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A Galrinho

Publications and source records attributed to A Galrinho.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Significance of the exercise test in the assessment of graft patency after myocardial revascularization with arteries only].

UNLABELLED: Although treadmill exercise testing (TET) has been used to identify ischaemia and determine clinical prognosis after myocardial revascularization, considerable controversy remains on its role in the detection of obstructive lesions of the arterial grafts. AIM: To assess the value of TET in determining the patency of arterial conduits after coronary bypass surgery with complete revascularization. METHODS: Twenty five patients - 21 men and 4 women; age 53.7 +/- 8.7 years - submitted to complete myocardial revascularization exclusively with arterial conduits (CABG-A), undergoing coronary angiography and a symptomlimited TET (Bruce protocol) within 9 months after CABG-A. Angiograms were visually classified in 2 groups (Group I - conduits without lesions, n = 14; Group II > 50% stenosis or occlusion of > or = 1 conduit, n = 11). Clinical characteristics and the following parameters of the TET were compared: total exercise time (ETime); metabolic equivalents (METS); % of predicted maximal heart rate (% MHR); exercise-induced ST depression (decreases ST); and occurrence of angina. The arterial conduits used were: left internal mammary artery -24-; right internal mammary artery -11-; gastroepiploic artery -14-. RESULTS: There were no differences in age, gender, left ventricular systolic function, severity of coronary artery disease, and number of conduits per patient. Group I attained superior values for the following parameters: ETime (p < 0.01) and METS (p < 0.01). Among Group II there were more patients with angina (p = 0.03). Fourteen patients exceeded 8 METS (11 from Group I and 3 from Group II - p = 0.002-). There was no statistical difference among the number of patients with ST depression during exercise. CONCLUSIONS: After CABG-A the exercise tolerance seems to be related with the patency of the conduits and may play an important role in the detection of graft abnormalies. On the contrary, exercise-induced ST depression had low specificity in detecting obstructive lesions of the conduits.

Coronary Artery Bypass↗
PubMed1996

[Endocarditis in patients with endocardial catheters; role of transesophageal echocardiography for its detection (report of 4 clinical cases)].

UNLABELLED: To evaluate the usefulness of transesophageal echocardiography in the diagnosis of patients with non-prosthetic intracardiac material and clinical suspicion of endocarditis. A brief review of the literature was also made. PATIENTS: All the clinical cases of patients with febril syndrome, clinical suspicion of endocarditis and non-prosthetic intracardiac material who were referred to our Department of Echocardiography for an echocardiographic examination - transthoracic and transesophageal approach. RESULTS: Four patients were found from our revision, three of them had a permanent endocavitary pacing catheter and one had a central venous catheter. Transthoracic echocardiography confirmed the diagnosis in three patients, but did not provide accurate information in two cases due to deficient acoustic window. Transesophageal echocardiography confirmed the clinical suspicion of endocarditis in all four patients and gave more information about the size and site of vegetations, involvement of cardiac valves and existence or absence of abcesses. CONCLUSIONS: Transesophageal echocardiography improves the diagnosis of right heart endocarditis in patients with non-prosthetic intracardiac material providing more accurate information, sometimes with prognostic and therapeutic importance.

Adult↗
PubMed1996

[Mitral prosthesis dysfunction--report of 3 clinical cases with unusual ultrasonography features].

Prosthetic valve obstruction is one of the most serious complications of mechanical cardiac valves. Clinicians must be aware of this diagnosis in patients with a worsening of functional NYHA class. Over the past years, echocardiography has imposed itself as the method of choice to diagnose and evaluate patients with suspected prosthetic valve obstruction. We present three clinical reports of prosthetic valve malfunction that have unusual echocardiographic features.

Echocardiography↗
PubMed1995

[Experience of the exclusive use of arteries in myocardial revascularization].

