RESUMEN
Left ventricular function at rest and during supine bicycle exercise was assessed by gated radionuclide angiography in 20 diabetic patients and 18 normal control subjects without clinical evidence of heart disease. The diabetic patients were aged 21 to 44 years and all except one used insulin. No subject developed chest pain or electrocardiographic changes during exercise. Both groups had a similar rest and exercise heart rate and blood pressure, and both achieved similar work loads. The control group had an ejection fraction at rest of 65.4 +/- 6.2% (mean +/- SD) and only 1 of 18 showed a decrease with exercise; peak exercise ejection fraction averaged 77.1 +/- 7.8%. The diabetic group had a mean ejection fraction at rest of 63.7 +/- 6.5%, similar to that of the control group, but 7 of 20 showed a decrease during exercise; the exercise ejection fraction averaged 67.7 +/- 9.7%, significantly lower than that of the control group (p less than 0.01). The diabetic patients varied widely in ejection fraction response to exercise, ranging from an increase of 25% to a decrease of 21%. This response did not correlate with age, sex, duration of diabetes, smoking, retinopathy, exercise heart rate, blood pressure or rate-pressure product, work load attained or ejection fraction at rest. These data suggest that approximately one-third of patients with diabetes have subclinical left ventricular dysfunction without correlation to risk factors for atherosclerosis or other diabetic complications. Whether this is due to unrecognized coronary artery disease or primary myocardial disease remains unknown.
Asunto(s)
Gasto Cardíaco , Complicaciones de la Diabetes , Cardiopatías/etiología , Volumen Sistólico , Adulto , Diabetes Mellitus/fisiopatología , Prueba de Esfuerzo , Femenino , Cardiopatías/diagnóstico por imagen , Cardiopatías/fisiopatología , Frecuencia Cardíaca , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , CintigrafíaRESUMEN
We studied the effects of coronary artery spasm on perfusion of the microvasculature in a patient with Prinzmetal's angina. Intracoronary injections of 99mTc and 131I-labelled macroaggregated human serum albumin were performed (1) at rest, (2) during spontaneous angina, (3) after the administration of nitroglycerin and (4) during pacing-induced spasm and the resultant scans compared. The resting scan was normal. Pain and spasm were associated with a perfusion defect that was localized to the anterior and inferior walls of the left ventricle. The localization of the perfusion defect corresponded with angiographically demonstrated spasm involving left anterior descending and distal circumflex coronary arteries. A subsequent myocardial infarction was localized by 43K scanning to the same perfusion area. Metabolic and parasympathetic stimulation studies were performed but were inconclusive. The patient's recurrent pains were ultimately controlled with large oral doses of isosorbide dinitrate.
Asunto(s)
Angina Pectoris Variable/diagnóstico , Angina de Pecho/diagnóstico , Enfermedad Coronaria/diagnóstico , Angina Pectoris Variable/tratamiento farmacológico , Angiografía Coronaria , Circulación Coronaria/efectos de los fármacos , Electrocardiografía , Humanos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Nitroglicerina/farmacología , Nitroglicerina/uso terapéutico , Marcapaso Artificial , CintigrafíaRESUMEN
Rest and exercise right and left ventricular function were compared using equilibrium gated radionuclide angiography in 19 normal sedentary control subjects (mean age 28 years, range 22 to 34) and 34 patients with hemodynamically documented congenital ventricular septal defect (VSD) (mean age 27 years, range 20 to 40). The 34 patients with VSD were divided into 3 groups: those in Group 1 (17 patients) had pulmonary to systemic blood flow ratios of less than 2 to 1; those in Group 2 (12 patients) had prior surgical closure of VSD (mean interval from surgery 17 years, range 9 to 22), and those in Group 3 (5 patients) had Eisenmenger's complex. Gated radionuclide angiography was performed at rest and during each level of graded supine bicycle exercise to fatigue. Heart rate, blood pressure, maximal work load achieved, and right and left ventricular ejection fractions were assessed. The control subjects demonstrated an increase in both the left and right ventricular ejection fractions with exercise (0.70 +/- 0.07 to 0.79 +/- 0.05 and 0.46 +/- 0.06 to 0.57 +/- 0.04; p less than 0.001 for left and right ventricles, respectively). All study groups failed to demonstrate an increase in ejection fraction in either ventricle with exercise. Furthermore, resting left ventricular ejection fraction in Groups 2 and 3 was lower than that in the control subjects (0.59 +/- 0.09 and 0.54 +/- 0.06 versus 0.70 +/- 0.07; p less than 0.001) and resting right ventricular ejection fraction was lower in Group 3 versus control subjects (0.30 +/- 0.07 versus 0.46 +/- 0.06; p less than 0.001). Thus (1) left and right ventricular function on exercise were abnormal in patients with residual VSD as compared with control subjects; (2) rest and exercise left ventricular ejection fractions remained abnormal despite surgical closure of VSD in the remote past; (3) resting left and right ventricular function was abnormal in patients with Eisenmenger's complex; (4) lifelong volume overload may be detrimental to myocardial function.
