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["Variant" angina: clinical, electrocardiographic and coronarographic aspects in 40 cases. Considerations for treatment (author's transl)].

Forty patients with chest pain and the electrocardiographic aspects of Prinzmetal's variant angina were studied by means of selective coronary arteriography. In 36 cases (90%) severe coronary lesions could be demonstrated: in 75% of the cases a critical obstruction involved a single major coronary trunk; only in 15% two or more vessels were affected. The vessel most frequently involved by critical obstruction was the left anterior descending (57%); in 5 cases (12.5%) a severe stenosis of the common left coronary trunk was present. In 8 cases critical stenosis were reduced by coronary dilators and were completely resolved in 2 cases. Peripheral lesions with multiple secondary branches involvement were present in none of the cases. A common finding was the absence of evident collateral anastomotic circulation. The comparison of the electrocardiographic manifestations of the anginal crisis and the angiographic findings showed a strict correlation between the area of subepicardial lesion and the major coronary vessel distributing to the corresponding myocardial region. Of the 40 patients, 17 were treated medically and 23 underwent a surgical aortocoronary bypass: the results (surgical mortality 22%; complete success 52%) are compared with those in the literature. Prognosis appears to be severe: coronary arteriography must be performed under criteria of urgency, and the possibilities of treatment must be considered on the basis of the angiographic findings.

Angina Pectoris↗
PubMed2000

Isolated noncompaction of the myocardium: an exceedingly rare cardiomyopathy. A case report.

Isolated noncompaction of the left ventricular myocardium is a rare cardiac disorder due to an arrest in myocardial morphogenesis. It is characterized by prominent and excessive trabeculation in a ventricular wall segment, with deep intertrabecular spaces perfused from the ventricular cavity. Echocardiographic findings are important clues for the diagnosis. Clinical symptoms include signs of left ventricular systolic dysfunction even to the point of heart failure, ventricular arrhythmias, and embolic events. We describe an adult case in whom the only clinical symptoms were life-threatening ventricular arrhythmias. Transthoracic echocardiography did not contribute to the diagnosis, which was made thanks to left ventricular contrast angiography. Electrophysiological testing induced a fast monomorphic sustained ventricular tachycardia, with hemodynamic impairment, that was refractory to pharmacological treatment, and for this reason a permanent cardioverter-defibrillator was implanted. A subsequently performed transesophageal echocardiographic examination showed a localized, regional increase in left ventricular wall thickness and degree of trabeculation. The causes and electrophysiological mechanisms of arrhythmias in noncompaction are still unknown: grossly irregular branching and connecting of myocardial fascicles in the noncompacted segments, isometric contraction with increased wall stress, and localized coronary perfusion impairment can all induce disorganized or delayed activation and increase the potential for arrhythmias. This is the first reported case of noncompaction in which an implantable defibrillator was used to control life-threatening arrhythmias.

Adult↗
PubMed2000

Ochratoxin A induces JNK activation and apoptosis in MDCK-C7 cells at nanomolar concentrations.

Ochratoxin A (OTA) is a ubiquitous fungal metabolite with nephritogenic, carcinogenic, and teratogenic action. Epidemiological studies indicate that OTA may be involved in the pathogenesis of different forms of human nephropathies. Previously we have shown that OTA activates extracellular signal-regulated kinases 1 and 2, members of the mitogen-activated protein kinases (MAPK) family, in the C7-clone but not in the C11-clone of renal epithelial Madin-Darby canine kidney (MDCK) cells. Here we show that nanomolar concentrations of OTA lead to activation of a second member of the MAPK family, namely, c-jun amino-terminal-kinase (JNK) in MDCK-C7 cells but virtually not in MDCK-C11 cells, as determined by kinase assay and Western blot. Furthermore, OTA potentiated the effect of tumor necrosis factor-alpha on JNK activation. In parallel to its effects on JNK, nanomolar OTA induced apoptosis in MDCK-C7 cells but not in MDCK-C11 cells, as determined by DNA fragmentation, DNA ladder formation, and caspase activation. In addition, OTA potentiated the proapoptotic action of tumor necrosis factor-alpha. Our data provide additional evidence that OTA interacts in a cell type-specific way with distinct members of the MAPK family at concentrations where no acute toxic effect can be observed. Induction of apoptosis via the JNK pathway can explain some of the OTA-induced changes in renal function as well as part of its teratogenic action.

Animals↗
PubMed1992

[Coronary angioplasty in postinfarct angina].