OBJECTIVES: To present the initial experience of a surgical team from Santa Marta Hospital using exclusive arterial grafts on coronary bypass surgery. SETTING: Cardiology and Cardiothoracic Departments. POPULATION AND METHODS: From November 1987 to May 1994, 176 consecutive patients were submitted to surgical myocardial revascularization with the exclusive use of arterial grafts. The patients were operated by one cardiothoracic surgical team. A revision of clinical and angiographic characteristics of the patients was done along with the surgical procedure and intrahospital morbidity. After hospital discharge, follow-up was done by direct evaluation and/or by a questionnaire made using phone or letter on a periodical basis. RESULTS: The medium number of coronary bypasses performed were 2.07 +/- 0.8. The left internal mammary artery was the vessel more frequently used, specially to the myocardial area supplied by the left coronary descending artery. The right internal mammary artery was the second arterial graft more currently used. Gastroepiploic artery was utilized preferentially to coronary arteries supplying the inferior wall of the heart. Hospital mortality was 3.4%-6 patients. One hundred twenty patients have a normal life, without physical restrictions, 25% of the patients have symptoms of angina that is severe in 9. Mean follow-up time was 34 +/- 10 months. IN CONCLUSION: Coronary artery bypass surgery with exclusive use of arterial grafts can be executed with an acceptable mortality and low morbidity rates, even in urgent cases, with relieve of cardiac symptoms and good quality of life.

Adult↗
PubMed1995

[Acute aortic dissection. Therapeutic strategies and results].

OBJECTIVE: To analyse early and medium-term results of patients (pts) with acute aortic dissection (DAO) regarding the importance of the different therapeutic modalities adopted. DESIGN: Retrospective study of the cases with DAO admitted in the cardiology intensive care unit of Santa Marta Hospital. POPULATION: 46 pts (aged 25 to 80 years) with the diagnosis of DAO from January/1989 throughout December/1993. RESULTS: early mortality rate (30 days) was 36%. DAO type A Two cases were treated only with medical therapy for they suffer from severe associated pathology. Twenty eight pts were treated surgically. In this group mortality concerning time passed from the beginning of the symptoms throughout the surgery was: < 24 h-31%, 24-72 h-40%, > 72 h-63%. Among 17 discharged pts mortality occurred in 7% during the first year. DAO type B In pts with uncomplicated Stanford type B DAO survival was 90%. Emergency surgery was performed in pts who developed complications such as rupture of the aorta, occlusion of major arteries or extension of dissection. In this particular group mortality was 66%. Among 11 discharged pts with type B DAO 9% died within one year. During the follow-up period of 17.4 +/- 14.8 months one third of the pts discharged from hospital had clinical events. CONCLUSION: despite new advances in diagnostic and therapeutic approaches, DAO still's reported as a relatively high hospital mortality situation. Remove pts to an institution with ability to perform quickly the correct diagnosis and treatment becomes essential. Clinical presentation, type of DAO, surgery timing when indicated and major complications were of particular importance in the prognosis of pts with DAO. The frequency of cardiovascular events in pts who left the hospital alive emphasized the need to maintain blood pressure within normal limits.

Acute Disease↗
PubMed1995

[Acute myocardial infarct: apropos a clinical case].

The AA describe a clinical case of acute myocardial infarction (A.M.I.) with prodromal angina and an initial diagnosis based exclusively on clinical criteria; the patient was submitted to thrombolysis and had recurrent angina which led to the performance of rescue percutaneous coronary angioplasty (P.T.C.A.) that was successful. The clinical situations that may precede A.M.I. are discussed and the importance of the clinical presentation in its diagnosis are stressed. The indications and benefits of rescue P.T.C.A. are also discussed and the AA. conclude that the patients with prodromata of A.M.I. must be kept under clinical observation, so that prompt necessary therapeutic measures may be undertaken and that rescue P.T.C.A. is a therapeutic option of proven clinical benefit.

Diagnosis, Differential↗
PubMed1994

[Multiplanar transesophageal echocardiography: technique, methodology, and applications].

