RESUMO
BACKGROUND: Early stages of coronary atherosclerosis are characterized by a mainly functional impairment of coronary vasodilator capacity under the impact of such risk factors as hypercholesterolemia. The goal of this study was to determine whether 6-month cholesterol-lowering therapy improves coronary flow reserve in patients with angina, reduced flow reserve despite minimally diseased coronary vessels or even normal angiogram, and mild to moderately elevated LDL levels on average. METHODS AND RESULTS: We noninvasively investigated 23 consecutive patients (18 men, 5 women; mean age, 56+/-7.6 years) with a mean LDL level of 165+/-34 mg/dL at baseline by PET for myocardial blood flow measurement with [13N]ammonia at rest and under dipyridamole stress (0.56 mg/kg) before and after lipid-lowering therapy with simvastatin for 6 months. Between baseline and the 6-month follow-up, total cholesterol concentration fell from 241+/-44 to 168+/-34 mg/dL, and the LDL level decreased from 165+/-34 to 95+/-26 mg/dL (P<0.001). Overall, coronary flow reserve increased from 2.2+/-0.6 to 2.64+/-0.6 (P<0.01). Maximal coronary flow increased significantly from 182+/-36 to 238+/-58 mL/minx100 g (P<0.001) at follow-up. Minimum coronary resistance declined significantly from 0. 51+/-0.12 to 0.40+/-0.14 mm Hg. mL-1. minx100 g (P<0.001). Concomitantly, a regression of anginal symptoms was observed in most patients. CONCLUSIONS: Our results suggest that cholesterol-lowering therapy with simvastatin may improve overall coronary vasodilator capacity assessed noninvasively by PET in patients with mild to moderate hypercholesterolemia. Consequently, intensive lipid-lowering therapy is considered a vasoprotective treatment for selected patients in very early stages of coronary atherosclerosis with the potential of preventing further disease progression.
Assuntos
Anticolesterolemiantes/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária/fisiologia , Sinvastatina/uso terapêutico , Tomografia Computadorizada de Emissão , Adulto , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/tratamento farmacológico , Angina Pectoris/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Circulação Coronária/efeitos dos fármacos , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologiaRESUMO
OBJECTIVES: We report the acute results and midterm clinical course after percutaneous transluminal septal myocardial ablation (PTSMA) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). BACKGROUND: In the treatment of HOCM, surgical myectomy and DDD pacemaker therapy are considered the standard procedural extensions to drug therapy with negatively inotropic drugs. As an alternative nonsurgical procedure for reducing the left ventricular outflow tract (LVOT) gradient, PTSMA by alcohol-induced septal branch occlusion was introduced. However, clinical follow-up has not been sufficiently described. METHODS: In 25 patients (13 women, 12 men; mean [+/- SD] age 54.7 +/- 15.0 years) who were symptomatic despite sufficient drug therapy, 1.4 +/- 0.6 septal branches were occluded with an injection of 4.1 +/- 2.6 ml of alcohol (96%) to ablate the hypertrophied interventricular septum. After 3-months, follow-up results of LVOT gradients and clinical course were determined. RESULTS: The invasively determined LVOT gradients could be reduced in 22 patients (88%), with a mean reduction from 61.8 +/- 29.8 mm Hg (range 4 to 152) to 19.4 +/- 20.8 mm Hg (range 0 to 74) at rest (p < 0.0001) and from 141.4 +/- 45.3 mm Hg (range 76 to 240) to 61.1 +/- 40.1 mm Hg (range 0 to 135) after extrasystole. All patients had angina pectoris for 24 h. The maximal creatine kinase increase was 780 +/- 436 U/liter (range 305 to 1,810) after 11.1 +/- 6.0 h (range 4 to 24). Thirteen patients (52%) developed a trifascicular block for 5 min to 8 days requiring temporary (n = 8 [32%]) or permanent (DDD) pacemaker implantation (n = 5 [20%]). An 86-year old woman died 8 days after successful intervention of uncontrollable ventricular fibrillation in conjunction with beta-sympathomimetics in chronically obstructive pulmonary disease. The remaining patients were discharged after 11.3 +/- 5.4 days (range 5 to 24), after an uncomplicated hospital course. Clinical and echocardiographic follow-up was achieved in all 24 surviving patients after 3 months. No cardiac complications occurred. Twenty-one patients (88%) showed clinical improvement, with a New York Heart Association functional class of 1.4 +/- 1.1. A further reduction in LVOT gradient was shown in 14 patients (58%). CONCLUSIONS: PTSMA of HOCM is a promising nonsurgical technique for septal myocardial reduction, with a consecutive reduction in LVOT gradient. Possible complications are trifascicular blocks, requiring permanent pacemaker implantation, and tachycardiac rhythm disturbances. Clinical long-term observations of larger patient series and a comparison with conventional forms of therapy are necessary to determine the conclusive therapeutic significance.
