Late effects of cardiomyoplasty on left ventricular mechanics and diastolic filling.

BACKGROUND: Dynamic cardiomyoplasty is a relatively new surgical procedure proposed for treatment of severe myocardial failure. Limited clinical experience suggests that this procedure reverses congestive heart failure, improving the long-term survival. METHODS AND RESULTS: In this investigation, the late effects (16.5 +/- 4.8 months after surgery) of cardiomyoplasty on left ventricular mechanics and diastolic filling were studied in eight male patients (mean age, 45 +/- 7 years). The investigation was performed with the myostimulator on and off (24 +/- 1 hours off) using a microtip catheter to obtain the left ventricular pressures simultaneously with Doppler (inflow velocities) and M-mode and two-dimensional echocardiographic recordings. Statistical comparisons were made with Student's t test for paired data. Dynamic cardiomyoplasty increased the maximal elastance (17 +/- 1 versus 21 +/- 1 mm Hg/cm, P = .006) and decreased the systolic wall stress (253 +/- 17 versus 190 +/- 12 g/cm2, P = .029). Left ventricular end-diastolic pressure decreased (27.1 +/- 2.8 versus 17.6 +/- 1.7 mm Hg, P = .019), as did end-diastolic circumferential wall stress (69 +/- 8 versus 37 +/- 5 g/cm2, P = .002). The chamber and muscle stiffnesses decreased (120 +/- 31 versus 52 +/- 11 mm Hg/cm, P = .017; 994 +/- 185 versus 426 +/- 76 g/cm2, P = .002, respectively). The pattern of left ventricular diastolic filling changed, with a decrease of early peak flow (231 +/- 20 versus 217 +/- 21 mL/s, P = .022), of deceleration time (163 +/- 28 versus 116 +/- 26 seconds, P = .001), and of flow area during rapid filling (105 +/- 15 versus 75 +/- 12 mL, P = .004) and an increase of flow area during atrial contraction (39 +/- 4 versus 88 +/- 9 mL, P = .001). CONCLUSIONS: Our detailed evaluation of left ventricular mechanics demonstrates that cardiomyoplasty has significant multiple beneficial effects on dilated myopathic heart.

Effects of dynamic cardiomyoplasty on regional wall motion, ejection fraction, and geometry of left ventricle.

BACKGROUND: Dynamic cardiomyoplasty may provide functional and hemodynamic improvement in patients with heart failure. The purpose of this study was to investigate the effects of cardiomyoplasty on global ejection fraction, regional wall motion, and geometry of the left ventricle. METHODS AND RESULTS: These parameters were determined in 10 patients submitted to cardiomyoplasty for treatment of refractory heart failure by left ventricular (LV) angiography. The studies were performed before and 16.5 +/- 4.8 months after cardiomyoplasty with the myostimulator turned on. They were repeated 24 +/- 1 hours with the myostimulator turned off in eight patients. LV ejection fractions were determined by the area-length method, and the centerline method was used for assessment of regional wall motion. LV geometry was studied by LV major-to-minor axis ratio and sphericity index. A LV ejection fraction improvement from 15 +/- 8% to 30.9 +/- 8.3% (p < 0.01) was demonstrated with the myostimulator turned on after cardiomyoplasty. The values with the myostimulator turned off were 23 +/- 13%, remaining higher than the values observed before surgery (p < 0.05). Regional wall motion analysis showed an improvement in all studied regions. Regarding the LV shape, the left ventricle became markedly more spheric in the diastole. CONCLUSIONS: Dynamic cardiomyoplasty may improve LV function in selected patients. The analysis of LV wall motion corroborated these results, and these changes were associated with modifications in the LV geometry.

[Comparison of the effects of diazepam, nifedipine, propranolol and a combination of nifedipine and propranolol, by sublingual administration, in patients with hypertensive crisis]. / Efeito comparativo do diazepam, nifedipina, propranolol e da associação nifedipina e propranolol, por via sublingual, em pacientes com crise hipertensiva.

PURPOSE: To evaluate the effects of sublingual administration of diazepam, nifedipine, propranolol and the association of nifedipine with propranolol patients with hypertensive crisis. METHODS: Eighty patients with hypertensive crisis, DAP greater than 120 mmHg, and mean age of 54 +/- 7.4 years, 33 women and 47 men, were evaluated. The AP was measured with an aneroid sphygmomanometer, in mmHg, in orthostatic position, before and after 10, 20, 30 and 60 minutes of treatment. The heart rate in one minute was also measured at the same intervals. The patients were divided randomly into four groups and treated, respectively, with 10 mg of diazepam, 10 mg of nifedipine, 40 mg of propranolol and 10 mg of nifedipine associated with 40 mg of propranolol. RESULTS: A significant and gradual reduction of SAP and DAP were observed in all groups of patients. The percentage of reduction, after 60 minutes, for SAP was, respectively, 10.1%, 12.9%, 15.4% and 16%, and for DAP 7.7%, 11.3%, 13.6% and 13% in groups I to IV. The heart rate did not change in groups I and II, but significative reduction was observed in groups III (p = 0.002) and IV (p = 0.009). CONCLUSION: The drugs used were effective for the treatment of hypertensive crisis, and the sublingual administration is an important and easy way for their administration.

[Endocarditis caused by Streptococcus bovis and colorectal neoplasms]. / Endocardite por Streptococcus bovis e neoplasias do cólon e reto.

PURPOSE: To evaluate the association of Streptococcus bovis endocarditis with large bowel neoplasms. PATIENTS AND METHOD: Twenty episodes (19 patients) of Streptococcus bovis endocarditis (5.05%) selected from 396 episodes of endocarditis followed up from 1978 to 1990. The mean age was 57.68 years, 16 (84.21%) were males. Previous heart disease was not known in nine (45%). Previous manipulation that might induce bacteremia was identified in three patients. Symptoms related to neoplasia of the digestive system were not informed. The mean time of follow up (17 cases) was 33.76 months, standard deviation 27.37 months. Sixteen patients were submitted to colonic evaluation (barium enema in 11, colonoscopy in 5 patients, and both were performed in 5 patients). RESULTS: Bowel neoplasias were diagnosed in 12 (75%) of 16 patients submitted to colonic evaluation, one colonic adenocarcinoma in one (8.33%), patient, histologic benign polyps in eight (66.6%). Two patients are waiting for colonoscopic resection. In one patient the polyp was lost after colonoscopic resection. CONCLUSION: The high incidence of large bowel neoplasia in patients with Streptococcus bovis endocarditis indicates that evaluation of the large bowel must be performed on in patients with S. bovis endocarditis in order to diagnose neoplasias, even in the absence of symptoms of bowel disease.