OBJECTIVE: To present the experience of transesophageal echocardiography with a multiplane probe, its methodology, the advantages, disadvantages and diagnostic improvements of this type of probe. SETTING: Laboratory of Echocardiography of the General Hospital Gregorio Marañon. MATERIAL AND METHODS: Analysis of the first 1000 examinations performed on hospitalized patients and outpatients, in most cases to study either native valvular heart disease and valvular prosthesis or to search for embolic sources. We evaluate the advantages, disadvantages, initial difficulties and complications of this type of probe. RESULTS: Multiplane probe provides continuous imaging from 0 degree to 180 degrees without need of intraesophagic movements. This type of probe increases the diagnostic capability of transesophagic echocardiography because it performs as a scanning of anatomy and pathological features of cardiac chambers and great vessels. Pulmonary artery and its branches, right heart chambers and tricuspid valve, inferior and superior vena cava, outflow tract of both ventricles, aortic root, pulmonary veins and segmental views of both ventricles are well analyzed. Also in native and prosthetic regurgitants jets, cardiac tumors and other masses, diagnosis and complications of endocarditis, aortic dissection and in anomalous return of pulmonary veins, multiplane probe proves to be more informative. There was no difficulties in the intubation despite the bigger size of the transducer. No severe complications occurred. The higher price and the initial more difficult understanding of the images are the only disadvantages we have found. CONCLUSIONS: Multiplane probe contributes to increase diagnostic capability of transesophageal echocardiography without significant risk and it is an important and promising refinement of the transesophageal technique.

Echocardiography, Transesophageal↗
PubMed1994

[Holt-Oram syndrome. Review and report of 2 familial cases].

In 1960 Holt and Oram reported a family in which upper extremity malformations were associated with a secundum atrial septal defect. Since then, more than 200 cases have been reported with a wide spectrum of phenotypes. The authors present the cases of one mother and daughter with Holt-Oram Syndrome (SHO).

Adult↗
PubMed1994

[Acute aortic dissection in pregnancy. Report of a clinical case].

Aortic Dissection seldom affects young women. Nevertheless, the structural changes in the arterial wall, that occur during pregnancy, may predispose women to this complication, particularly in the third trimester and peripartum period. Aortic Dissection in gestation is associated specially with the Marfan's syndrome. The authors report a case of a pregnant woman in the 35th week of gestation, without Marfan's disease, admitted to Hospital on suspicious of type A aortic dissection.

Acute Disease↗
PubMed1994

[Coronary fistula --clinical and angiographic review].

OBJECTIVE: To evaluate clinical and angiography date of patients (pts) in whom coronary arteriovenous fistula were detected. STUDY DESIGN: Retrospective study of diagnostic coronary angiographies done between 1988 and 1993 in whom coronary arteriovenous fistula were detected. SETTING: Patients submitted to cardiac catheterisation in the Cardiology Department of Santa Marta Hospital in whom coronary arteriovenous were detected. PATIENTS: Fourteen pts, 10 male and 4 female, with a mean age of 49 years (21-72). INTERVENTIONS: A retrospective analysis of clinical data and coronary artery anomalies was done. Whenever available, the Pulmonary Artery and the shunt (calculated through oximetries) were evaluated. RESULTS: The following pathologies were associated: rheumatic valve heart disease (3 pts), Tetralogy of Fallot (2 pts), atrial septal defect--ostium primum (1 pt), dilated cardiomyopathy (1 pt), hypertrophic cardiomyopathy (1 pt), atherosclerotic coronary artery disease (2 pts). Four pts were in atrial fibrillation and the others in sinus rhythm. Four pts had normal ECG. In 6 pts there was cardiomegaly on the chest X-rays. The fistula was single in 11 pts, double in one and multiple in 2 other pts. The fistula originated from the right coronary artery in 6 pts, the left anterior descending coronary artery in 5 pts, the circumflex coronary artery in 3 pts and the left main coronary artery in one pt. Eight drained to the pulmonary artery (or its branches), 2 to the coronary sinus, one directly to the right atrium, one to the right ventricle and one to the left atrium. In only 2 pts the fistula was closed. In 6 pts the associated anomalies were corrected. With a mean follow up of 24 months (1-72), 8 pts are asymptomatic, 4 complain of slight heart failure, 3 of angina pectoris and the pt with dilated cardiomyopathy died 1 year after being studied. CONCLUSION: A male predominance was found. Most fistulae were single. The artery mostly involved was the right coronary artery and the fistula drained more often to the pulmonary artery or its branches.

