of the transitional circulation, the structural features of the immature neonatal myocardium, as well as the developmental changes of the myocardial mechanics as shown by Doppler ultrasound.

Age Factors↗

PubMed1998

[The utility of various Doppler parameters at rest and during exercise for the diagnosis of residual stenosis after operation for aortic coarctation. A doppler-nuclear magnetic resonance comparison].

BACKGROUND: The postoperative follow-up of aortic coarctation (AoCo) is often characterized by persistent arterial hypertension, sometimes due to a residual narrowing at the site of surgical repair. A residual stenosis > or = 30% is considered to be significant. Anatomy of the aortic arch is best assessed by angiography, transesophageal echocardiography and magnetic resonance imaging (MRI). The use of these invasive and expensive procedures for routine examination in all patients who develop late systemic hypertension cannot be justified. Consequently, it would appear to be useful to find some noninvasive methods, such as Doppler gradients, that are capable of identifying any residual anatomic narrowing. OBJECTIVES: We compared different Doppler parameters obtained at rest and during exercise with the degree of narrowing at the site of surgical repair measured by MRI, in order to identify the indices predictive of residual stenosis. METHODS: Thirty-nine patients (26 M, 13 F) were studied after AoCo repair. Mean age was 21.7 +/- 9.7 years (9-49). Their age at the time of repair was 10 +/- 9.7 years (0.1-27) and the postoperative follow-up was 11.5 +/- 6 years (2-25). Systolic blood pressure measurement and Doppler echo for calculation of the transisthmic gradient at rest and during exercise on a bicycle ergometer were performed in all patients. The peak systolic gradient (PGs) over the isthmus was calculated using the simplified Bernoulli equation: PGs = 4 x (V2(2)-V1(2)), where V1 and V2 are the peak velocities in the ascending and descending aorta. In addition, at the end of exercise the peak diastolic gradient (PGd) was measured at the end of the T wave on the ECG, and the systolic velocity half-time (SVHT), as the time interval from the peak to the half peak systolic velocity. MRI of the aorta was performed to measure the diameter of the isthmus (AI) and of the descending aorta at the diaphragm (DA). Residual narrowing at the isthmus was expressed as stenosis % = [(1-(AI/DA)]%. RESULTS: At rest: systolic blood pressure 128.3 +/- 22.5 mmHg, PGs 15.9 +/- 8.1 mmHg (1-32). None of the patients had PGd. At peak exercise: systolic blood pressure 207 +/- 37 (160-265) mmHg, PGs 32.3 +/- 14.7 mmHg (8-70), SVHT 96 +/- 23 msec (60-139) and PGd 7.2 +/- 4.8 mmHg (1-17). Stenosis % measured by MRI was 23.1 +/- 14.5% (0-53) and in particular, it was < 30% in 25 patients and > or = 30% in 14 patients. Both the PGs at rest and the other Doppler parameters at peak exercise (PGs, SVHT, PGd) correlated with stenosis %. SVHT together with PGd on exercise Doppler represented the combination of two variables that was best for predicting a residual stenosis. When all three variables obtained by exercise Doppler were combined, every patient with residual stenosis was correctly identified. In particular, the combination (PGs > or = 28 mmHg + SVHT > or = 108 msec + PGd > or = 8 mmHg) identifies all patients with stenosis > or = 30%, while the combination (PGs < or = 38 mmHg + SVHT < 108 msec + PGd < 10 mmHg) excluded those with significant stenosis. CONCLUSION: Parameters obtained from the transisthmic gradient (PGs, SVHT, PGd) measured at peak exercise by CW-Doppler can diagnose a residual stenosis % in operated AoCo. We propose using this noninvasive method of identifying patients who need to be referred for MRI.

Adolescent↗

PubMed1997

Echocardiographic evaluation of systolic and diastolic left ventricular function following arterial switch operation in the neonatal period for transposition of the great arteries. Midterm results.

