RESUMEN
OBJECTIVE: The main goal of this study is to determine the efficiency of the cardiomyoplasty procedure on patients with cardiomyopathy of different origins (ischemic and idiopathic origins). METHOD: Between June 1993 and August 1995, 24 patients underwent dynamic cardiomyoplasty with the left latissimus dorsi muscle in our institution. Early and midterm results, as well as the changes in hemodynamics and functional status during follow-up, were compared. RESULTS: Early mortality rate was 20.8% (five patients). Concomitant coronary revascularization, a preoperative left ventricular ejection fraction below 20%, and a functional capacity of class IV (intermittently) were associated with early mortality. The mean follow-up time was 17.3 months. Survival analysis (including early mortality) extending to the twenty-fourth month revealed no difference between the ischemic and idiopathic groups (55% vs 85%, respectively, p = 0.09). Functional status improved in the both groups. Ejection fractions were improved after cardiomyoplasty in all patients, regardless of their cause. Cardiac indices were higher 6 months after the operation. Changes in pulmonary capillary wedge pressure, peak pulmonary artery pressure, and left ventricular end-diastolic volume were not significant. CONCLUSION: Although cardiomyoplasty improves functional capacity and hemodynamics in patients with both idiopathic and ischemic cardiomyopathy, the idiopathic group is thought to achieve optimal benefit with regard to lower complication rates and lower early mortality expectancy owing to the absence of concomitant coronary revascularization.
Asunto(s)
Cardiomiopatías/cirugía , Cardiomioplastia , Isquemia Miocárdica/cirugía , Adulto , Cardiomiopatías/mortalidad , Cardiomiopatías/fisiopatología , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/fisiopatología , Complicaciones PosoperatoriasRESUMEN
BACKGROUND: A major concern in evaluating dynamic cardiomyoplasty has been whether the synchronous stimulation of latissimus dorsi muscle is essential for benefit or not. We studied 10 patients to determine the efficacy of the systolic augmentation generated by the synchronous electrical stimulation of the latissimus dorsi muscle. METHODS: Left ventricular ejection fraction, end-systolic and end-diastolic volume indexes, and stroke volume index obtained during resting, peak exercise, and recovery periods ("on" values) were compared with those obtained 1 week after cessation of electrical stimulus ("off" values). Double product and estimated total body oxygen consumption at peak exercise were also calculated and compared. RESULTS: Higher ejection fractions (0.36 +/- 0.07 versus 0.33 +/- 0.06 at rest, 0.40 +/- 0.07 versus 0.33 +/- 0.07 at peak exercise, and 0.37 +/- 0.06 versus 0.31 +/- 0.06 at recovery).(ABSTRACT TRUNCATED)
Asunto(s)
Cardiomioplastia , Marcapaso Artificial , Ecocardiografía , Prueba de Esfuerzo , Humanos , Consumo de Oxígeno , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
Widened dispersion of refractoriness has been considered to lead to an increase in atrial vulnerability. In this study, we obtained simultaneous monophasic action potential recordings by 2 special catheters from 2 different loci in the right atrium in 9 normal subjects (Group 1) and in 7 patients with paroxysmal atrial fibrillation (Group 2). We measured action potential duration at 50% (APD50) and 90% (APD90) repolarization from both loci in the right atrium during steady-state through one of the two catheters. The differences between APD50 and APD90 recorded by the two catheters were designated as dispersion of APD50 and dispersion of APD90, respectively. While, the mean APD50 and APD90 were 149.7+/-16.9 and 228.3+/-44.7 ms respectively in Group 1, the corresponding values for Group 2 were 145.7+/-33.5 and 213.5+/-53.1 ms. The difference between the 2 groups was not statistically significant. However, the dispersion of APD50 and APD90 were 13.8+/-13.8 and 10.0+/-9.7 ms in Group 1 and 42.8+/-19.6 and 57.1+/-32.4 in Group 2, respectively and the difference between the 2 groups for both measurements was statistically significant (P<0.01). Another finding was a high correlation between age and dispersion of APD90 in the whole population studied (r=0.82, P<0.001). With these findings, although one can not derive the conclusion that patients with paroxysmal atrial fibrillation have a greater dispersion of repolarization, our finding of increasing dispersion of repolarization with age could be an explanatory factor for the increased prevalence of atrial fibrillation with advanced age.
