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Biomedical subjects

A Brusca

Publications and source records attributed to A Brusca.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Results of coronary artery bypass surgery. Surgical mortality, survival and follow-up functional state. Multivariate discriminant analysis of relative risk factors].

Clinical results of coronary artery bypass surgery, have been evaluated by analyzing operative mortality, late survival, late functional results and their related risk factors. Four hundred and thirty-seven consecutive patients who underwent coronary artery bypass surgery between January, 1979, and December, 1983, were the clinical material of this study. The gender of patients was male in 89% of the cases; age ranged from 34 to 78 years with a mean of 54.8 +/- 8.2 (SD). Patients with combined surgical procedures were excluded. Follow-up averaged 55.7 months; 404 survivors have been contacted (97% of the total study population, if operative and late deaths are added); 218 patients underwent a control exercise test; postoperative employment status was determined for 242 individuals. The operative mortality was 5.49% (24 patients). Death was due to cardiac causes in 75% of the cases. The overall actuarial survival rate was 85 +/- 1.9% after 5 years and 83.4 +/- 2.2% after 7 years. When non-cardiac related deaths were excluded the actuarial rates were 88 +/- 1.7% and 87.2 +/- 1.9% after 5 and 7 years respectively. Actuarial freedom from all ischemic events (cardiac related death, late myocardial infarction or recurrence of angina) was 66.1 after five years, and was 70.2% if operative deaths were excluded. Actuarial freedom from recurrence of angina for patients alive at follow-up was 78.7% after five years, actuarial freedom from myocardial infarction was 93.5%. The mortality hazard showed a diphasic response, being higher perioperatively and constant in the following 5 years of follow-up. All ischemic events, both singularly and together, showed an accelerated rate of occurrence at the first and after the fifth postoperative year, the slope of the curve being quite flat during the 1 to 5 year interval. The control exercise test was negative for 62.8% of the patients, positive for 33.5% and undeterminable in 3.7%. Employment status was postoperatively unaffected in 49.6% of the cases, while 27.3% of the patients retired: the remaining individuals had already retired before surgery. Statistical analysis (stepwise logistic regression) identified age (p = 0.002) and cross-clamp time (p = 0.016) as significant risk factors of operative mortality. The ejection fraction showed a value close to statistical significance (p = 0.06).(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗
PubMed1988

[Differences in patients with chronic pulmonary embolism and primary pulmonary hypertension].

Chronic pulmonary embolism is a rare disease which can occur at first with pulmonary hypertension. In these cases it may be difficult to distinguish between primary pulmonary hypertension. We examined nine patients with Chronic Pulmonary Embolism (CPE) (three females and six males, mean age 45 +/- 13 years, range 21-67 years) and ten patients with Primary Pulmonary Hypertension (PPH) (seven females and three males, mean age 35 +/- 13 years, range 10-56 years) who came to our attention during the years 1973-1986 (mean follow up 3 years). All patients had an electrocardiogram, chest x-ray, echocardiogram, cardiac catheterization with pulmonary angiography; seven patients with CPE and eight with PPH had perfusion lung scans. Progressive dyspnoea was the main feature in all the patients; four out of nine with CPE and none of the ones with PPH had a previous history of thrombophlebitis. In all the patients the electrocardiogram, chest x-ray and echocardiogram showed signs of pulmonary hypertension, so that a clear distinction between the two groups was not possible. Cardiac catheterization showed pulmonary pressure values higher in patients with PPH as compared to the ones with CPE (systolic pressure 96 mmHg vs 70 mmHg, diastolic pressure 49 mmHg vs 31 mmHg, mean pressure 65 mmHg vs 45 mmHg). Pulmonary angiography in more than half of the patients with CPE showed a "cut off" of two or more lobar branches of the pulmonary arteries. In the patients with PPH pulmonary angiography showed a dilatation of the main pulmonary artery and a diffuse bilateral hypoperfusion. Perfusion lung scan in all the cases of CPE showed zonal perfusion defects, while in all cases of PPH, with the exception of one, it was largely normal. Venograms in the districts of the inferior vena cava demonstrated thrombosis in two out of six patients with CPE. Negative venograms were found in the five patients with PPH who had this investigation performed. One patient with CPE had a surgical embolectomy, the other eight had anticoagulant oral treatment. During the follow-up period three patients with CPE and five with PPH died within five years and within fifteen months respectively, of the diagnosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

[Percutaneous pulmonary valvuloplasty in adults. An immediate evaluation and follow-up of 3 cases].

