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W Tracz

Publications and source records attributed to W Tracz.

At least 55 records · Page 3Linked to original sources
PubMed1996

Thallium-201 myocardial perfusion imaging in patients before and after successful percutaneous transluminal coronary angioplasty.

We studied the value of exercise thallium-201 (Tl-201) scintigraphy for evaluation of myocardial perfusion improvement and the detection of restenosis in patients after successful percutaneous transluminal coronary angioplasty (PTCA). Fifty-three patients (43 male and 10 female) ages 38-71 years (mean 55.3) were analysed. Exercise Tl-201 scintigraphy was performed before PTCA, and 6-10 days and then 3-6 months after the procedure. In all patients repeated coronary angiography was done 3-6 months after PTCA. Before PTCA myocardial perfusion defects were observed in all patients. Immediately after PTCA, an improvement in myocardial perfusion was noted in 36 patients (61%). Total normalisation of the scintigraphic picture was observed in only 12 patients. Coronary angiography after 3-6 months showed patency of dilated vessels in 11 out of those 12 patients (91.3%). In scintigraphy, performed 3-6 months after PTCA, a normal scan was present in 20 patients and recurrence of stenosis was found in only 2 of those 20. Stenosis was found in 22 (60%) of 33 patients with perfusion defects. For the purpose of describing the character of the myocardial perfusion changes, statistical analysis of a number of segments was performed. The predictive value of Tl-201 scintigraphy for detection of restenosis was established. The positive value for the procedure performed 6-10 days after PTCA was 56%, and the negative value of prediction of restenosis was 91%. Three to 6 months after PTCA, a high negative value of scintigraphy was observed (-90%) and a low positive predictive value was still present (63%).

Adult↗
PubMed1996

[Scintigraphic evaluation of myocardial perfusion after using TI-201 in patients before and after successful percutaneous transluminal coronary angioplasty].

We analysed 53 patients (43 men and 19 women) age 38-71. Exercise TI-201 scintigraphy was performed before PTCA, 6 to 10 days and 3 to 6 months after PTCA. Before PTCA in all the patients myocardial perfusion detects on scintigraphy were observed. The imaging performed 6 to 10 days after PTCA showed an improvement seen as a decrease in the number of ischaemic segment in 36 patients (67.9%) and total normalisation of scintigraphic picture in 12 patients. Coronary angiography performed 6 months after PTCA showed patency of the dilated vessel in 11 (91.3%) among these patients. In exercise TI-201 scintigraphy performed 3 to 6 months after PTCA normalised scan was observed in 20 patients, recurrence of stenosis was found only in 2 (10%) of those patients. In 33 patients with transient perfusion defects, angiographic restenosis was found in 22 (60%) patients. Predictive value of exercise TI-201 scintigraphy for occurrence of restenosis was established. Positive predictive value of the study performed 6 to 10 days after PTCA was 56%. Negative predictive values of such a study was 91%. Similarly, for detection of restenosis in scan performed 3 to 6 months after PTCA there was found a strong negative predictive value-90% and a weak positive predictive value-63%.

Adult↗
PubMed1996

[Long-term observation of patients with biopsy proven myocarditis or dilated cardiomyopathy].

Dilated cardiomyopathy (DC) and myocarditis (MCD) are still cardiac diseases of unknown etiology and pathogenesis. Due to uncertain natural history of MCD also treatment remains controversial. We observe long-term outcome of 30 pts with biopsy-proved MCD (group I) and 25 pts with DC (group II). The diagnosis of MCD was established on Dallas criteria of MCD. Almost all pts presented symptoms of congestive heart failure. All group I pts were treated with immunosuppressive agents: azathioprine 1.5 mg/kg/d and prednisone with initial dose of 1.5 mg/kg/d. After tapering off 0.75 mg/kg/d of prednisone and initial dose of azathioprine were given up to 6 months. All pts obtained digitalis, diuretics, ACEI, antiarrhythmic drugs if necessary. We studied the survival and clinical status (NYHA class) of treated pts. Clinical improvement was observed in 93% of pts with MCD within 6 months, but 20% of pts deteriorated within the next 6 months. Almost all pts survived 1 year. Out of 30 pts with MCD, 16 pts remain in lower NYHA class (NYHA I-II) between 26 and 69 months of follow-up. Within the group II (DC) 28% of pts died in the first year of observation. Out of 15 pts in 14 pts advanced chronic heart failure (NYHA III-IV) is presented in the end of observation. Echocardiographic parameters of pts with congestive heart failure and biopsy-proved MCD or DC did not differ significantly. We observed correlation between improvement of the LV echocardiographic parameters and improvement of clinical status of treated pts.