Asunto(s)
Fibrilación Atrial/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Potenciales de Acción , Adulto , Factores de Edad , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Previous studies have reported controversial results regarding the effectiveness of systemic thrombolysis in preventing left ventricular (LV) thrombus after acute myocardial infarction (MI). HYPOTHESIS: This study was performed to evaluate the influences of thrombolysis, and particularly successful reperfusion, on the incidence of LV thrombus formation after acute anterior MI. METHODS: In all, 191 patients suffering from a first attack of acute anterior MI were prospectively evaluated by two-dimensional echocardiography and coronary angiography, performed at the end of the first week and within the first two weeks of MI, respectively. Of these, 98 who presented within 12 h of onset of symptoms received intravenous streptokinase (1.5 million IU), while the remaining 93 patients who, either because of contraindications or late admission, did not receive thrombolytic treatment served as control group. All patients received aspirin and full-dose anticoagulation with intravenous heparin. Successful reperfusion in the streptokinase group was assessed by enzymatic and electrocardiographic evidence. RESULTS: The overall incidence of LV thrombi was 24.6% (47/191). When all patients were evaluated, no statistically significant difference was found between the frequency of LV thrombi in the patients who had thrombolysis (22.4%) and those who did not (26.8%), despite a trend toward the formation of fewer thrombi in the initial group (p > 0.05). However, the patients who had successful reperfusion with streptokinase (n = 64) had significantly reduced incidence of LV thrombi compared with those who did not receive thrombolytic therapy (20 vs. 26.8%, p < 0.05). Stepwise multivariate analysis suggested that LV abnormal wall motion score (p = 0.01) and presence of LV aneurysm were independent predictors of LV thrombus formation in patients with acute anterior MI. CONCLUSION: Not all patients who received streptokinase for acute anterior MI, but only those with successful reperfusion had reduced incidence of LV thrombi. The favorable effects of thrombolysis on LV thrombus formation are probably due to the preservation of global LV systolic function.
Asunto(s)
Fibrinolíticos/uso terapéutico , Cardiopatías/prevención & control , Ventrículos Cardíacos , Infarto del Miocardio/complicaciones , Reperfusión Miocárdica , Estreptoquinasa/uso terapéutico , Terapia Trombolítica , Trombosis/prevención & control , Anciano , Angiografía Coronaria , Femenino , Cardiopatías/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/terapia , Trombosis/diagnóstico por imagen , Resultado del TratamientoRESUMEN
BACKGROUND: Although there is increasing evidence for the beneficial effect of thrombolytic therapy on global left ventricular (LV) function in acute myocardial infarction (AMI), the data concerning the early effect of thrombolytic therapy on the incidence of left ventricular aneurysm (LVA) formation and its relationship to clinical and angiographic determinants are limited. HYPOTHESIS: The study aimed to determine the independent factors involved in the development of LVA and to evaluate whether thrombolytic therapy has any preventive effect on the development of LVA in AMI. METHODS: In all, 350 consecutive patients suffering from a first attack of AMI were included. Of these, 205 who arrived within 12 h of onset of symptoms received thrombolytic therapy (thrombolytic group) and the remaining 145 patients served as control group. All patients received aspirin and maximal-dose anticoagulation with intravenous heparin therapy. Early successful reperfusion was assessed by enzymatic and electrocardiographic evidence, and late vessel patency was evaluated according to Thrombolysis in Myocardial Infarction (TIMI) classification. Patients with TIMI grade 2 or 3 flow were considered to have vessel patency. RESULTS: The overall incidence of LVA was 11.7% (41/350), and no statistical difference was