BACKGROUND: Neonatal arterial one-stage switch operation (ASO) for transposition of the great arteries (TGA) is currently the procedure of choice for TGA. There is a potential risk of myocardial damage related to coronary artery reimplantation and sudden pressure overload imposed on the left ventricle after discontinuation of the cardiopulmonary bypass. OBJECTIVES: This study was carried out in order to evaluate left ventricular systolic and diastolic function in children following ASO. METHODS: We studied 32 children (22 M, 10 F), mean age 23.7 +/- 24.6 months (range 0.5-97.2) following ASO, without any hemodynamically significant residual stenosis by 2D- and Doppler-echocardiography. Twenty-five had TGA with intact ventricular septum and 7 with ventricular septal defect. Mean age at time of one-stage repair was 8.9 +/- 6.9 days (range 2-30) and the mean time of follow-up 23.5 +/- 24.6 months (range 0.3-96). At the time of evaluation all the children were asymptomatic. Regional wall motion of the left ventricle was assessed by 2D-echo. Volumes, mass index, M/V ratio, afterload, systolic function (FS% and VCFc), contractility (stress-velocity SVI and stress-shortening SSI relations) and preload (functional preload index FPI = SSI-SVI) of the left ventricle were determined by m-mode echo together with non-invasive blood pressure monitoring. Left ventricular diastolic function was determined by PW Doppler of transmitral flow. All parameters were compared with those of 32 normal controls matched for age, sex and body surface area. RESULTS: Left ventricular regional wall motion was normal in all but 5 cases who showed a slight reduction of the septal systolic motion. Volumes and EF% did not differ in post-ASO group vs controls. There was a small increase of the mass index in the post-ASO group vs controls (62.8 +/- 14.1 vs 56.2 +/- 6.5 g/m2; p = 0.02) and the M/V ratio did not differ. FS% and VCFc were not different between the 2 groups. Peak and end-systolic meridional stress also did not differ in the 2 groups. A normal contractile state was present in the post-ASO group. The preload was slightly reduced in the post-ASO children (FPI -0.6 +/- 0.94 vs 0.07 +/- 0.63; p = 0.001). Parameters of left ventricular diastolic function were not significantly different between the 2 groups. CONCLUSIONS: In conclusion in children undergoing neonatal ASO for TGA with intact septum or ventricular septal defect, evaluated after a mean post-surgical follow-up of 2 years, systolic and diastolic performance of the left ventricle was normal. Regional wall motion abnormalities with slightly reduced septal motion were detected in 5 cases. The reason for the small increase in mass index is unknown. The slight reduction of the preload is related to the routine drug therapy in the patients studied early after surgical repair.

Child, Preschool↗

PubMed1996

[Corrected transposition of the great arteries in geriatric age. Report of a case diagnosed by magnetic resonance imaging].

Corrected transposition of the great arteries (cTGA) is a rare condition, and few patients with this abnormality survive the 50th year of age because of associated anomalies or the subsequent development of left atrioventricular valve regurgitation or heart block or both. We report the case of a 75 years old man with cTGA without associated anomalies which seems to be of particular interest because of the following reasons: 1) cTGA is a rare condition in advanced age; 2) the diagnosis has been made by MRI which allowed a complete segmental analysis; 3) this case confirms that the morphologic right ventricle in systemic position can function appropriately over a long term. We conclude that MRI can be an alternative to Echocardiography in patients with complex congenital cardiac disease who exhibit a poor ultrasound window.

Aged↗

PubMed1995

[Planar myocardial scintigraphy with technetium-99m-sestamibi in acute myocardial infarct treated with thrombolytic therapy].