Adult↗
PubMed1994

[Acute myocardial infarct: the prognostic significance of complex coronary lesions].

OBJECTIVE: The aim of our study was to analyze the possible influence of coronary lesion morphology on the prognosis of patients (pts) with Acute Myocardial Infarction (AMI) evaluated by coronary angiography before hospital discharge. DESIGN: Retrospective study. SETTING: Study performed at the Cardiology Department of a Central Hospital. MATERIAL AND METHODS: 141 consecutive pts admitted because of AMI were evaluated, with an age average of 53.4 +/- 9.6 years, who had hospital discharge. All pts were submitted to angiography between the 2nd and 3rd week after AMI. The ventriculography was evaluated to determine the ventricular function score, as defined by the CASS protocol. The coronarography was performed to access the number of diseased vessels and to analyze their lesion morphology. Complexity was defined by the presence of one of the following characteristics: irregularity, shoulder, ulcers, filling defects, contrast retention and ecstasy. TWO GROUPS OF PTS WERE CONSIDERED: Group I--n = 64 pts, with complex lesions, and Group II--n = 69 pts with non complex lesions. Seven pts were excluded from the study because they had no significant coronary disease. Mean time of the follow up was 21.4 +/- 8.5 months and was similar in the two groups. The cardiac events considered were angina after AMI; reinfarction; heart failure; new hospital admission, percutaneous transluminal coronary angioplasty; coronary artery bypass grafting and death. RESULTS: In relation to both groups no statistically significant difference was found concerning sex, age, left ventricular function score and number of diseased vessels. In group I a higher incidence was found for cardiac events (p 0.006) and for the occurrence of angina after AMI (p < 0.02). In this group the number of pts with cardiac events was also higher (p < 0.01). No difference was found in relation to each of the morphologic characteristics and a high risk profile could not be found. CONCLUSIONS: Besides left ventricular function and the number of diseased vessels, the analysis of coronary lesion morphology, evaluated 2 to 3 weeks after AMI, could be useful in risk stratification after AMI.

Adult↗
PubMed1993

[Atrial fibrillation and coronary disease].

OBJECTIVE: To study the incidence of atrial fibrillation in patients (pts) with angiographic coronary artery disease and its relation with clinical and angiographic parameters. DESIGN: Retrospective study. SETTING: Six hundreds consecutive pts, submitted to diagnostic coronary angiography, performed in Hemodynamic Laboratory of Santa Marta Hospital (from 88/04/03 to 90/05/04). MATERIAL AND METHODS: From six hundreds pts were excluded 43 because they had also valvular heart disease and/or minimal coronary artery lesions. Two groups were considered: Group I-pts with atrial fibrillation (n = 7) and Group II-pts in sinus rhythm (n = 549). We evaluated the following parameters: age, sex, clinical history, basal ECG, cardiac enlargement in chest X-ray, angiographic score of LVF, left ventricular diastolic pressure (LVDP), ventricular aneurysm, mitral regurgitation and number of vessels disease. RESULTS: We only found significant statistically differences between the two groups concerning the following parameters: a) age-mean age was superior in group I (Group I-64.2 +/- 8.2 versus 56.3 +/- 9.6), the number of pts older than 60 years in group I was 75% vs 33.8% in group II (p < 0.02); b) heart failure-the incidence was superior in group I, 37.5% vs 9% in group II (p < 0.03); c) cardiac enlargement in chest X-ray-75% pts of group I vs 22% of group II (p < 0.002); d) moderate to severe mitral regurgitation-25% of pts in group I vs 5% of pts of group II (p < 0.05). CONCLUSIONS: Atrial fibrillation is an unusual rhythm in pts with angiographic coronary artery disease. Its presence is related with age, clinical evidence of heart failure, cardiac enlargement and moderate to severe mitral regurgitation.

Age Distribution↗
PubMed1993

Clinical and electrophysiologic characteristics in patients with Wolff-Parkinson-White pattern.