found between the incidence of LVA between the two groups (11.7 vs. 11.7%, p>0.05). However, the patients receiving thrombolytic therapy and exhibiting a patent infarct-related artery (PIRA) (n = 125, 61%), had a significantly reduced incidence of LVA compared with those who did not (7.2 vs. 18.8%, p= 0.015). In univariate analysis, vessel patency, proximal left anterior descending artery (LAD) stenosis, total LAD occlusion, multivessel disease, and hypertension were found to be important factors in LVA formation after AMI. After adjustment for other clinical and angiographic variables, total LAD occlusion (odds ratio [OR] 3.62,95% confidence interval [CI] 2.45-8.42, p = 0.0014), absence of PIRA (OR 2.92, 95% CI 1.41-09, p = 0.0037) and proximal LAD stenosis (OR 2.11, 95% CI 1.05-4.71, p = 0.045) remained the independent determinants of LVA formation after AMI. CONCLUSION: Our data indicate that not all patients who received thrombolytic therapy, but only those with PIRA had evidently reduced the incidence of LVA. Patients with total LAD occlusion, with proximal LAD stenosis, and without PIRA were found to have increased risk for formation of LVA after AMI. These findings indicate that the presence of vessel patency has a preventive effect on LVA formation in AMI.
Asunto(s)
Aneurisma Coronario/prevención & control , Infarto del Miocardio/complicaciones , Reperfusión Miocárdica , Terapia Trombolítica , Adulto , Circulación Colateral , Aneurisma Coronario/etiología , Angiografía Coronaria , Circulación Coronaria , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Estudios Prospectivos , Estreptoquinasa/uso terapéutico , Activador de Tejido Plasminógeno/uso terapéutico , Función Ventricular IzquierdaRESUMEN
In this case report, a patient with rheumatic mitral stenosis and R-1 subtype single coronary artery arising from the ascending aorta ("high take-off" origin) and coursing between the aorta and pulmonary artery is presented. The clinical significance and differential diagnosis are discussed. To the authors' knowledge, this is the first case reported in the literature with a single R-1 subtype coronary artery that shows "high take-off" origin.
Asunto(s)
Anomalías de los Vasos Coronarios/complicaciones , Estenosis de la Válvula Mitral/complicaciones , Cardiopatía Reumática/complicaciones , Aorta/patología , Aortografía , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Diagnóstico Diferencial , Ecocardiografía , Ecocardiografía Doppler en Color , Femenino , Humanos , Persona de Mediana Edad , Estenosis de la Válvula Mitral/diagnóstico por imagen , Arteria Pulmonar/patología , Cardiopatía Reumática/diagnóstico por imagenRESUMEN
Previous studies showed that increased QT dispersion (QTd) has been observed during episodes of myocardial ischemia or infarction and identify the patients at risk of arrhythmia or sudden death. The objective of this study is to investigate the relationship between coronary artery disease and QTd during the Valsalva maneuver. The study population included 85 subjects (21 with normal coronary arteries, 35 with stable angina pectoris, and 29 with unstable angina pectoris). Twelve-lead surface ECGs were recorded at 50-mm/sec paper speeds and were obtained before the Valsalva maneuver and during the strain phase. The results indicate a significant difference in mean time increase between the control group and the group with stable angina pectoris (mean difference = 16.10 milliseconds, p<0.000), and between the control group and the group with unstable angina pectoris (mean difference = 35.26 milliseconds, p<0.000). The mean difference in time between these groups was also compared (mean difference = 19.17 milliseconds), and was statistically significant (p<0.000). There are some conditions like constipation, severe coughing spells, nausea, vomiting, and carrying or lifting heavy objects that increase intrathoracic pressure and may increase QT dispersion. Therefore, all these conditions should be treated appropriately and carrying or lifting heavy objects is forbidden, especially in patients with coronary artery disease.