Assuntos
Angioplastia Coronária com Balão , Cardiomiopatia Hipertrófica/terapia , Etanol/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/etiologia , Complexos Cardíacos Prematuros/fisiopatologia , Cardiomiopatia Hipertrófica/tratamento farmacológico , Cardiomiopatia Hipertrófica/enzimologia , Ablação por Cateter , Causas de Morte , Vasos Coronários , Creatina Quinase/análise , Depressão Química , Ecocardiografia , Etanol/efeitos adversos , Feminino , Seguimentos , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/terapia , Septos Cardíacos/patologia , Humanos , Injeções Intra-Arteriais , Pneumopatias Obstrutivas/complicações , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacos , Marca-Passo Artificial , Volume Sistólico/fisiologia , Simpatomiméticos/efeitos adversos , Resultado do Tratamento , Fibrilação Ventricular/etiologia , Função Ventricular Esquerda/fisiologiaRESUMO
The aim of our study was to determine the prevalence of the factor V mutation (position 1691 G-->A) in patients with angiographically diagnosed coronary artery disease and myocardial infarction and, as a control, in blood donors. This mutation has already been proved to be the main genetic risk factor for venous thrombosis. In order to detect this mutation in exon 10 of the factor V gene we established a microtiter plate based hybridization assay for the specific detection of wild-type and mutant sequences in factor V gene segments, obtained after amplification by polymerase chain reaction. This test enables us to screen a large number of samples. The mutation was detected in 29 of 317 coronary artery disease (CAD) patients (9.1%) and 18 of 190 blood donors (9.5%) investigated. The mean activated protein C resistance ratios were 3.18 and 3.11, with nearly identical distribution. No increased prevalence of the factor V mutation was found in the CAD group. In 10 of 29 CAD patients (35%) with the factor V 1691 G-->A mutation and in 124 of 288 CAD patients without the mutation (43%) there was a history of myocardial infarction. From our data we conclude that there is no increased risk of developing coronary atheroma or consecutive myocardial infarction resulting from the factor V mutation with protein C resistance.
Assuntos
Doença das Coronárias/genética , Fator V/genética , Heterozigoto , Infarto do Miocárdio/genética , Mutação Puntual , Proteína C/metabolismo , Adenina/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/epidemiologia , Suscetibilidade a Doenças , Resistência a Medicamentos/genética , Feminino , Guanina/química , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prevalência , Fatores de RiscoRESUMO
A concomitant phenomenon of hypercholesterolemia is reduced coronary vasodilatation capacity due to disturbed endothelial function. Endothelial function can be partially or completely normalized by reducing cholesterol levels through drug therapy, but it is still unclear how rapidly this desired effect is achieved. An interval of between weeks and months has been presumed. LDL apheresis (LDL-A) is capable of achieving a high-degree LDL cholesterol reduction within hours. With positron emission tomography (PET), carried out immediately before and after LDL-A, changes in coronary reserve due to this abrupt LDL cholesterol reduction could be measured both quantitatively and non-invasively. In nine patients (six women, three men) with documented coronary artery disease and hypercholesterolemia, PET was carried out immediately before and 18-20 h after LDL-A. A reduction in LDL cholesterol (from 194 +/- 38 to 81 +/- 20 mg/dl), facilitated significant improvement in myocardial blood flow (MBF) (173 +/- 63 versus 226 +/- 79 ml/min per 100 g) after pharmacologic recruitment of coronary flow capacity (dipyridamole stress), coronary flow reserve (CFR) (1.91 +/- 0.68 versus 2.48 +/- 0.68) and minimum coronary resistance (MCR) (0.61 +/- 0.18 versus 0.43 +/- 0.16 mmHg/100 g per min per ml) within 24 h. Plasma viscosity was reduced slightly, by 6.6%. Probably for the first time, a 30% improvement in coronary vasodilatation capacity could be demonstrated quantitatively and non-invasively by PET after a single LDL-A within 24 h.