OBJECTIVES: (1) To obtain a relation between clinical and electrophysiologic characteristics in patients with Wolff-Parkinson-White pattern. To evaluate the atrial vulnerability for inducing atrial fibrillation and its relation to the electrophysiologic protocol phase. (3) To study the effects of flecainide on the treatment of induced sustained supraventricular arrhythmias. SETTING: Department of Cardiology at Santa Marta Hospital. METHODS: An electrophysiologic testing was performed in twenty-three consecutive patients aged from 14 to 55 years, with Wolff-Parkinson-White (WPW) pattern on ECG. Two groups of patients were considered: group I with 12 asymptomatic or nearly asymptomatic patients; group II with 11 symptomatic patients. The parameters studied were the anterograde effective refractory period of the accessory pathway, the number of patients with different types of supraventricular tachycardias (SVT), the relation between the stimulation protocol phase (scanning/DDT/burst) and the occurrence of atrial fibrillation, and the effects of the flecainide on the treatment of induced sustained supraventricular arrhythmias. RESULTS: Statistically significant differences were obtained between group I and II concerning the number of patients in whom induced atrial fibrillation with conduction by the accessory pathway and RR < or = 250 msec was found (0 vs 6, p = 0.0045). No differences were obtained among the anterograde refractory period, the induction of atrial fibrillation independently of the type of atrioventricular conduction, and the induction of atrioventricular reentrant tachycardia and or atrial flutter. The induction of atrial fibrillation was attained during the Scanning/DDT protocol phase in 7 patients in whom this arrhythmia was found with conduction by the accessory pathway and in 2 without preexcitation. All the induced sustained supraventricular arrhythmias were converted by intravenous flecainide. CONCLUSIONS: (1) Only the symptomatic patients have a high risk profile which suggest that electrophysiologic testing do not need to be performed in those with no symptoms. (2) As atrial vulnerability is higher in patients with induced atrial fibrillation and conduction by the accessory pathway, a more intensive ambulatory control seems to be necessary. (3) The results of intravenous flecainide administration on the treatment of sustained induced supraventricular arrhythmias, advocate its use during the electrophysiologic procedures in patients with ventricular preexcitation and WPW pattern.

Adolescent↗
PubMed1992

Functional significance of premature ventricular complex morphology evaluated during treadmill exercise stress test in patients with coronary artery disease.

OBJECTIVES: To evaluate the relation between premature ventricular complexes morphology and left ventricular myocardial systolic function in patients with proved coronary artery disease. SETTING: Department of Cardiology at General Hospital. METHODS: From 112 patients (pts) with proved coronary artery disease, thirty-three pts with premature ventricular complexes (PVC) detected during treadmill exercise stress test were selected. Two groups of pts were considered: group I-20 pts with regular contour or with a narrow notching (< 40 ms; type I PVC) and group II-13 patients with wide notching (> 40 ms; type II PVC). In each group the following parameters were studied: ejection fraction, QRS duration, duration of exercise, number of metabolic units and the prevalence of ventricular aneurysm and mitral regurgitation. RESULTS: Statistical significant differences were found between group I and II concerning the mean ejection fraction (59.2% vs 48.6%; p < 0.05). The prevalence of ventricular aneurysm and mitral regurgitation was higher in patients with type II ventricular premature complexes (10% vs 30%). CONCLUSION: Particular characteristics of premature ventricular complexes detected during treadmill exercise stress test, in patients with proved coronary artery disease, suggest the presence of left ventricular myocardial systolic dysfunction.

Coronary Disease↗
PubMed1992

[Annuloaortic ectasia: report of a case].

The authors describe a case of a patient with annuloaortic ectasia (AAE) and severe aortic regurgitation. The diagnostic was made by angiography. He was submitted to a Bentall's procedure; replacement of the ascending aorta by a conduit and of aortic valve by a mechanical prosthesis with reimplantation of coronary arteries into the conduit. The only complication was atrial fibrillation with fast ventricular response. Nowadays he is clinically well, in NYHA class I. The authors make some considerations about AAE, its surgical treatment and its results.

Aortic Diseases↗