Asunto(s)
Enfermedad Coronaria/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Maniobra de Valsalva , Anciano , Angina de Pecho/fisiopatología , Angina Inestable/fisiopatología , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
It has been shown that QT dispersion (QTD) increases during episodes of myocardial ischemia or infarction. However, no extensive data on the relation between the diseased coronary artery or the localization of stenosis and the QTD are available. The aim of the study was to examine the relation between QTD and diseased coronary artery and lesion localization during exercise stress test in patients with single coronary artery disease without prior myocardial infarction. One hundred nineteen patients with single coronary artery disease and 53 patients with normal coronary arteries were enrolled in study. All patients underwent exercise stress test with modified Bruce protocol, and QT interval parameters were measured at rest and at minute 2 of the recovery (rec-2) period. QT dispersion at rest was found higher in all single-vessel disease groups compared with that in the control group, and corrected QT dispersion at rec-2 period was also markedly higher in left anterior descending, circumflex, and right coronary artery groups compared with that in the control group. No relation was found between QT dispersion and diseased coronary artery or the lesion localization. In conclusion, no qualitative difference was found between QT dispersion and diseased coronary artery or proximal or distal lesion localization. However, it was observed that patients with single-vessel disease had wider baseline QT dispersion as compared with that in the control group, which further increased significantly with exercise. This finding supports the idea that severity of localized ischemia rather than extent of coronary artery disease would be expected to have a greater effect on inducible QT dispersion.
Asunto(s)
Enfermedad Coronaria/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Adulto , Angiografía Coronaria , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del ObservadorRESUMEN
Atherosclerotic renal artery disease is common among patients with hypertension over the age 50 years who are resistant to medical treatment. In this case report, the authors present a 55-year-old woman with unilateral renal artery stenosis with a history of cardiac arrest. QT prolongation and evident hypokalemia were the main clinical findings of the patient. The patient also had an episode of polymorphic ventricular tachycardia during hospitalization that degenerated into ventricular fibrillation. After successful balloon dilation of the stenotic renal artery, the patient stayed normotensive and normokalemic without medication, and no arrhythmia was observed during the 6-month follow-up period.
Asunto(s)
Obstrucción de la Arteria Renal/complicaciones , Torsades de Pointes/etiología , Angioplastia de Balón , Electrocardiografía , Femenino , Humanos , Hipertensión Renovascular/complicaciones , Hipopotasemia/complicaciones , Persona de Mediana Edad , Obstrucción de la Arteria Renal/terapia , Torsades de Pointes/diagnóstico , Fibrilación Ventricular/etiologíaRESUMEN
It has previously been shown that leukocyte elastase is involved in the pathogenesis of atherosclerosis. Few studies have addressed the relation between leukocyte elastase concentrations and coronary artery disease (CAD). The authors investigated (1) the clinical significance of leukocyte elastase determination in the diagnosis of CAD and (2) the relation between plasma leukocyte elastase concentration and lesion morphology. The study included 185 subjects (140 men, 45 women) who underwent coronary angiography during investigation of chest pain; 135 had coronary stenosis (Group I) and 50 had nonstenotic coronaries (Group II). Among Group I patients, those with simple atheromatous plaques were distinguished from those with complex plaques. Elastase concentrations in Group I were greater than in Group II (57.1 +/- 1.16 micrograms I[-1] vs 27.6 +/- 1.0 microgram, I[-1], P<0.001), and greater in complex plaque patients than in those with simple plaques (64.5 +/- 1.24 micrograms I[-1] vs 45.9 +/- 1.01 micrograms I[-1], P<0.001). Logistic regression analysis showed (1) that elastase concentration, age, and sex had independent value for prediction of CAD and (2) that among Group I patients, the risk of complex plaques was greatest for those with high elastase concentration. These results suggest that plasma leukocyte elastase concentration is a sensitive diagnostic marker of CAD and that high values of elastase may indicate the presence of complex atheromatous plaques.