Assuntos
Remoção de Componentes Sanguíneos , Circulação Coronária , Lipoproteínas LDL/sangue , Adulto , Feminino , Hemorreologia , Humanos , Hipercolesterolemia/sangue , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão , VasodilataçãoRESUMO
Twenty patients with end-stage heart failure and preexisting malignancies underwent heart transplantation at a single center, with a neoplasm-free interval before the procedure of 0 to 240 months. Twelve patients were long-term survivors (2 to 72 months); there were 2 early and 6 late deaths, thus justifying heart transplantation in patients with preexisting malignancies in individual cases.
Assuntos
Cardiopatias/cirurgia , Transplante de Coração , Neoplasias/epidemiologia , Contraindicações , Feminino , Seguimentos , Cardiopatias/complicações , Cardiopatias/epidemiologia , Humanos , Terapia de Imunossupressão , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/terapia , Seleção de Pacientes , Prognóstico , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
In vivo evaluation of the Lillehei-Kaster heart valve prosthesis was performed in 28 patients; 22 had undergone aortic valve replacement and 6 had had mitral valve replacement. Mean pressure gradients ranged from 6 to 53 mm Hg in aortic prostheses; valve area varied from 0.83 to 2.9 cm2. The maximum opening angle of 80 degrees was never reached in this group of patients; opening angles ranged from 57 to 74 degrees without evidence of disc malfunction. There was no correlation between the ratio of effective to geometric valve area and the degree of opening of the disc occluder. Similar results were found in the mitral valve group. Gradients ranged from 6.0 to 12.5 mm Hg and valve area from 1.6 to 2.2 cm2. The maximum opening angle was 59 to 63 degrees. It is concluded that incomplete opening of the disc occluder in pivoting-disc valves is not necessarily a sign of disc malfunction. Lillehei-Kaster valves smaller than 18 mm in internal diameter should be avoided in adults, and outflow aortoplasty for implantation of a larger prosthesis should be used in patients who have a narrow aortic root.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/normas , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Insuficiência da Valva Aórtica/cirurgia , Estudos de Avaliação como Assunto , Feminino , Alemanha Ocidental , Próteses Valvulares Cardíacas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , PressãoRESUMO
We reviewed the reports of 27 patients who had an aortic valve replacement after previous coronary artery bypass grafting. The aortic valve disease -- mainly aortic stenosis -- showed a rapid rate of progression. In the time interval between coronary artery bypass grafting and aortic valve replacement of 4.6+/-2.2 years the peak-to-peak pressure gradient of the aortic valve rose from 20.2+/-14.3 to 63.0+/-22.7 mmHg. As there is a great interest to identify the patients with a high risk of a rapid progression because of a high mortality of an aortic valve replacement as the second cardiac operation following a coronary artery bypass grafting we also reviewed the cardiac catheterisation films and found a high incidence of calcification and impaired aortic valve motion (81.5% of the patients had already calcified aortic valves and 81.5% had a impaired valve motion) at the time of coronary artery bypass grafting. We concluded that if a patient has to be operated for coronary artery disease an aortic valve replacement should be considered not only according to hemodynamic criteria but also when the aortic valve is calcified or its leaflets' motion is impaired.