BACKGROUND: The recurrence of transient myocardial ischemia is a frequent event in the course of acute myocardial infarction. Postinfarction angina develops more frequently after a non-Q wave infarction, and after effective thrombolysis; when uncontrolled by standard medical treatment, it is associated with an increased incidence of unfavorable cardiac events. Therapeutic strategies involve aggressive medical therapy, frequent use of early angiography, and mechanical coronary revascularization with bypass surgery or transluminal coronary angioplasty (PTCA). PATIENTS: We retrospectively examined 68 consecutive patients treated with PTCA for postinfarction angina. Of the whole, 36 (53%) had sustained a non-Q wave infarction; 29 (43%) had been treated with thrombolysis in the acute phase. Ischemia was in the infarction zone in 94% of cases; mean EF was 61.5 +/- 12%, and in 18 cases EF was < 55%. RESULTS: In 7 cases two arteries were dilated. There were no deaths related to the procedure. The overall success rate was 91.2%. Major complications occurred in 2 cases (1 acute occlusion with reinfarction, 1 major dissection requiring emergency surgery). The results are analyzed according to the time interval between index infarction and PTCA. In 28 cases (Group A) PTCA was performed within 30 days due to medically refractory symptomatology; in 40 cases (Group B) PTCA was postponed to beyond 30 days from infarction. In Group A involvement of the left anterior descending coronary artery was more frequent (75% of cases vs 40%; p = 0.009). The success rate in Group A was slightly lower than for Group B (85.7% vs 95%); the incidence of complications was higher (7.1% vs 0%), although not statistically different. At 6 month follow-up a restenosis was found in 10 cases (16% of successful PTCAs, 21% of angiographic controls). CONCLUSIONS: We conclude that for patients with postinfarction angina, selected for a suitable coronary anatomy, PTCA is an effective therapeutic option, with a high success rate, low immediate morbidity, and good mid-term results. The risk of intraprocedural complications appears only slightly higher for patients with unstable symptoms, who undergo PTCA earlier after infarction.

Adult↗
PubMed1979

[Postinfarction left ventricular aneurysm. A method for volume determination and its correlation with hemodynamic and angiographic parameters (author's transl)].

On the hypothesis that encroachment on left ventricular performance by postinfarction aneurysm (An) is related to its size, a method was investigated for the measurement of aneurysmal dimensions. On radioopaque plastic casts grossly ellipsoidal in shape with addition of masses in different position to simulate aneurysms, satisfactory data for volume calculation were obtained by the association of the ellipsoid formula applied to the contractile portion with the formula of the hemispheroid applied to the aneurysmal section, the difference between real and calculated volumes being not more than +/-5%. In 100 Pts. with previous myocardial infarction, showing at ventriculography akinetic-diskinetic segments of the left ventricular wall, the absolute volume of An and its percentage value of the total left ventricular volume (V An%) were measured. A statistical correlation was studied with other hemodynamic and angiographic parameters of left ventricular function. Cardiac index and angiographic stroke volume decreased with increasing V An%, but with a low correlation, of no statistical significance; only for An with a volume of 60% or more C.I. and SV were constantly reduced. The LVEDP, higher than normal in 80% of the cases, rose with increasing V An%, but with a correlation of low statistical significance. The EDV increased progressively and significatively with increasing V An%, resulting therefore in relation with the extension of noncontracting segment.

Angiocardiography↗
PubMed1989

[Angiographic morphology of coronary lesions in various syndromes of ischemic cardiopathy].

The angiographic morphology of coronary lesions is often completely ignored in the prognostic and decision-making process related to patients with coronary disease. We performed this study to evaluate the possibility of identifying complex or complicated atherosclerotic lesions by means of routine diagnostic coronary arteriography, and to assess their prevalence in the different syndromes of ischaemic heart disease. From an overall group of 200 successive cases studied using coronary angiography, 111 patients with significant coronary artery disease in whom a "culprit lesion" could be identified were retrospectively selected. The angiographic morphology of coronary lesions was defined according to an original classification as: 1) simple stenosis, 2) complex lesion, 3) thrombosis. Of the 111 patients, 36 had been studied for stable angina, 31 for unstable angina, 10 for a non-Q wave myocardial infarction, 34 for transmural infarction. The clinical groups did not show any significant differences when compared on the basis of number of vessels involved and degree of narrowing of the ischaemia-producing artery. Significant differences were found when angiographic morphology was analyzed. In stable angina 78% of ischaemia producing lesions appeared as simple stenoses, while 92% of the unstable or more severely ischaemic patients exhibited complicated lesions (p less than 0.001). In unstable angina and non-Q infarction a complex lesion was present respectively in 71% and 60% of the cases; clear-cut intraluminal thrombosis was demonstrated in 23% of unstable angina, in 30% of non-Q wave infarction and in 39% of transmural infarction (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

[Bypass aorto-coronarico. Correlazione tra dati clinici, emodinamici ed angiografici e risultato operatorio in 100 casi (author's transl)].