BACKGROUND: Nuclear cardiology permits the estimation of the myocardial infarction size and the result of the thrombolytic therapy. The aim of the study was to demonstrate the feasibility of the planar myocardial scintigraphy with Technetium-99-m-sestamibi in the coronary intensive care unit for the early identification of the infarct size and the result of the thrombolytic therapy. MATERIALS AND METHODS: We considered 10 patients affected by a first myocardial infarction (5 anterior and 5 inferior wall) then treated with thrombolytic therapy (APSAC 30 U. iv) within an interval of 3 hours from the onset of the symptoms. Technetium-99-m-sestamibi was injected before the thrombolytic therapy and the planar imaging was registered after 2-3 hours with a mobile gamma-camera. After 24 hours and before patient discharge we repeated the scintigraphic evaluation. Within 24 hours from the thrombolytic therapy the coronary angiography was performed for the demonstration of patency of the infarct-related artery. The left ventricle myocardial perfusion was divided in the 3 planar projections into 13 segments. The perfusion in each segment was evaluated with a perfusion score: 0 = normal perfusion, 1 = moderately reduced, 2 = severely reduced, 3 = absent. The sum of the hypoperfused segments represented the infarct size. A perfusion score improvement greater than 40% was considered a marker of reperfusion. RESULTS: The infarct size involved 4.4 +/- 1.4 segments in the anterior and 2 +/- 0.6 segments in the inferior wall infarctions (p < 0.05). The scintigraphic imaging made 24 hours after the myocardial infarction allowed the diagnosis of coronary reperfusion in 7 patients. The coronary angiography demonstrated the infarct related artery patency in 9 patients (all with TIMI perfusion score = 3). The nuclear imaging at patient discharge provided the diagnosis or reperfusion in 8 cases and demonstrated an improvement of the myocardial perfusion score in 5 cases. CONCLUSION: The scintigraphic imaging with Technetium-99-m-sestamibi in the patients with a myocardial infarction treated with thrombolytic therapy is feasible with a mobile gamma-camera in the intensive coronary care unit. The quality of planar imaging is good and allows the evaluation of myocardial infarct size and efficiency of thrombolytic therapy. An earlier scintigraphic imaging should be taken into consideration for a more timely non-invasive evaluation of patients who need coronary angiography and, if necessary, a rescue PTCA.

Aged↗

PubMed1995

[Left ventricular remodelling at 3 months from a first transmural infarct: the effect of physical activity and of the patency of the necrotic artery on changes in volume and segmental kinetics].