Assuntos
Valva Aórtica/cirurgia , Calcinose/complicações , Ponte de Artéria Coronária , Doença das Coronárias/complicações , Doenças das Valvas Cardíacas/complicações , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/classificação , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Calcinose/cirurgia , Doença das Coronárias/cirurgia , Progressão da Doença , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , UltrassonografiaRESUMO
BACKGROUND AND AIMS OF THE STUDY: Percutaneous mitral valvulotomy has been shown to be an accept able alternative to surgery as treatment for selected patients with severe mitral stenosis. Uncertainty still exists regarding predictors of unsuccessful outcome. MATERIALS AND METHODS: 308 patients with severe mitral stenosis underwent Inoue single balloon valvulotomy over a 48-month period and were followed up for a mean of 14.5 +/- 16.8 months (range one to 64 months). Two hundred and sixty-seven (Group I) improved clinically and remained stable throughout the follow up, while subsequent surgery was required in 41 (Group II) after 38.2 +/- 143.5 days (range one to 1,212). Clinical and echocardiographic parameters of the two groups were compared to find significant predictors of an unsuccessful outcome. RESULTS: Significant differences between the groups were observed for NYHA class (2.7 +/- 0.6 vs. 2.9 +/- 0.6, p < 0.05), mitral valve area (1.0 +/- 0.3 vs. 0.9 +/- 0.2 cm2, p < 0.01), left atrial end-systolic dimension by echo (51.3 +/- 8.0 vs. 55.4 +/- 10.2 mm, p < 0.01) and an echocardiographic scoring system including grading for eccentricity of the mitral orifice and distribution of commissural calcification (7.5 +/- 2.0 for Group I and 8.7 +/- 2.0 for Group II, p < 0.001). CONCLUSIONS: Mitral valves that are more likely to have an unsuccessful outcome can be identified by hemodynamic, clinical and echocardiographic criteria, including grading for eccentricity of the mitral orifice and distribution of commissural calcification.
Assuntos
Cateterismo , Ecocardiografia , Estenose da Valva Mitral/terapia , Adulto , Idoso , Calcinose , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Estenose da Valva Mitral/classificação , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/patologiaRESUMO
In a consecutive series of 1109 patients undergoing aortic valve replacement (AVR) between January 1988 and December 1990, there were 48 patients (33 female, 15 male) over 80 years of age (mean age 83.5 years, median 82.9 years). Of those, 33 had aortic stenosis and 15 combined aortic valve disease, with additional coronary artery disease being present in 36. Isolated AVR was performed in 25 patients, and it was combined with coronary venous bypass grafting, with 1-4 (mean 1.8) peripheral anastomoses in 23. Two patients died within 30 days (early mortality 4.2%). Non-fatal complications included one hemiparesis, four transient cerebral disorders, two cases of pneumonia which led to ventilatory assistance, three rethoracotomies because of postoperative bleeding, 15 tachycardias and one transient AV block. Late results were obtained after a median follow up time of 22 months. There were eight late deaths (four cardiac related, four not related) and a low incidence of non-fatal complications (two episodes of gastrointestinal bleeding while on oral anticoagulation, one cerebral transient ischemic attack and one acute left ventricular failure). Nine patients are in NYHA Class I, 12 in Class I-II, 11 in Class II, three in Class II-III and three in Class III. Of the surviving 38 patients, four are currently living in a home for the aged or a nursing home, while all the others are living in their own homes and are able to sustain a relatively independent life-style. We conclude that in very old patients with aortic valve disease, AVR can be performed with low mortality and few non-fatal complications.
Assuntos
Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/reabilitação , Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Doença das Coronárias/complicações , Doença das Coronárias/cirurgia , Feminino , Seguimentos , Próteses Valvulares Cardíacas/mortalidade , Próteses Valvulares Cardíacas/reabilitação , Humanos , Masculino , Complicações Pós-Operatórias , PrognósticoRESUMO
Metabolic impairment and perfusion abnormalities are known to occur in hypertensive heart disease (HHD) and in cardiomyopathies. Free fatty acid (FFA) extraction is severely inhibited in a number of pathobiochemical reactions. This parameter was assessed using the radiolabeled FFA analogue 123I-(p-iodo-phenyl-)-pentadecanoic acid (IPPA) and 201Tl as perfusion marker, both of them injected at maximal physical workload. The regional extraction fraction of IPPA (IPPA-EF) was estimated by relating the regional IPPA and 201Tl uptake to each other. In HHD (normal coronary arteries) with posterior wall thickness less than or equal to 12 mm IPPA-EF was 77 +/- 18% (SD) in septum and 92 +/- 17% in the posterolateral wall (N = 13), with thickness of greater than 12 mm 60 +/- 23% in septum and 61 +/- 20% in the posterolateral wall (N = 8) when compared with IPPA-EF in normal subjects (= 100%, N = 9). In hypertrophic cardiomyopathy (HCM) IPPA-EF averaged 51 +/- 20% in septum and 87 +/- 10% in the posterolateral wall (N = 11). In these patient groups no systematic regional changes in 201TI uptake were observed. In dilated cardiomyopathy (DCM) both IPPA-EF and 201Tl uptake showed distinct regional variations and a great interindividual variability with a mean IPPA-EF reduction of 12% (N = 9). Thus, IPPA uptake in primarily non-ischemic myocardial disease may already be compromised when 201Tl uptake is unchanged. The double-nuclide method for IPPA-EF determination allows to eliminate the influence of flow in FFA imaging and enhances the potential of scintigraphy in the differential diagnosis of HHD versus coronary artery disease.