The immediate and late results of percutaneous pulmonary valvuloplasty in three symptomatic adult patients (21, 38 and 45 years) with severe pulmonary valve stenosis are reported. The right ventricle-pulmonary artery gradient fell from 135 mmHg to 50 mmHg in patient n. 1, from 124 mmHg to 95 mmHg in patient n. 2 and from 132 mmHg to 27 mmHg in patient n. 3. Six months later a further hemodynamic study showed a further reduction in the gradient in patient n. 1 and n. 2 (28 and 33 mmHg). A year and half after of clinical follow-up symptomatic improvement is still present without any clinical or echo-Doppler signs of restenosis. In conclusion, percutaneous pulmonary valvuloplasty is a simple and safe procedure for severe pulmonary valve stenosis even in adults with immediate and long-term good results.

Adult↗
PubMed1987

Long term results (15-30 years) of surgical repair of aortic coarctation.

The late outcome in 226 patients who survived surgical repair of aortic coarctation was assessed 15-30 years after operation. Twenty six patients died during the follow up mainly from causes related to surgical repair or to associated cardiovascular anomalies. The survival rates of patients operated on between the ages of four and 20 years are 97%, 97%, 92% at 10, 20, and 30 years after operation. For patients operated on after the age of 20 the corresponding rates are 93%, 85%, and 68%. This difference is statistically significant from the fifteenth year of follow up onwards. The survival of patients operated on before the age of 20 is not significantly different from that of a comparable general Italian population. Recoarctation occurred in only 8% of patients who had end to end anastomosis, whereas it occurred in 35% of those who had other types of operation. Two thirds of the patients were hypertensive at the last visit. The actuarial curve shows that blood pressure was normal in most patients 5-10 years after operation, but 30 years after coarctation repair only 32% of patients are expected to be normotensive. Thus early repair of aortic coarctation appears to improve long term survival. Intervention in older patients and when blood pressure is high seem to be the most important predictors of late hypertension.

Adolescent↗
PubMed1987

[2 cases of arrhythmogenic dysplasia of the right ventricle of familial occurrence].

Cases of familial arrhythmogenic right ventricular dysplasia (ARVD) have been reported by many authors, and a genetic mechanism of transmission has been hypothesized. Both autosomal dominant and autosomal recessive mechanism of inheritance were suggest. We present a father and a daughter affected by arrhythmogenic right ventricular dysplasia, belonging to a family with many cases of sudden death. Both of them presented with an episode of ventricular tachycardia with left bundle branch block. The clinical diagnosis was made according to electrocardiographic, echocardiographic, angionuclear and hemodynamic criteria of ARVD. The familia analysis suggest an autosomal dominant mechanism of transmission.

Adolescent↗
PubMed1987

[Doppler study of porcine bioprosthesis at the mitral site].

Twenty-nine asymptomatic patients with porcine (9 Liotta, 8 Carpentier, 8 Hancock and 4 Xenomedica) mitral prosthesis without clinical findings of prosthetic dysfunction and with normal M-mode and two-dimensional echocardiography were studied with pulsed and continuous wave Doppler. The following parameters of prosthetic function were evaluated: 1) maximum velocity (Vmax); 2) mean pressure gradient; 3) pressure half-time (P 1/2 t); 4) functional prosthetic area or Doppler orifice area (DOA); 5) mitral prosthetic regurgitation (MR); 6) tricuspid regurgitation (TR), if associated. P 1/2 t reproducibility was tested. For the study of the bioprosthetic function the transducer was located in apical position with the best alignment between ultrasonic beam and flow direction in the apical four-chamber view. The best acoustic signal was the guide to an optimal Doppler recording, analyzed for calculations. In 26 patients without MR at Doppler examination Doppler data were as follows: Vmax 1.6 +/- 0.2 m/sec (1.2-2 m/sec); mean pressure gradient: 4.4 +/- 2.7 mmHg (1.4-13 mmHg); P 1/2 t = 94.2 +/- 19.8 msec (55-140 msec); DOA = 2.4 +/- 0.6 cm2 (1.5-4 cm2). Mild unsuspected MR was detected in 3 patients, but the other parameters did not differ from those of the other 26 patients. TR was found in 10 patients. The degree of reproducibility of P 1/2 t was 0.92. Only the P 1/2 t value was longer among Hancock and Liotta or Xenomedica bioprosthesis (p = 0.005). Furthermore P 1/2 t was longer in the patients with longer follow-up periods than in the others (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Electrophysiologic study in supine and upright positions in patients with Wolff-Parkinson-White syndrome].