OBJECTIVE: Aim of this perspective study was to assess in patients (pts) with a recent first transmural myocardial infarction (MI) the influence of a physical training, of MI location and of the patency of the infarct-related coronary artery on the modification of the left ventricle volumes and wall motion score. METHODS: One hundred and four consecutive pts with a first transmural MI without clinical contraindication (heart failure, moderate or severe mitral regurgitation, severe postinfarction angina, claudication or severe orthopedic problems) were randomly assigned to a rehabilitation group (A) and to a control group (B). Ten days after acute MI all pts underwent a coronary angiography. A complete echocardiographic examination was performed 10 and 90 days after MI, and an ergometric evaluation 20 and 90 days after MI. Ventricle volumes, ejection fraction (EF) and wall motion score were calculated by a two-dimensional echocardiogram. Thirteen pts (12.5%) were excluded from the study because of the bad quality of the echocardiographic images. There were 8 dropouts (7.8%) due to bypass surgery or to coronary angioplasty. Of the 83 pts who have concluded the study 46 (55%) belonged to the Group A and 37 (45%) to the Group B. Thirty-six had anterior MI (20 Group A), 41 inferior MI (22 Group A) and 6 lateral or posterolateral MI (4 Group A). RESULTS: At the base-line the ventricular volumes, the EF, the wall motion score and the Total Work Capacity (TWC) were not different in the two groups. Three months after the MI the pts of the Group A demonstrated, in comparison with the controls, a reduction of left ventricle end-diastolic volume index (EDVi 75.4 +/- 18.1 ml/m2 vs 85.3 +/- 27.9 ml/m2; p < 0.05) and an increased TWC (7146 +/- 3566 Kgm vs 4494 +/- 2728 Kgm; p < 0.001). In the Group A the comparison of the base-line data with those observed 3 months later showed a reduction of the EDVi from 81.9 +/- 16 to 75.4 +/- 18.1 p < 0.05, of the end-systolic volume index (ESVi) from 43.6 +/- 11.9 to 38.1 +/- 14 ml/m2, p < 0.05, of the wall motion score from 6.7 +/- 2.3 to 5.5 +/- 2.9 p < 0.05 and a great increase of the TWC (from 4483 +/- 2407 Kgm to 7146 +/- 3566 Kgm; p < 0.0001). No parameter in the Group B showed any significant modification in the same period. The tendency to reduce the volume and improve the physical performance with exercise training was greater in the inferior MI (ESVi from 41.3 +/- 12.3 to 34.7 +/- 11.6 ml/m2, p = 0.07 - TWC from 4652 +/- 2446 to 8115 +/- 3954 Kgm, p < 0.001) than in the anterior MI (ESVi from 445.8 +/- 10.7 to 42.1 +/- 17.2 ml/m2, p = ns - TWC from 4085 +/- 2103 to 5829 +/- 2256 Kgm, p < 0.05). When comparing pts with an occluded infarct-related coronary artery with TIMI grade 0-2 flow with those with a patent one (TIMI grade 3 flow), no significant differences in any considered parameter except for the collateral vessels score were found (1.48 +/- 0.97 vs 0.29 +/- 1.64 p < 0.05). After 3 months 20 pts presented larger EDVi compared to the baseline, and compared to the 34 pts with a smaller EDVi, they had a higher serum myocardial enzymatic peak (LDH 2035 +/- 1423 vs 1346 +/- 683 p < 0.01, CK 3096 +/- 2339 vs 2099 +/- 1520, p < 0.05) an inferior collateral score (0.47 +/- 0.77 vs 0.67 +/- 1.98, p < 0.01) and they mainly belonged to the Group B (55%). Twenty pts had an initial EF < or = 40% (range 22-40%): 5 of the 6 pts of this group, who increased the EDVi after 3 months belonged to the Group B while 9 of the 10 pts who reduced it belonged to the Group A. CONCLUSIONS: Intensive physical training during the 3 months following a first transmural MI significantly improves the physical performance, reduces the ventricle size and improves the wall motion score. Such improvement could not be found in the control group and is not related to the patency of the culprit coronary artery. The pts with an inferior MI tended to gain a major advantage from the physical activity than the pts with an anterior

Aged↗

PubMed1994

[Exercise 201-thallium myocardial scintigraphy in left bundle branch block].

BACKGROUND: Reduced septal uptake of 201-Thallium in patients with left bundle branch block is reported in literature as having a variable frequency (between 14% and 100%) and in such patients the value of exercise Thallium-scintigraphy for the diagnosis of the left anterior descending coronary artery disease is limited by the great number of false-positive tests. The aim of this study was to assess the prevalence and the diagnostic sensitivity of this septal defect in a group of patients with left bundle branch block. METHODS: We evaluated the exercise 201-Thallium myocardial scintigraphy of 54 patients with a stable left bundle branch block. The clinical and/or echocardiographic evaluation excluded the presence of primitive, valvular and hypertensive cardiomyopathies and of previous myocardial infarction. The planar myocardial scintigraphic imaging was acquired according to the "stress-redistribution" protocol. Only 37 patients underwent an echocardiographic examination and following clinical and/or scintigraphic indications; 27 patients underwent a coronary angiography for the evaluation of coronary stenosis. RESULTS: The 201-Thallium imaging showed septal defects in 36 patients (67%) and the presence of defects in other segments in 14 patients. The echocardiographic evaluation showed an interventricular septal defect contraction abnormality in 19 cases in the 27 patients with septal defect and in 4 cases in the 10 patients with negative scintigraphy (Fisher NS). Twenty-seven patients (23 with- and 4 without septal defect) underwent a coronary angiography, which showed in 6 cases critical stenosis of the left descending anterior artery, in 5 of the right coronary, in 3 of the Circumflex artery and in 16 normal coronary angiograms. The presence of the septal uptake defect showed a diagnostic sensitivity and specificity for the detection of the left anterior descending coronary artery disease of respectively 67% and 52% (whereas using a semi-quantitative analysis of 100% and 19%). The scintigraphy showed a sensitivity and specificity for the detection of the right coronary artery disease of respectively 80% and 100% and for the circumflex coronary artery stenosis of 0% and 100%. CONCLUSIONS: We found a high prevalence of septal perfusion defects (67%) and this results shows a high sensitivity but a low specificity for the diagnosis of the left anterior descending coronary disease; the semi-quantitative analysis improves the sensitivity, but leads to a further reduction of the specificity. The female patients had a prevalence (70%) similar to the general population but demonstrated a higher percentage of false-positive. The 201-Thallium scintigraphy has a high diagnostic accuracy for the detection of the right coronary artery stenosis, while it is less accurate regarding the circumflex artery disease.