Assuntos
Cardiomiopatias/diagnóstico por imagem , Coração/diagnóstico por imagem , Radioisótopos do Iodo , Iodobenzenos , Radioisótopos de Tálio , Cardiomiopatias/etiologia , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , CintilografiaRESUMO
OBJECTIVES AND DESIGN: Simultaneous invasive comparative measurements in order to validate the blood pressure measuring device Omron F3 for use in the finger, in accordance with the German Institute for Validation (DIN) 58130 protocol. METHODS: A total of five consecutive simultaneous blood pressure comparative measurements were carried out in each of 15 patients (n = 75). Blood pressure was measured in the left index finger using the blood pressure measuring device Omron F3, and at the same time invasively using a pigtail catheter situated in the aortic arch. The measuring arrangements, validation of the unit of invasive measurement and evaluation were all carried out in accordance with the DIN 58130 protocol. RESULTS: The blood pressure measuring device Omron F3 for use in the finger fulfils the criteria of the European Standard prEn 1060-3. Systolic blood pressure decreased by 2.9+/- 6.6 mmHg and diastolic blood pressure decreased by 2.6+/- 5.9 mmHg. CONCLUSION: The blood pressure measuring device Omron F3 measures blood pressure reliably and accurately if used correctly in appropriate patients. Before using the device for the first time, comparative blood pressure measurements in the upper arm, using the standard auscultatory blood pressure measurement technique according to Riva-Rocci and Korotkoff, should be carried out, in order to check the accuracy of measurement.
Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Dedos/fisiopatologia , Hipertensão/fisiopatologia , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
In 52 patients with exercise angiography (12 normals, 31 with coronary heart disease, 9 with congestive cardiomyopathy) exercise ECGs were examined for R-wave changes. An increasing R-wave amplitude was found an insensitive sign of ischemia in patients with coronary heart disease (sensitivity 29%, specificity 81%). Sensitivity and specificity of the observed ST depression in this study were 83% and 71%, respectively, as reported by others. There was no positive correlation between the changes in the R-wave amplitude and left ventricular end-diastolic volume during exercise, thus there was no proof of the existence of the so-called Brody effect in humans.
Assuntos
Volume Cardíaco , Doença das Coronárias/diagnóstico , Eletrocardiografia , Esforço Físico , Cateterismo Cardíaco , Doença das Coronárias/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume SistólicoRESUMO
The effects of atrial pacing and dynamic exercise in the supine position on systolic time intervals (STI) were compared in 10 normals. In another group of 13 normals, the effect of exercise alone on STI was tested. A linear shortening of electromechanical systole (QS2) and left ventricular ejection time (LVET) with increasing heart rate was demonstrated with right atrial pacing and dynamic exercise in the frequency range between 60 and 140 beats/min. However, the shortening of LVET was significantly less (p less than 0.01) with exercise compared to pacing. This is explained by an increase in left ventricular stroke volume with exercise. The preejection period (PEP) was significantly (p less than 0.001) shortened with exercise, but there was no change with atrial pacing. Thus, changes in heart rate (HR) alone, without changes in the dynamic state of the heart, did not influence PEP. It is suggested that PEP at rest should not be corrected for heart rate. The supine exercise regression equations for correction of heart rate for LVET and PEP differ from both the resting and the upright exercise regression equations. With exercise a frequency correction of STI using regression equations should be abandoned. Instead, uncorrected STI at standard heart rates (e.g., 100, 110, and 130 beats/min) should be taken for comparison. Heart rate standardization should be employed using the formula: Formula (See Text).