It is well known that in patients with Wolff-Parkinson-White (W.P.W.) adrenergic activity stimulation induced by exercise or isoproterenol I.V. infusion shortens the anterograde effective refractory period (E.R.P.) of the accessory pathway. Our purpose was to evaluate whether the upright position produces similar changes on the electrophysiologic properties of the accessory pathway and influences reciprocating tachycardias induction. In 18 patients, with W.P.W. syndrome, who underwent electrophysiologic study, we determined the anterograde E.R.P. of the accessory pathway and attempted to induce a reciprocating tachycardia in the supine and in the upright position. In 13 patients (72%) the anterograde E.R.P. of the accessory pathway shortened in the upright position (303 +/- 104 msec vs 331 +/- 123 msec; p less than 0.001); in 4 patients (22%) it was unchanged; in 1 patient was not defined, being inferior to the atrium E.R.P. We were able to induce a reciprocating tachycardia in 3 patients in the supine position, in 6 patients in the upright position. Electrophysiologic testing in the upright position improves the evaluation of the accessory pathway electrophysiologic properties.

Adolescent↗
PubMed1986

Clinical and electrocardiographic features and long-term results of electrical therapy in patients with isolated His bundle disease.

The clinical, ECG, and electrophysiologic findings of 35 consecutive patients with second- and third-degree intra-His block with normal QRS complexes were examined. The follow-up period varied between 12 and 120 months (mean 45). Seventy-seven per cent of the patients were women. Underlying heart disease was present in 43% of the patients. ECGs were characterized by both second-degree type I and type II atrioventricular block, normal or slightly prolonged PR interval of the conducted beats or of the first conducted beat of a Wenckebach sequence, and by subtle changes in the initial forces of the QRS complexes of the escape beats. Electrophysiologic study showed normal sinus and atrioventricular node function and normal infra-His conduction in all patients. In four patients repetitive bradycardia-dependent intra-His block was induced. Thirty-two patients were permanently paced soon after the initial evaluation and three during the follow-up period. Total long-term mortality rate was 23%. None of the patients developed bundle branch block.

Adult↗
PubMed1986

Atypical chest pain: coronary or esophageal disease?

Retrosternal pain can be caused both by cardiac and esophageal disease. This work presents the results of cardiac and esophageal investigations in 55 patients, who had atypical chest pain. Isolated esophageal disease was found in 45% of the subjects while 14.5% had significant coronary arterial disease. Both diseases were found in 10.9% of the patients and neither disease in 29%. We conclude that esophageal disease is very frequent in patients with atypical chest pain but it does not always completely account for the symptoms. Such patients should, in our opinion, be submitted to an electrocardiographic stress test. If the result is positive or non-diagnostic, coronary cineangiography should be performed, irrespective of the results of esophageal investigations. If the electrocardiographic stress test is negative, coronary investigations can be deferred. Esophageal investigations can account for the symptoms in about half of such cases.

Adult↗
PubMed1986

Short- and long-term effects of propafenone in ventricular arrhythmias.

