Indicator-dilution methods in estimation of cardiac output in clinical shock.
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Biomedical subjects
Publications and source records attributed to A Oriol.
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In a retrospective study, during which 179 patients had undergone percutaneous transluminal coronary angioplasty (PTCA), the overall initial success rate fell suddenly and unexpectedly from more than 90% to 70.4%: 54.9% in patients not receiving antiplatelet therapy and 86.4% in patients treated orally with 300 mg triflusal three times daily or 300 mg acetylsalicylic acid plus 75 mg dipyridamole three times daily. The initial success rate was similar in patients with unstable (66.0%) and stable (77.6%) angina. The overall incidence of severe complications (mainly occlusion) was 16.2% and was significantly (P less than 0.01) greater in the patients not receiving antiplatelet therapy (23.1% versus 9.1%). There was no significant difference between incidence according to antiplatelet therapy used. It is concluded that antiplatelet therapy during the peri-angioplasty period (from 2 days before to 2 days after) may prevent periprocedural events in patients undergoing PTCA.
Four patients who underwent heart transplantation, in whom coronary obstruction was seen early after transplantation, are described. Repeated acute rejection episodes were detected within the first 2 months in each patient. Coronary obstruction or ischemia was shown through a combination of T1-201 isotopic study findings, evidence of vasculitis of a small coronary arteriole seen at endomyocardial biopsy, or coronary angiographic results. Vigorous treatment for rejection (antithymocyte globulin and bolus methylprednisolone) was given, and coronary artery lesions or myocardial ischemia resolved after treatment. Rejection-induced coronary obstruction should be considered in patients with repeated acute rejection episodes who are predisposed to the development of vascular rejection. Early after transplantation such obstruction is caused by diffuse vasculitis of small and medium-sized vessels and may be reversed with increased immunosuppression.
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