Assuntos
Estimulação Cardíaca Artificial , Frequência Cardíaca , Contração Miocárdica , Esforço Físico , Sístole , Adulto , Humanos , Masculino , DescansoRESUMO
Between January 1985 and April 1992 we implanted 477 Mitroflow pericardial bioprostheses in 476 patients in our clinic. All except one valve prostheses were implanted in the aortic position. There were 160 male and 316 female patients, with a mean age of 74.1 years (range 30-89 years). Combined cardiac procedures were performed concomitantly with aortic valve replacement in 45 patients (9.5%): coronary artery revascularisation (n = 38), endarterectomy of the internal carotid artery (n = 4) and multiple valve replacement (n = 3). The sizes of the implanted Mitroflow prostheses were 100% in 19 mm, 70% in 21 mm, 60% in 23 mm and 8% in more than 25 mm. The hospital mortality was 1.3% (n = 5). During the mean follow-up period of 47.6 months valve failure requiring reoperation occurred in 7 patients (1.2%). The actuarial freedom from tissue failure is 89.9 +/- 2.5% and the actuarial survival rate is 90.3 +/- 1.7% (27 deaths) at 7 years. These findings corroborate our policy to continue to implant a pericardial prosthesis in the aortic position, especially in elderly patients with a smaller aortic annulus.
Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica , Bioprótese/efeitos adversos , Bioprótese/estatística & dados numéricos , Feminino , Seguimentos , Alemanha/epidemiologia , Alemanha Ocidental/epidemiologia , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/mortalidade , Próteses Valvulares Cardíacas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Taxa de Sobrevida , Fatores de TempoRESUMO
Primary tumors of the heart are very rare. We report a case of a 28-year old female patient in whom a tumor of the left ventricle was first diagnosed by transthoracic echocardiography. Angiography, nuclear magnetic resonance imaging and fasting positron emission tomography with 18-fluorodesoxyglucose suggested the diagnosis of a well vascularized tumor. The tumor was subtotally excised during heart surgery under total cardiopulmonary bypass and histological examination identified a predominantly vascular hamartoma.
Assuntos
Neoplasias Cardíacas/diagnóstico , Hemangioma/diagnóstico , Adulto , Feminino , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Hemangioma/cirurgia , HumanosRESUMO
OBJECTIVE: Percutaneous mitral valvuloplasty has been shown to be an acceptable alternative to surgery as treatment for selected patients with severe mitral stenosis. We examined hemodynamic, echocardiographic, and pathomorphologic findings in a series of 308 patients undergoing balloon valvuloplasty, 41 of whom underwent subsequent surgery, in search of possible predictors of an unsuccessful outcome. INTERVENTION AND RESULTS: Patients with severe mitral stenosis underwent Inoue single ballon valvuloplasty over a 48-month period and had follow-up for a mean of 14.5+/-16.8 months (range 1 to 64 months). Of the 308 patients, 267 (Group I) were clinically improved and stable throughout follow-up, while subsequent surgery was required in 41 (Group II) after 38.2+/-143.5 days (range 1 to 1212). Significant differences between the groups were observed for NYHA class (2.7+/-0.6 vs 2.9+/-0.6, p<0.05), mitral valve area (1.0+/-0.3 vs 0.9+/-0.2 cm2, p<0.01) and left atrial endsystolic dimension by echo (51.3+/-8.0 vs 55.4+/-10.2 mm, p<0.01). Two of the 41 Group II patients underwent surgery for left to right shunting, 1 for tamponade and 2 were lost to follow-up. The excised mitral valves of the remaining 36 patients all showed calcification and/or fibrosis: 9 homogenous, 5 non-homogenous; 19 were classified as having a funnel-shaped deformity, and 3 did not fit into a discrete category. Among the funnel-shaped valves, 13 had a tear versus 6 where dilation was primarily accomplished by stretching. Only one of 9 valves with homogenous calcification was torn, whereas a tear was noted in 3 of the 5 with non-homogenous calcification. CONCLUSION: Funnel-shaped valves and those with non-homogenous distribution of calcification and/or fibrosis appear to be least suitable for balloon valvuloplasty.
Assuntos
Oclusão com Balão , Cateterismo , Estenose da Valva Mitral/cirurgia , Adulto , Idoso , Constrição Patológica , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Estenose da Valva Mitral/diagnóstico por imagem , ReoperaçãoRESUMO
The effort ECG is one of the most useful and most commonly employed methods for the early diagnosis of coronary disease in patients with a normal ECG at rest. Perfection of a computerised method for this purpose is reported. An effort test is run on the cyclergometer and the ECG is read for 2 min at rest, during the test, and for 3 min afterwards. The chest bipolar leads are used. The diagnostic possibilities are greatly improved by computerisation and interpretation of the effort ECG.