Asunto(s)
Pruebas Enzimáticas Clínicas , Enfermedad Coronaria/diagnóstico , Elastasa de Leucocito/sangre , Plasma/enzimología , Angina de Pecho/diagnóstico , Angina Inestable/diagnóstico , Biomarcadores/sangre , Pruebas Enzimáticas Clínicas/métodos , Pruebas Enzimáticas Clínicas/estadística & datos numéricos , Angiografía Coronaria , Femenino , Humanos , Técnicas para Inmunoenzimas/instrumentación , Recuento de Leucocitos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Neutrófilos , Sensibilidad y EspecificidadRESUMEN
Complications related to percutaneous placement of intra-aortic balloon pump counterpulsation are still high despite major refinements in catheter design and techniques. One hundred and forty-eight patients in whom intra-aortic balloon pumping was inserted were classified into two groups on the basis of the insertion technique. Group I included 103 patients in whom the conventional percutaneous insertion was used. A sheathless insertion technique was used in group II (n = 45). The overall complication rate was 16.6% (25 of 150), in which lower limb ischaemia was the most common complication. The limb ischaemia was noted in 12 patients (11.5%) in group I and 4 patients (8.9%) in group II (statistically not significant). Peripheral vascular disease, diabetes mellitus and female gender were found to be significant predictors of limb ischaemia (p = 0.01, p = 0.02 and p = 0.03, respectively). In conclusion, sheathless insertion of intra-aortic balloon pump catheters does not reduce the incidence of limb ischaemia.
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Cardiopatías/terapia , Contrapulsador Intraaórtico/efectos adversos , Isquemia/etiología , Pierna/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Equipo , Femenino , Humanos , Incidencia , Isquemia/epidemiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Herein we report a case of a cardiac echinococcal cyst located in the interventricular septum and producing a mild obstruction of the left ventricular outflow tract. The cyst was detected by cross-sectional echocardiography and thoracic computed tomography and treated successfully with mebendazole.
Asunto(s)
Cardiomiopatías/diagnóstico , Equinococosis/diagnóstico , Mebendazol/uso terapéutico , Adulto , Cardiomiopatías/tratamiento farmacológico , Equinococosis/tratamiento farmacológico , Ecocardiografía , Tabiques Cardíacos , Ventrículos Cardíacos , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
A seroepidemiological study was conducted to assess the seroprevalence of hepatitis B surface antigen (HBs Ag) and antibodies to hepatitis C virus (Anti-HCV) in 14,196 patients hospitalized in our cardiology clinics. Threehundred and fifty five (355) patients (2.43%) were found to be positive for HBs Ag, a hundred and sixty six (166) patients (1.09%) were positive for Anti-HCV and ten patients (0.07%) were positive for both. The presence of HBs Ag and Anti-HCV was similar in patients living in rural and urban areas. The presence of risk factors was greater in the patients with Anti-HCV. The prevalences of HBs Ag and Anti-HCV were found to be comparable with those reported in other mediterranean countries in Europe.
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Hepatitis C , Estudios Seroepidemiológicos , Hepatitis B , Anticuerpos contra la Hepatitis C , Humanos , Turquía/epidemiologíaRESUMEN
A 66-yr-old woman was admitted to our clinic with signs and symptoms suggesting either pulmonary embolism or pneumonia. Subsequently she was diagnosed as having pneumonia, but since pulmonary artery pressure was high on echocardiography, pulmonary angiography was performed to exclude the possibility of pulmonary embolism. No findings suggestive of pulmonary embolism were evident on pulmonary angiogram, but there was a fistulous connection between the left pulmonary artery and the innominate vein. To our knowledge, this report represents the first case of a fistula between the pulmonary artery and a systemic vein.