In 100 consecutive patients, subjected to myocardial revascularization by aorto-coronary saphenous vein bypass grafting with a standard technique, several clinical, hemodynamic and angiographic data were studied in correlation with the short-term prognosis. The operative mortality (6% on the whole) appeared to be strictly correlated with the degree of left ventricular impairment. Among the considered hemodynamic indices (LVEDP, CI, EDV, EF), EF was the most significant one: mortality was 0% if EF was normal, but raised to 15 and 40% respectively, when this was moderately or severely reduced. The operative risk was heavily aggravated if 4 or more indices of left ventricular impairment were present, mortality being 45% versus 1% in patients with abnormality of 3 or less parameters. The extension of coronary artery involvement proved to be a lesser prognostic factor than the degree of complements of the surgical revascularization. No correlation was found between the preoperative value of the hemodynamic parameters and the incidence of perioperative myocardial infarction (18% in the total series).

Adult↗
PubMed1985

[The diagnosis of prosthesis pathology in biological and mechanical valves. I. Clinical and echocardiographic evaluation].

We retrospectively evaluated the clinical and echocardiographic findings of 50 patients with documented malfunctioning of cardiac prosthetic valves. The prostheses, mechanical or biological, were in 24 cases in a mitral and in 26 cases in an aortic position. Prosthetic dysfunction was due to thrombosis, fibro-calcific degeneration, fibrous cloth, bacterial infection, dehiscence, mismatch. The clinical features were represented by cardiac insufficiency of different degrees, up to global congestive failure unresponsive to medical treatment, by sudden low-output syndrome, arrhythmias, angina. The changes in auscultatory findings have appeared important clues to prosthetic malfunction, but we stress the necessity of an instrumental documentation of the type and grade of dysfunction. Echocardiography has represented an essential tool for a rapid and accurate noninvasive diagnosis of prosthetic pathology. The echocardiographic examination, except 2 false negatives, has consistently provided informations useful for therapeutic decisions. In 7 cases in critical clinical conditions (refractory heart failure or shock) the echocardiographic examination has afforded the exact documentation and identification of prosthetic pathology, allowing by itself a surgical decision.

Aortic Valve↗
PubMed1985

[Prosthetic pathology of mechanical and biological valves in the mitral and aortic position. II. Hemodynamic-angiographic evaluation and anatomo-surgical aspects].

The catheterization parameters of 42 patients with surgically confirmed prosthetic valve malfunction were retrospectively analyzed in order to evaluate the role of hemodynamic and angiocardiographic examination in the diagnosis of prosthetic complications. The invasive investigation provided in all cases more precise informations regarding the type and grade of prosthetic malfunction as compared to noninvasive techniques. Transvalvular gradients could be quantified, the amount of regurgitation could be defined and associated lesions (paraprosthetic aneurysms, aortic root dissection, fistulas secondary to bacterial endocarditis) could be recognized. The surgical exploration confirmed prosthetic malfunction in all cases except two, with fibrous tissue ingrowth: at the moment this complication is not distinguishable from thrombosis and no specific diagnostic signs have been described either with invasive or noninvasive techniques. In our experience the patients who can benefit from hemodynamic examination are: patients with echocardiographic examination of poor technical quality, patients in whom noninvasive investigations can not completely explain the clinical status ("false negative" echocardiograms, multiple prosthetic valves), all cases in whom cardiac surgery requires a precisely detailed evaluation of the prosthetic malfunction. The opportunity or necessity to perform an invasive study in patients with clinically suspected or proven prosthetic malfunction should be discussed individually.

Angiocardiography↗
PubMed1979

Echocardiographic diagnosis of congenital left ventricular - right atrial communication.

2 patients, aged 8 mth and 48 yr, referred for a clinical diagnosis of ventricular septal defect, were studied by ultrasound. In both a fluttering and an anterior bowing of the systolic segment of the tricuspid valve was found, consistent with a left ventricular--right atrial communication. Diagnosis was confirmed by angiography and open-heart surgery, showing in 1 patient a supravalvular defect, and an infravalvular one in the other. The postoperative echocardiograms of the tricuspid valve were normal. Ultrasound appears to be a safe and simple method in detecting this rare cardiac abnormality.

Echocardiography↗