Assuntos
Doença das Coronárias/diagnóstico , Diagnóstico por Computador , Eletrocardiografia , Teste de Esforço , HumanosRESUMO
Hypertrophic cardiomyopathy is defined as a primary, sometimes familial and genetically fixed myocardial hypertrophy. In the obstructive form of the disease (HOCM) a dynamic outflow tract obstruction of the left, occasionally also the right ventricle can be found. HOCM is the most frequent cause of stress-induced syncope or sudden cardiac death in younger patients. An individual estimation of prognosis is difficult although several risk factors have been identified. In addition to standard therapy of symptomatic patients (medical treatment with betablockers and calcium-antagonists of verapamil-type as well as surgical myotomy/myectomy) DDD-pacemaker implantation and percutaneous transluminal septal myocardial ablation (PTSMA) by alcohol-induced septal branch occlusion have been introduced. After PTSMA significant outflow tract gradient reduction can be achieved in > 90% of patients. Due to remodeling after circumscribed myocardial necrosis further gradient reduction has been observed during follow-up. Optimization of ablated septal area by echocardiographic monitoring resulted in reduction of the most important complication (trifascicular block with need of permanent pacemaker implantation) and improvement of acute and follow-up results. Long-term follow-up and comparison with established treatment options are necessary to evaluate the definitive importance of the promising new treatment.
Assuntos
Cardiomiopatia Hipertrófica/terapia , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Masculino , Marca-Passo Artificial , Taxa de SobrevidaRESUMO
Seven prospective, epidemiological studies indicate plasma fibrinogen levels (over 300-350 mg/dl) as an important, independent cardiovascular risk factor for subsequent myocardial infarction and stroke. Furthermore, several clinical studies revealed an association between fibrinogen and both the angiographic and clinical degree of coronary heart disease. In addition, a significant relation of fibrinogen with the number of occluded coronary vessels was found. The following pathophysiologic mechanism are of particular importance: Fibrinogen is a main determinant of plasma viscosity and red cell aggregation. Both phenomena deteriorate blood fluidity especially in the microcirculation. Fibrinogen plays a central role in platelet aggregation and performs an essential substrate in the coagulation cascade. Thus, high fibrinogen levels may favor a hypercoagulable state resulting in final thrombotic events of cardiovascular disease. Fibrinogen is also involved in atherogenesis by stimulating proliferation and migration of smooth muscle cells. Several determinants of fibrinogen levels are known. Smoking is the strongest one in healthy persons. This clinically important effect is dose related. Consequently, cessation of smoking is a major step to lower fibrinogen and subsequently the individual cardiovascular risk. Reduction of overweight and maintenance of regular physical activity are further nonpharmacologic means. Fibrates decrease fibrinogen about 10-30% on an average. Finally, intermittent low-dose Urokinase for end-stages of coronary artery disease and LDL-apheresis (HELP) represent additional approaches to reduce fibrinogen.
Assuntos
Transtornos Cerebrovasculares/sangue , Fibrinogênio/metabolismo , Infarto do Miocárdio/sangue , Adulto , Idoso , Transtornos Cerebrovasculares/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Estudos Prospectivos , Valores de Referência , Fatores de RiscoRESUMO
Today, self-measurement of blood pressure is seen as the optimal goal in improving the compliance of the hypertensive patient, but it can only be reached by using well trained medical staff. In this, the role of nurses is particularly vital. We administered a questionnaire to 77 nurses and 146 doctors to determine their levels of knowledge concerning blood pressure measurement techniques and pitfalls, and definition of hypertension. The general knowledge of both groups was insufficient. Whereas doctors showed greater medical knowledge, nurses were better at the techniques. Both were equally deficient in defining hypertension. We therefore set up a short course (3h) in blood pressure measurement to evaluate knowledge and provide further training. The course consisted of a pretest, a short training programme and a post-training test. Post-training test results showed an average improvement in defining hypertension from 5% to 85%. We conclude that short-term training courses in blood pressure measurement are needed for nurses and doctors, particularly young doctors. We also need more coverage in the medical press to stimulate interest in this vital topic.