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Fístula Arteriovenosa , Venas Braquiocefálicas/anomalías , Arteria Pulmonar/anomalías , Anciano , Angiografía , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Venas Braquiocefálicas/diagnóstico por imagen , Femenino , Humanos , Hipertensión Pulmonar/etiología , Arteria Pulmonar/diagnóstico por imagenRESUMEN
In this report, we describe a case of sustained ventricular tachycardia of right ventricular outflow tract origin, induced by dobutamine infusion in a patient with symptomatic, frequent ventricular premature depolarizations but no documented clinical ventricular tachycardia. Radiofrequency catheter ablation abolished not only the ventricular tachycardia itself, but also the frequent ventricular premature depolarizations responsible for all the symptomatology. In conclusion, provocation by catecholamine infusion may have a place in the search for an alternative to antiarrhythmic therapy in patients with isolated, frequent and symptomatic ventricular premature depolarizations.
Asunto(s)
Ablación por Catéter , Taquicardia Ventricular/diagnóstico , Complejos Prematuros Ventriculares/cirugía , Adulto , Bloqueo de Rama/fisiopatología , Electrocardiografía Ambulatoria , Femenino , Humanos , Complejos Prematuros Ventriculares/complicacionesRESUMEN
The object of our study was to compare the value of exercise stress testing with simultaneous dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography for the diagnosis of coronary artery disease. Sixty-nine patients with either suspected or proven coronary artery disease underwent simultaneous dobutamine technetium-99m isonitrile single-photon emission computed tomography and stress echocardiography, and treadmill exercise electrocardiography. Dobutamine echocardiography and technetium-99m isonitrile single-photon emission computed tomography revealed a higher overall sensitivity than exercise testing (94 vs 60%, P < 0.001), but dobutamine stress echocardiography showed a higher specificity than both technetium-99m isonitrile single-photon emission computed tomography and exercise testing (86 vs 64%, P < 0.05, for both tests). In addition, the diagnostic accuracy of dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography was higher than that of exercise testing (91 vs 61%, P < 0.001; 86 vs 61%, P < 0.001, respectively). Dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography are superior to exercise testing in the diagnosis of coronary artery disease, and dobutamine stress echocardiography can act as an alternative to technetium-99m isonitrile single-photon emission computed tomography.
Asunto(s)
Cardiotónicos , Enfermedad Coronaria/diagnóstico , Dobutamina , Ecocardiografía , Electrocardiografía , Prueba de Esfuerzo , Tomografía Computarizada de Emisión de Fotón Único , Adulto , Anciano , Medios de Contraste , Angiografía Coronaria , Enfermedad Coronaria/fisiopatología , Ecocardiografía/efectos de los fármacos , Electrocardiografía/efectos de los fármacos , Prueba de Esfuerzo/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Tecnecio Tc 99m SestamibiRESUMEN
Between 1974 and April, 1988, 9 patients with congenital coronary artery fistulas underwent surgical repair. Of these, 4 were female and 5 male, ranging in age from 6 to 50 years (mean 28.2 +/- 18.9). Seven patients were symptomatic (congestive heart failure and/or angina), whereas in 2 patients the diagnosis was established through the investigation of an asymptomatic continuous murmur. The origin of the fistula was the left main coronary artery in 1, left anterior descending artery (LAD) in 2, circumflex artery (Cx) in 3, Cx + LAD in 2 and LAD + right coronary artery in 1 patient. The sites of termination of the fistulous tract were the pulmonary artery in 6, the right atrium in 1, the right ventricle in 1 and the left ventricle in 1 patient. In 2 cases the fistulous tracts were ligated without utilizing cardiopulmonary bypass (CPB). In 7 cases CPB was instituted and in 6 of these the fistulous communications were closed from within the termination chamber, in 1 patient the fistula was closed through a coronary arteriotomy during elective ventricular fibrillation. There was no operative mortality and long term follow-up was uneventful after a mean follow-up of 5.4 +/- 5.2 years, with 8 patients still completely asymptomatic. Surgical therapy is recommended for patients having coronary artery fistulas in order to prevent fistula-related complications. In those cases requiring CPB, closure of the fistula from the involved chamber only is suggested.