The effectiveness of short- (15 days) and long- (12 months) term propafenone treatment was assessed in 53 patients presenting with more than 30 premature ventricular complexes per hour as detected by 24-hour ambulatory Holter monitoring. Thirty-nine patients had no apparent concomitant heart disease while 14 had chronic coronary artery disease. The effects of propafenone were analysed by ambulatory Holter monitoring after 15 days and at 3, 6 and 12 months. The initial dose was 150 mg four times daily and was increased up to 300 mg four times daily when necessary. Favourable short-term effects were obtained in 39 patients (73.6%). After 12 months, 17 patients (32.1%) were still on propafenone treatment with good results. Treatment was discontinued on account of low compliance in 28.3%. This was because treatment was ineffective even at high doses in 15.2%, because of severe side effects in 13.2%, because of proarrhythmic effects in 5.6% and for other causes in 5.6%.

Adolescent↗
PubMed1986

[Conduction disorders and sites of calcification of the mitral ring: 2-dimensional echocardiographic study].

The association between a calcified mitral annulus and impairment of cardiac impulse transmission is well known. However informations on the relations between the site of mitral calcification and conduction disturbance are still scanty. Twenty-nine patients (22 women and 7 men, mean age 64.4 +/- 13.1 years) with M-mode and two-dimensional echocardiographic evidence of mitral annulus calcifications were studied. The "annulus" was subdivided in 4 segments: antero-medial, antero-lateral, postero-medial and postero-lateral. Conduction disturbances were present in 15 patients (51.7%). Atrio-ventricular or intra-ventricular conduction defects were found in 12 out of 15 patients with calcifications of the antero-medial segment and only in 3 of 14 subjects without antero-medial calcifications (P less than .01). The presence of conduction defects therefore seems to be significantly increased when calcium deposition is located near the conduction system.

Adult↗
PubMed1984

Holter monitoring and provocative maneuvers in assessment of unipolar demand pacemaker myopotential inhibition.

Myopotential inhibition was produced by a combination of different provocative maneuvers in 423 (77%) out of 550 consecutive unipolar pacemaker patients. The most useful maneuvers were the hand-to-shoulder press (90% positivity) and the hand-to-hand press (60% positivity). Three groups of 20 patients were then submitted to 24 hours of Holter monitoring. Group A during the provocative maneuvers had shown myopotential inhibition and symptoms of cerebral ischemia. In group B symptomless myopotential inhibition had been induced. Group C had no myopotential inhibition nor symptoms during the tests. Abnormal pacemaker pauses related to myopotential inhibition were recorded during Holter monitoring in 90% of group A and in 80% of group B patients, but only group A patients showed symptoms. Thus in patients who are able to practice provocative isometric maneuvers and who can be selected according to their response, Holter monitoring seems to offer few advantages in discovering myopotential inhibition and related symptoms.

Adolescent↗
PubMed1984

Electrocardiographic and electrophysiologic features of dual pathways within the His bundle.

Electrophysiological evidence of dual intrahisian pathways has been shown in a patient with diseased His bundle. The main electrocardiographic features, in this case were: 1). 1:1 A-V conduction with alternating short and long PR intervals; 2). unexpected A-V Wenckebach sequences; and 3). unexpected interruption of Wenckebach sequences by early captures of the ventricles with short and fixed PR intervals. These features were due to the following causes: 1). different E.P. properties of the two pathways producing a shift of conduction from a fast conducting pathway (FCP) to a slow conducting pathway (SCP); 2). a concealed reentry from the SCP into the FCP; and 3). a phase of "unexpected conduction" in the FCP.

Aged↗
PubMed1984

Severe electrocardiographic abnormalities during arfonad administration.

Severe and reversible electrocardiographic abnormalities (first degree atrioventricular block, left bundle branch block, ventricular fibrillation), were induced by the administration of Arfonad in a patient with type III acute aortic dissection previously chronically treated with alpha-methyl-dopa. Any other possible cause of the electrocardiographic changes was excluded on the basis of clinical findings and laboratory studies. The explanation of the electrocardiographic abnormalities induced by Arfonad are not readily apparent, also on careful review of the literature. We suggest a strict electrocardiographic monitoring during Arfonad administration especially in patients with cardiac conduction defects and previous administration of cardiac cathecholamines depleting drugs.

Adult↗