Asunto(s)
Defectos del Tabique Interventricular/fisiopatología , Corazón/diagnóstico por imagen , Esfuerzo Físico , Adulto , Presión Sanguínea , Complejo de Eisenmenger/diagnóstico por imagen , Complejo de Eisenmenger/fisiopatología , Eritrocitos , Prueba de Esfuerzo , Femenino , Frecuencia Cardíaca , Defectos del Tabique Interventricular/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Contracción Miocárdica , Cintigrafía , Volumen Sistólico , TecnecioRESUMEN
Cardiomyopathy develops in some individuals who have a susceptibility to malignant hyperthermia. We studied right ventricular endomyocardial biopsy specimens from nine patients defined as having this disorder because of positive caffeine contracture tests on skeletal muscle biopsy specimens. Three patients had clinical evidence of cardiomyopathy and six did not. Light microscopy showed cytoplasmic contraction bands, perinuclear clearing, and a mild to moderate variation in myocyte and nuclear size. Ultrastructurally cytoplasmic contraction bands were associated with cardiac villi, myofiberlysis, and myofibrillolysis. These changes and occasional breaks in the sarcolemma were regarded as artefacts of the biopsy procedure. Megamitochondriosis with accompanying degenerative changes in the mitochondria were also seen and probably indicate increased cell metabolism; vacuolation of the cytoplasm was regarded as an "aging" phenomenon. Thus, the biopsy specimens were abnormal, but the changes were artefactual or nonspecific and were not unique to this group of patients. Biopsy did not provide a morphological explanation for abnormal cardiac function.
Asunto(s)
Hipertermia Maligna/complicaciones , Hipertermia Maligna/patología , Adolescente , Adulto , Cafeína/efectos adversos , Cardiomiopatías/complicaciones , Femenino , Halotano/efectos adversos , Cardiopatías/genética , Humanos , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Contracción Miocárdica/efectos de los fármacos , Miocardio/patologíaRESUMEN
Thirty-five patients with atrioventricular (AV) discordance underwent repair of major intracardiac defects. Ventricular septal defect (VSD) was the most frequently encountered lesion, present alone or in combination with other lesions in 86% of these patients. Pulmonary stenosis (51%) and tricuspid insufficiency (37%) were the other lesions encountered. The initial operative mortality of 8.6% is approaching that for these same defects when repaired in the patient with normal atrioventricular connections. However, the late mortality of 19% with an average follow-up of 4.4 years is higher than expected in the absence of AV discordance. Reoperation for residual or recurrent defects was required in 9 of the 32 survivors and was associated with a mortality of 33%. Seven of the 9 reoperations were required for tricuspid valve dysfunction. Elective repair of major anomalies in association with AV discordance can be accomplished safely, but these patients require careful long-term follow-up in anticipation of late problems.
Asunto(s)
Bloqueo Cardíaco/complicaciones , Cardiopatías Congénitas/cirugía , Adolescente , Adulto , Niño , Preescolar , Femenino , Bloqueo Cardíaco/diagnóstico , Cardiopatías Congénitas/complicaciones , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Masculino , Estenosis de la Válvula Pulmonar/congénito , Estenosis de la Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Tricúspide/congénito , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
A case report details the operative technique used in the repair of complete transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis in a patient who had had Baffes procedure previously. Experience in managing 10 patients with complete TGA who had undergone a Baffes procedure is discussed. Four patients with a large VSD had pulmonary vascular disease. The condition of 1 of them was improved by a palliative Mustard operation. Four children with isolated TGA underwent a successful modified Mustard repair. The 2 remaining patients had a VSD and pulmonary stenosis; in 1 the condition was palliated by a Glenn shunt. The other is the subject of the case report. The mean interval between the Baffes procedure and the second operation was 11 years. There was 1 late death after secondary repair. Follow-up in the remaining 6 patients at a mean of 10.6 years indicates a favorable outcome.