Adolescent↗
PubMed1996

Successful full-term pregnancy in a patient three and a half years after a heart transplant.

The patient is a 28 year old woman who received a heart transplant in 1992 secondary to hypertrophic cardiomyopathy with unremarkable post-operative course. In the period immediately post transplantation the patient was on a four-drug immunosuppressive regimen which was subsequently changed to standard three-agent therapy. This therapy was continued until the patient became pregnant. In the first trimester only Cyclosporine (CsA) was used, and thereafter, the patient was continued on the previous three agent regimen. Toward the end of pregnancy a rise in systolic pressure was observed, but the child was delivered by spontaneous vaginal delivery without complications in the 38th week of pregnancy. The newborn weighed 3320 g and was in good health. A sharp fall in the newborn CsA blood levels was observed post delivery reaching zero level on the third day of life. At the present time, both mother and baby are in good health, 6 weeks after delivery.

Adult↗
PubMed1993

[Results and complications of PTCA].

Between January 1987 and June 1992 we performed 189 PTCA procedures in a group of 153 patients (127 men, 26 women) aged 28 to 69 years, mean 52.3. 203 coronary vessels were dilated. In 136 pts one vessel was dilated, one vessel with two narrowings were dilated in 16 pts and in 17 pts two-vessel PTCA was performed. Due to restenosis, PTCA was repeated, once in 26 pts, twice in 3 pts and three times in 1 patient. Effective dilatation was achieved in 81.8% of cases and in this number, circumflex and marginal branch of left coronary artery were successfully dilated in 90.7%, left anterior descending in 84.6%, right coronary artery in 84.2% of cases. Attempts to recanalize these vessels were effective in 52%. There were no lethal complications of PTCA, acute occlusion of artery occurred in 5.9% of dilated vessels. Emergency coronary bypass had to be performed in 5.2% pts due to acute artery occlusion. PTCA supported by surgical stand-by appears to be a safe procedure with high direct effectiveness.

Adult↗
PubMed1993

[Morphology of atheromatous change during and after PTCA and occurrence of restenosis].

The frequency of restenosis incidence in a group of 72 patients after effective PTCA as well as dependence of its incidence on dilated coronary artery and morphology of sclerotic changes according to ACC/AHA classification were analyzed. The subject of analysis included also effect of the degree of residual stenosis on restenosis incidence as well as determining dependence between the degree of dissection after PTCA on restenosis rate. Restenosis was stated in 20 (20.7% percent) patients, in 26 cases (29%) among 88 dilated coronary arteries. Restenosis was more frequently observed in cases of left coronary artery dilatation. Analyzing restenosis occurrence in relation to morphology of sclerotic changes according to ACC/AHA classification its more frequent incidence in type B (35%) and type C (44%) in comparison type A--25% of this classification was observed. The percentage of residual stenosis was higher in the group of restenosis and amounted to 22.8% in comparison to the residual stenosis of 13% in the group of patients with no reported restenosis. Localized dissection can be a good predictor of results after successful PTCA. More frequent incidence of limited dissection took place in 34% of dilated coronary arteries without restenosis in relation to 20% of cases with restenosis. No evidence of dissection as well as long dissection after PTCA was associated with higher degree of restenosis. Angiographic evaluation of the morphology of sclerotic changes in view of degree of dissection after PTCA is a good predictor of results after angioplasty.

Adult↗
PubMed1993

[Myocardial infarction in pregnancy].

We report two cases of pregnant women who developed an acute myocardial infarction. The proposed cause of massive myocardial anterior and interventricular wall infarction of the first patient appears to be bacterial intracoronary thrombus during the course of bacterial endocarditis. Acute insufficiency of the mitral valve caused by rupture chordae tendineae of the anterior mitral left was another complication. Labor contractions occurred on the 13th day of treatment. On the next day the patient gave birth to a healthy child by elective cesarean section. She was also qualified for an operation because of increased signs of left ventricular heart failure. Preoperative coronary angiography revealed occlusion of the anterior descending branch and reconstruction of its periphery. Other vessels were not changed. The patient was subjected to implantation of artificial valve, an aortocoronary by-pass and repair of atrial septal defect. Eighteen months follow up was uneventful. The second case was a 29 year-old pregnant woman who had previously undergone mitral commissurotomy admitted because of an acute myocardial infarction in the II trimester. No complication of the disease was observed.