Aged↗

PubMed1994

[Transesophageal echocardiographic diagnosis of coronary fistula in an adult patient].

There are only a few reports about the utility of transesophageal echocardiography (TEE) in diagnosing coronary artery fistulas. We report a case of an adult patient with an unsuspected fistula between the right coronary artery and the right atrium, which was identified and correctly described by TEE. This diagnosis was subsequently confirmed by selective coronary angiography and surgical findings.

Cardiomyopathies↗

PubMed1994

[The value of nuclear magnetic resonance tomography in evaluating the patency of aortocoronary bypass grafts].

BACKGROUND: Patients with previous coronary artery bypass graft surgery often present with pain of unknown origin. Noninvasive documentation of graft patency is of obvious clinical importance. METHODS: In order to assess the efficacy of magnetic resonance imaging (MRI) in evaluating graft patency, 44 patient with prior coronary artery bypass graft surgery and a history of chest pain were studied by coronarography and MRI. MRI was performed within 2.1 +/- 3.8 days from coronarography using a 0.5 Tesla magnet, Spin-Echo T1 technique, cardiac and respiratory gating and scannings in transaxial plans. A graft was defined as patent, if a signal void was identified in at least two different slices in a position consistent with a bypass graft. Images were analyzed by two different observers aware of the type of surgery but not the result of the coronarography. RESULTS: Eighty-nine out of 100 grafts were classified correctly by MRI. Sixty-three grafts were patent as shown by coronarography; 59 of them were classified correctly by MRI. Thirty-seven grafts were shown as occluded; 30 of them were classified correctly by MRI. In particular, 43 out of 45 grafts to the left anterior descending artery, 18 of them using the internal mammary artery, 23 out of 30 graft to the left circumflex artery and 23 out 25 grafts to the right coronary artery were classified correctly. CONCLUSIONS: This study demonstrates the capability of MRI to evaluate coronary artery bypass graft patency with a sensitivity of 94% and specificity of 81%; this technique has significantly clinical limitations because resolution is not adequate to evaluate the presence of graft stenosis.

Adult↗

PubMed1993

[Long-term follow-up in patients operated on for aortic coarctation. The echo-Doppler and MRI assessment of left ventricular function and the transisthmic gradient].