Asunto(s)
Transposición de los Grandes Vasos/cirugía , Adulto , Prótesis Vascular , Estudios de Seguimiento , Defectos del Tabique Interventricular/cirugía , Humanos , Masculino , Métodos , Estenosis de la Válvula Pulmonar/cirugía , Factores de Tiempo , Vena Cava Inferior/cirugíaRESUMEN
A patient with tetralogy of Fallot who presented at 58 years of age is described. Following surgical intracardiac repair he had 20 years of improved functional capacity. Though such surgery is now usually performed in infancy, the literature indicates that surgical correction of tetralogy of Fallot in appropriate adults is associated with low mortality and good long-term results.
Asunto(s)
Tetralogía de Fallot/cirugía , Factores de Edad , Cianosis/etiología , Ecocardiografía Doppler , Electrocardiografía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Aptitud Física , Tetralogía de Fallot/complicaciones , Tetralogía de Fallot/diagnósticoRESUMEN
BACKGROUND: Medical treatment of the elderly is changing to include the aggressive management of coronary artery disease with percutaneous transluminal coronary angioplasty. OBJECTIVE: The purpose of this study was to review major hospital events of patients aged 70 years or more, who underwent a first percutaneous transluminal coronary angioplasty. METHODS: A retrospective medical record review was done of 246 consecutive patients of 70 years or more, from January 1985 to December 1988, at a tertiary care community hospital. Adverse events and the factors that influenced outcome were identified. RESULTS: Of 246 patients (age range, 70-85 years, mean = 73.6), 19 died, 4 had a cerebral vascular accident, 11 had a transfusion and 11 underwent coronary artery bypass grafting. Sixteen patients had acute vessel closure and 8 died. Twenty-five patients had one event and 21 patients had more than one. DISCUSSION: The event rate after percutaneous transluminal coronary angioplasty in the elderly is high. CONCLUSIONS: Knowledge of the factors that influence adverse events (diagnostic category, success of procedure, degree of coronary artery disease and age) will assist the critical care team to plan and implement appropriate care.
Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Trastornos Cerebrovasculares/epidemiología , Enfermedad Coronaria/terapia , Infarto del Miocardio/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/mortalidad , Angioplastia Coronaria con Balón/enfermería , Transfusión Sanguínea/estadística & datos numéricos , Causas de Muerte , Trastornos Cerebrovasculares/etiología , Trastornos Cerebrovasculares/mortalidad , Puente de Arteria Coronaria/estadística & datos numéricos , Enfermedad Coronaria/clasificación , Enfermedad Coronaria/diagnóstico , Cuidados Críticos , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Planificación de Atención al Paciente , Grupo de Atención al Paciente , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Aneurisma de la Aorta/diagnóstico , Rotura de la Aorta/diagnóstico , Auscultación Cardíaca , Adolescente , Adulto , Rotura de la Aorta/diagnóstico por imagen , Aortografía , Cateterismo Cardíaco , Cineangiografía , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Circulación Coronaria , Adolescente , Adulto , Angiografía , Animales , Presión Sanguínea , Cateterismo Cardíaco , Gasto Cardíaco , Circulación Colateral , Perros , Femenino , Humanos , Masculino , Matemática , Métodos , Persona de Mediana Edad , Técnica de Dilución de Radioisótopos , Radioisótopos , Descanso , XenónAsunto(s)
Insuficiencia de la Válvula Mitral/fisiopatología , Técnica de Dilución de Radioisótopos , Xenón/administración & dosificación , Cateterismo Cardíaco , Gasto Cardíaco , Cineangiografía , Atrios Cardíacos , Humanos , Infusiones Parenterales , Métodos , Insuficiencia de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/fisiopatología , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , RadioisótoposAsunto(s)
Enfermedad Coronaria/tratamiento farmacológico , Contracción Miocárdica/efectos de los fármacos , Nitroglicerina/administración & dosificación , Perfusión , Adulto , Circulación Colateral/efectos de los fármacos , Vasos Coronarios , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Inyecciones Intraarteriales , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , RadiografíaAsunto(s)
Válvula Aórtica/cirugía , Fascia/trasplante , Prótesis Valvulares Cardíacas , Muslo , Adulto , Anciano , Angiografía , Válvula Aórtica/patología , Aortografía , Aspergilosis/complicaciones , Autopsia , Cateterismo Cardíaco , Embolia/etiología , Fascia Lata/patología , Fascia Lata/trasplante , Femenino , Estudios de Seguimiento , Auscultación Cardíaca , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Sepsis/etiología , Trasplante Autólogo , Fibrilación Ventricular/etiologíaAsunto(s)
Estenosis de la Válvula Aórtica/congénito , Válvula Aórtica/cirugía , Adolescente , Adulto , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Niño , Preescolar , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas , Humanos , Lactante , Recién Nacido , Masculino , Mortalidad , Complicaciones Posoperatorias , RecurrenciaRESUMEN
The effect on myocardial perfusion distribution of intracoronary glyceryl trinitrate in a dose (60 micrograms) insufficient to cause alterations in systemic blood pressure or heart rate was studied in eight patients with angiographically demonstrated collaterals from the left coronary system to the distal right coronary artery. Double isotope imaging using technetium-99m and iodine-131 labelled albumin macroaggregates allowed each patient to serve as his own control. The reproducibility of the imaging and data handling techniques was shown in 12 control patients. Glyceryl trinitrate caused a significant diminution in the collateral-mediated fractional perfusion while increasing that of the native coronary bed.