Adult↗
PubMed1991

[Infectious aortic valve endocarditis. Echocardiographic evaluation].

In the group of 37 patients (pts) with infective endocarditis of aortic valve comparative analysis of echocardiograms with intraoperative or pathomorphological findings was performed. Infection caused development of vegetations in 17 pts, cusp rupture in 7 and perivalvular abscess in 4 pts. Echocardiographic examination enabled diagnosis of vegetations in 16 pts. In 2 pts abscess cavity was shown between mitral and aortic annulus. Two-dimensional echocardiography provided more detailed data concerning number and localization of vegetation, and development of perivalvular abscess cavity. However cusps rupture was shown by M-mode echograms in 4 from 7 pts. In the course of antibiotic therapy 7 pts died: from 30 pts treated surgically the result of treatment was beneficial in 27. The examinations confirmed poor clinical prognosis of premature mitral valve closure for the patients with aortic insufficiency.

Abscess↗
PubMed1990

[Value of echocardiography in detection of vegetation and their clinical significance].

The aim of the study was to assess usefulness of echocardiography in bacterial vegetations detection as well as their clinical value as the indicator for surgical treatment. 44 patients aged 16-65 (mean 37.6) with infective mitral and aortic valve endocarditis underwent the study. Authors assessed clinical state taking into consideration blood culture tests as well as M-mode and parasternal and apical projections two-dimensional echocardiographic examinations. Data were compared with intraoperative or pathomorphological findings to estimate specificity and sensitivity of echocardiography in bacterial vegetation detection. Vegetations were pathomorphologically or intraoperatively stated in 21 patients (48%). M-mode echocardiography revealed changes in 16 patients, and two-dimensional one in the next 3. In the group of 23 patients without vegetations, concordance between intraoperative findings and echocardiographic results was stated in 19 subjects. Therefore, sensitivity and specificity of two-dimensional echocardiography were respectively 91% and 83%. Vegetations stated in two-dimensional echocardiographic examination had an unfavourable prognosis. Embolic complications were observed in 14, and myocardial infarction in 7 of 21 patients with bacterial vegetations. Authors thought it advisable to early operate on such patients. Whereas in patients without vegetations embolic complications were stated only in 3, and myocardial infarction in 1 patient. Therefore two-dimensional echocardiography making bacterial vegetations detection possible in patients with infective valve endocarditis allows to identify patients with higher risk of thromboembolic complication or death.

Adolescent↗
PubMed1989

[Late results of the treatment of mitral valve defects by implantation of an artificial heart valve].

The authors analyzed a group of 50 patients with an implanted artificial mitral valve. Group I consisted of 20 patients with an isolated left venous ostial stenosis. Group II consisted of 23 patients with a complex mitral disease, and group III--of 7 patients with mitral incompetence. Depending on the degree of improvement, the first two groups were divided into two subgroups: group Ia (13 patients) and group IIa (15 patients) with full clinical improvement, and group Ib (7 patients) and group IIb (8 patients) still requiring cardiological drugs and from time to time--dehydrating drugs. The observation time was from 1.5 to 4 years (on the average 39 months). In all the patients the artificial valve functioned properly. Before and after surgery the clinical state was evaluated according to NYHA, heart volume index (WOS), cardiopulmonary index (WSP) by a radiological examination, left-ventricular diastolic dimension (WRLK), left-ventricular systolic dimension (WSLK), left-ventricular end-diastolic volume index (WOKRLK), left-ventricular end-systolic volume index (WOKSLK), right-ventricular diastolic dimension (WRPK) and left atrium were evaluated by means of echocardiographic examination. Before surgery all the patients underwent the measurements of pressures in the pulmonary circulation, pulmonary resistance and heart index. The authors found a correlation between a degree of improvement after surgery and a functional group before surgery. Eleven patients from functional group III according to NYHA had been (before surgery) in a state of advanced circulatory failure (IV functional group). Clinical improvement was confirmed by statistically significant decrease in heart dimension evaluated by radiological and echocardiographic examinations. In group I left atrium dimension (LP) was significantly statistically larger in patients with incomplete clinical improvement. The authors also found a dependence of a distant result on a degree of hypertension in pulmonary artery, increased pulmonary resistance and decrease in stroke volume.

Adolescent↗