BACKGROUND: Hyperdynamic left ventricular function and increased left ventricular mass has been recently reported in the long-term follow-up of patients after successful repair of aortic coarctation (AoCo). METHODS: We studied 35 patients, mean age 22.7 years (range 1-47), following repair of AoCo in order to evaluate: 1) left ventricular mass and systolic function by M-mode echocardiography in comparison with 20 healthy control subjects; 2) the prevalence of systemic hypertension; 3) systolic blood pressure and the trans-isthmic gradient by CW Doppler at rest and after exercise; 4) subjects with a hypertensive response and/or with a significant trans-isthmic gradient during exercise, correlating such parameters with indexes of left ventricular function and the ratio of aortic isthmus/aortic diaphragmatic diameters (AOI/AOD) by means of Magnetic Resonance (MR). At the time of operation, mean age was 12.4 years (range 1 mo-40 yrs) and the follow-up period was 10.1 years (range 6 mo-26 yrs). RESULTS: Left ventricular mass index (Mi) was significantly greater in comparison with that of the controls (96.5 +/- 25 vs 71.5 +/- 16.6 g/m2; p < 0.001); the mean velocity of circumferential shortening (mVCFc) was increased (1.4 +/- 0.25 vs 1.2 +/- 0.16 circ/s; p < 0.005); the end systolic meridional stress (ESS) was decreased (37.3 +/- 11.1 vs 47.9 +/- 13.1 g/cm2; p < 0.005) while the peak systolic meridional stress (PSS) was not significantly different in the two groups. Fourteen out of 35 patients (40%) showed an exaggerated mVCFc for the level of ESS, which indicates an increased inotropic state. Hypertension at rest was present in 10 patients (28%). Mean age at the time of operation of the hypertensive group was higher than that of the normotensive one (21.4 +/- 10 vs 8.9 +/- 8.6 yrs; p < 0.001). All patients showed a small systolic gradient across the side of coarctation repair at rest (mean 13.1 mmHg; range 0-30). The exercise test was stopped in 5 patients because of hypertension (> 250 mmHg); 24 patients (80%) showed an exercise-induced hypertension. The mean gradient at maximal exercise was 25.9 mmHg (range 0-52); 6 patients (20%) developed a diastolic gradient. With MR it was possible to evaluate the anatomy of the aortic arch and the descending aorta in all cases. The mean ratio AOI/AOD was 0.81 (range 0.63-1). The age at the time of operation showed a positive correlation with the systolic blood pressure (r = 0.63; p < 0.001) and with Mi (r = 0.45; p < 0.005). The systolic blood pressure and the gradient at maximal exercise also showed a positive correlation (r = 0.40; p < 0.01). CONCLUSIONS: In the long-term follow-up of patients after successful coarctation repair there are persistent alterations of left ventricular function with hypertrophy, hyperkinesia and increased inotropic state. Hypertension at rest and after exercise could persist despite good surgical results.

Adolescent↗

PubMed1993

[Magnetic resonance with the spin-echo technic in the noninvasive evaluation of the patency of aortocoronary bypasses: preliminary data].

BACKGROUND: Patients with previous coronary artery bypass graft surgery often develop chest pain due to ischemic or nonischemic causes. Noninvasive evaluation of graft patency is thus of obvious potential importance. METHODS: In order to assess the efficacy of magnetic resonance imaging (MRI) in evaluating graft patency after coronary artery bypass graft surgery, 16 patients with prior surgery and history of chest pain were studied prospectively by coronarography and MRI. These 16 patients with a total of 40 grafts were evaluated, using MRI with Spin-Echo T1 technique within 3.6 +/- 4.4 days from coronarography with a 0.5 Tesla magnet, cardiac and respiratory gating and scannings in transaxial planes. A graft was defined as patent if a signal void was identified in at least two different slices in a position consistent with a bypass graft. Images were analyzed by two different observers aware of the type of surgery but not the result of the coronarography. RESULTS: Thirty-six out of the 40 grafts were classified correctly by MRI. Twenty-eight grafts were patent as shown by coronarography; 26 of them were classified correctly by MRI. Twelve grafts were shown as occluded; 10 of them were classified correctly by MRI. In particular, all of the 14 grafts to the left anterior descending artery (3 of them using the internal mammary artery), 13/16 of the grafts to the left circumflex artery and 9/10 of the grafts to the right coronary artery were classified correctly. CONCLUSIONS: This study demonstrates the capability of MRI to evaluate coronary artery bypass graft patency with a sensitivity of 92.8% and specificity of 83.3%; this technique has significant clinical limitations because resolution is not adequate to evaluate the presence of graft stenosis.

Adult↗

PubMed1993

[Acute myocardial infarction in a young adult with multiple coronary aneurysms resulting form Kawasaki disease].