Asunto(s)
Circulación Colateral/efectos de los fármacos , Circulación Coronaria/efectos de los fármacos , Nitroglicerina/farmacología , Enfermedad Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Masculino , CintigrafíaRESUMEN
Twenty-seven adult patients with the cyanotic type of tetralogy of Fallot had total intracardiac repair during the past five years at the Toronto General Hospital. Twenty-one of 27 patients (77%) had had a previous shunting operation performed five to 21 years prior to the total intracardiac repair. Seventeen of 21 (81%) of these anastomoses were patent at the time of the total intracardiac repair. The hospital mortality was 11% and was attributable to hemorrhage - a well-recognized problem in adult tetralogy, due to excessive collateral circulation. All 24 surviving patients followéd up from six months to five years showed marked clinical improvement, with disappearance of the cyanosis and reduction in acne and clubbing. Permanent heart block has not occurred. Late hemodynamic studies showed a significant persisting shunt in two out of 16 or 12%.
Asunto(s)
Tetralogía de Fallot/cirugía , Adolescente , Adulto , Factores de Edad , Circulación Colateral , Cianosis , Estudios de Seguimiento , Bloqueo Cardíaco/epidemiología , Hemodinámica , Hemorragia/mortalidad , Humanos , Persona de Mediana Edad , Cuidados Paliativos , Complicaciones Posoperatorias/epidemiología , Insuficiencia Respiratoria/epidemiología , Tetralogía de Fallot/mortalidadRESUMEN
The influence of smoking, hyperlipidemia, and glucose intolerance on graft patency and rate of progression of obstructive disease in the native circulation was assessed in 99 patients 1 1/2 years after aortocoronary bypass grafting. There were 24 patients in whom none of these risk factors was identified. There were 42 patients with one, 29 with two, and four with three risk factors. Overall graft patency rate was 74%. Graft patency was not significantly influenced by any of these factors either singly or in combination. Progression of obstructive disease in both proximal and distal segments of grafted vessels and in nongrafted vessels was not significantly increased by the presence of one, two, or three risk factors. Over all, there was progression in 56% of segments proximal to grafts, in 8% distal to grafts, and in 14% of nongrafted vessels. Longer term studies will be required to establish any adverse influence of these risk factors on saphenous vein bypass grafts and native circulation.
Asunto(s)
Angina de Pecho/cirugía , Puente de Arteria Coronaria , Circulación Coronaria , Complicaciones de la Diabetes , Hiperlipidemias/complicaciones , Complicaciones Posoperatorias/epidemiología , Fumar/complicaciones , Adulto , Anciano , Glucemia/análisis , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Prueba de Tolerancia a la Glucosa , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Pronóstico , Riesgo , Vena Safena/trasplante , Trasplante AutólogoRESUMEN
A 53-year-old woman underwent cardiac catheterization for assessment of coronary arterial disease. An unexpected finding of a gradient between right atrium and right ventricle led to the discovery of an unsuspected right atrial myxoma. The diagnosis was established by the presence of a filling defect in the right atrial angiocardiogram and by the demonstration of "tumour vessels" by selective right coronary angiography. Selective coronary angiography can visualize the blood supply to an intracardiac tumour and thus confirm the diagnosis preoperatively.