Asunto(s)
Anomalías de los Vasos Coronarios/cirugía , Fístula/cirugía , Adolescente , Adulto , Fístula Arterio-Arterial/congénito , Fístula Arterio-Arterial/diagnóstico , Fístula Arterio-Arterial/cirugía , Puente Cardiopulmonar , Niño , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Electrocardiografía , Femenino , Fístula/congénito , Fístula/diagnóstico , Estudios de Seguimiento , Atrios Cardíacos/anomalías , Atrios Cardíacos/cirugía , Soplos Cardíacos , Ventrículos Cardíacos/anomalías , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Arteria Pulmonar/anomalías , Arteria Pulmonar/cirugíaRESUMEN
In this study, we tried to disclose certain electrocardiogram (ECG) criteria that might be useful in the classification of posteroseptal accessory atrioventricular pathways as right and left in patients with pre-excitation in whom the accessory pathway localization was verified by subsequent successful ablation. Twenty such patients with posteroseptal accessory pathways (mean age 34.9 +/- 9.8; 11 male, 9 female) were included in the study. Localization of the accessory pathway was right posteroseptal in 13 (65%) and left posteroseptal in 7 (35%). Common to all these 20 patients with posteroseptal accessory pathways was a QRS polarity positive in lead L1 and negative in leads D3, aVL. In patients with right posteroseptal accessory pathways, QRS polarity was negative in lead V1 in all and positive in lead V2 in 90%. On the other hand, none of the patients with left posteroseptal accessory pathways showed negative QRS polarity in lead V1. In conclusion, these findings strongly suggest that in patients with pre-excitation, a QRS polarity negative in lead V1 and positive in lead V2 is an important surface ECG finding that signifies right-sided localization of a posteroseptal accessory pathway. In cases with left posteroseptal accessory pathways, QRS polarity in leads V1 and V2 has been found to be either biphasic or positive.
Asunto(s)
Nodo Atrioventricular/fisiopatología , Ablación por Catéter/métodos , Electrocardiografía/métodos , Tabiques Cardíacos/inervación , Síndrome de Wolff-Parkinson-White/fisiopatología , Adulto , Nodo Atrioventricular/cirugía , Fascículo Atrioventricular/fisiopatología , Femenino , Tabiques Cardíacos/fisiopatología , Humanos , Masculino , Síndrome de Wolff-Parkinson-White/cirugíaRESUMEN
To compare the value of exercise electrocardiography with dobutamine stress echocardiography and exercise technetium-99m isonitrile single-photon emission computed tomography for coronary artery disease, 70 patients with either suspected or proven coronary artery disease underwent dobutamine stress echocardiography, exercise technetium-99m isonitrile single-photon emission computed tomography (mibi-SPECT) and treadmill exercise electrocardiography (ECG). Dobutamine echocardiography and exercise mibi-SPECT revealed a higher overall sensitivity than exercise testing (90 vs 57%, p < 0.001; 96 vs 57%, p < 0.001, respectively). Dobutamine stress echocardiography showed a higher specificity than both exercise mibi-SPECT and treadmill exercise electrocardiography (90 vs 71%, p > 0.05; 90 and 62% p < 0.05, respectively) but the difference between dobutamine stress echocardiography and exercise mibi-SPECT was not statistically significant. Diagnostic accuracy of dobutamine stress echocardiography and exercise mibi-SPECT was higher than that of exercise testing (90 vs 59%, p < 0.001; 89 vs 59%, p < 0.001, respectively). Dobutamine stress echocardiography and exercise mibi-SPECT have superiority over exercise testing in the diagnosis of coronary artery disease and dobutamine stress echocardiography is an alternative for exercise mibi-SPECT.