A young male patient with no risk factors for atherosclerotic disease suffered from an acute myocardial infarction at the age of 22 years, and was subsequently found to have multiple coronary artery aneurysms by coronary angiography. The transthoracic echocardiography was unable to identify coronary anomalies, whereas the transesophageal approach did show aneurysmatic lesions of the left anterior descending artery. These could have been caused by a previous episode of Kawasaki disease, a pathological finding that should be considered in any young adult presenting with proximal discrete coronary artery aneurysms.

Adult↗

PubMed1992

[The adenosine test in association with 99m-technetium sestamibi tomoscintigraphy in the diagnosis of coronary pathology].

BACKGROUND: The exogenous adenosine is able to provoke a coronary vasodilation, which is the same as the one provoked by the papaverine and greater than the one provoked by the dipyridamole. We report our experience in using exogenous adenosine in association with technetium-99m-sestamibi tomoscintigraphy for a diagnostic test on the coronary artery disease (CAD). METHODS: We considered 22 patients (18 male and 4 female, mean age 57 years) affected by angiographically demonstrated coronary artery disease (stenoses > or = 50%). Adenosine was infused at a dosage of 0.070 mg/kg/min for 3 minutes and, if well tolerated, the dosage was increased to 0.140 mg/kg/min; in the third minute of the major dosage the radioisotope was injected. The myocardial perfusion imaging at rest was evaluated on the following day. RESULTS: The test was completed on 21 of the 22 patients, and 20 of the latter were subjected to the maximal dosage of the adenosine infusion. Clinically irrelevant adverse effects were observed in 20 cases; only one patient developed a II degree type 1 AV block. Angina occurred in 19 patients. Coronary angiography demonstrated significant stenosis of 35 vessels: the left anterior descending (LAD) in 14 patients, the left circumflex (LCx) in 8 and the right coronary artery (RCA) in 13. In detecting CAD, the test in our study demonstrated a sensitivity of 85% in the LAD disease, of 89% in the LCx disease and of 77% in RCA disease. CONCLUSIONS: The adenosine infusion associated with technetium-99m-sestamibi tomoscintigraphy demonstrated an elevated incidence of adverse effects which are of short duration and clinically irrelevant. The method was shown to be highly sensitive in detecting the CAD.

Adenosine↗

PubMed1991

[Transesophageal echocardiography in the diagnosis of cor triatriatum in the adult].

Cor triatriatum (CT) is a rare congenital defect, surgically correctable, and sometimes difficult to diagnose by cardiac catheterization. This report describes three young patients with this particular defect, one of whom was sent to us because of signs of right ventricular failure. The diagnosis of CT was made by transesophageal echocardiography and confirmed by cardiac catheterization and surgical data. The other two cases underwent cardiac catheterization and cardiac surgery during infancy for other congenital defects. The diagnosis of CT was made only during post-operative controls by transthoracic echocardiography. In these two cases transesophageal echocardiography provided the most valuable information about the morphological features of the membrane and the mitral valve, and about the flow between the two left atrial chambers.

Adolescent↗

PubMed1991

[Immediate results of percutaneous mitral valvuloplasty using Inoue catheter. Personal experience in the first 15 cases].

Mitral valvuloplasty with an Inoue balloon catheter was performed at our institution in 15 patients affected by mitral stenosis. All were severely symptomatic (class NYHA III or IV). Transthoracic and transesophageal echocardiography showed a mitral score less than 10 (Wilkins criteria). Patients with thrombi in the left atrium and those with important mitral regurgitation were excluded. The mitral valve area increased from 0.98 +/- 0.2 to 1.89 +/- 0.4 cm2 and the transvalvular gradient decreased from 18.2 +/- 7.5 to 6.7 +/- 3.7 mmHg. There was a small increase of the mitral regurgitation. Two complications occurred during the procedure: the first was a haemopericardium, which was percutaneously drained, and the other a rupture of the anterior mitral leaflet with acute, severe mitral regurgitation necessitating urgent surgical correction. Applying the criteria of Herrmann, the results were optimal in 11 and suboptimal in 3 cases.

Adult↗