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Biomedical subjects

A Reale

Publications and source records attributed to A Reale.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Winging effect in interatrial defect after transseptal mitral valvuloplasty: an anatomical study].

In the balloon catheters the redundancy of the deflated balloon produces 2 or 3 sort of thin wings. The presence of wings can reduce the catheter "pushability" or, in certain conditions, can determine tissue lesion (winging effect). Simulating a transeptal valvuloplasty of the mitral valve by technique of the 2 balloon in human fresh heart, we studied the winging effect over the interatrial septum in 12 hearts; in the first 6 the atrial septum was dilated with a 6 mm balloon (Group A), in the second 6 the atrial septum was dilated with a 10 mm balloon (Group B). The procedure was completed introducing consecutively 2 bigger balloons (15 + 20 mm). We suppose that the winging effect of the 2 bigger balloons (15 + 20 mm) could counter balance the theoretical advantage of a small balloon (6 mm). The atrial septal defect (ASD) after septal dilatation was 5.0 +/- 0.59 mm x 1.56 +/- 0.25 mm (long axis x short axis) in Group A and 6.53 +/- 0.35 x 2.16 +/- 0.39 mm in Group B (p less than 0.01). The final ASD (after introducing the 2 bigger balloons) was 7.04 +/- 1.06 x 2.36 +/- 0.57 mm in Group A and 7.03 +/- 0.18 x 2.16 +/- 0.32 mm in Group B (NS). Our data show that the winging effect can determine biological negative effects.

Catheterization↗
PubMed1990

[Changes in R wave voltage during exercise: are they a sign of changes in ventricular volume or of myocardial ischemia?].

In an attempt to assess the significance of R wave amplitude changes during exercise in patients with coronary artery disease, we retrospectively analysed radionuclide as well as exercise test results of 147 patients with either suspected or already ascertained coronary artery disease, 126 men and 21 women, whose mean age was 56.0 +/- 9.3 years, 56 of which with previous myocardial infarction (16 on the anterior, 33 on the inferior and 7 on the lateral wall), who underwent a simultaneous evaluation of regional ventricular function by means of first pass angiography with multielement gamma-camera and of myocardial perfusion by means of single photon emission computerized tomography. All patients received 2 iv injections of 99mTc-methoxy-isobutyl-isonitrile at rest and at peak of a computerized bicycle stress test, whose end-points were ST segment depression greater than or equal to 1 mm or the attainment of a heart rate greater than 85% of maximal age-predicted one. R wave amplitude was measured by means of a magnifying lens on an averaged ECG complex, selecting for each patient the precordial lead showing the largest R wave amplitude. Absolute values of left ventricular volumes were computed by means of a standardized method from first pass angiography data. Patients were divided in subgroups according to the presence and to the number of coronary territories with evidence of stress-induced myocardial ischemia at radionuclide study.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Fulguration of the bundle of His. Description of 3 new cases].

With the purpose to call attention to the clinical utility of fulguration of the His bundle (a therapeutic procedure somewhat neglected in Italy) 3 new cases are presented. All patients had a long history of supraventricular tachyarrhythmias refractory to conventional treatment. Patients 1 and 2, in whom surgical correction of tetralogy of Fallot and mitral valve replacement, respectively, had been performed several years before, had chronic atrial tachycardia with congestive heart failure. Patient 3 suffered from persistent atrial flutter, in the absence of demonstrable organic heart disease. Three shocks of 320 J were necessary to induce complete AV block in patient 1 and 2. In patient 3, a single discharge (320 J) resulted in interruption of AV conduction. Twenty-four hours after the procedure, a rate-responsive ventricular pacemaker was implanted in all patients. The success of the procedure was confirmed 3 months later, during transitory pacemaker inhibition. Patients 1 and 3 exhibited atrial tachycardia and atrial flutter, respectively, but complete AV block was still present, with junctional escape rhythm at a rate of 40 and 45 b/min; in patient 2 atrial tachycardia with high degree AV block, and a mean ventricular rate of 75 b/min, were observed. Refinement of transcatheter ablative techniques is desirable. However, even in the present status, catheter ablation of the His bundle is an effective, low-risk procedure for patients with refractory supraventricular tachyarrhythmias.

Adult↗
PubMed1989

Determinants of end-stage idiopathic dilated cardiomyopathy: a multivariate analysis of 104 patients.

Our purpose in this study was to investigate the correlation of clinical, electrocardiographic, hemodynamic, and histopathologic features at diagnosis with the long-term prognosis in 104 patients with idiopathic dilated cardiomyopathy to determine which factors are the independent determinants of the end-stage disease. During a mean follow-up of 3.8 +/- 3.5 years, 35 patients (33%) died, 14 (13%) suddenly and 21 (20%) from congestive heart failure. Univariate analysis of survival curves disclosed that clinical and electrocardiographic variables at diagnosis were similar in survivors and non-survivors. On the contrary, patients who subsequently died had higher mean right atrial pressure (p = 0.0001), right ventricular end-diastolic pressure (p = 0.0061), mean pulmonary artery pressure (p = 0.0001), and left ventricular systolic (p = 0.0049) and end-diastolic (p = 0.0021) pressure than survivors. They also exhibited larger left ventricular end-diastolic (p = 0.0046) and end-systolic (p = 0.0027) volumes, lower ejection fraction (p = 0.0001), and a greater proportion had severe mitral regurgitation (p = 0.0095). Univariate analysis of histologic findings collected in a subgroup of patients referred since 1984 revealed a mild degree of myocellular hypertrophy to be associated with a poor prognosis (p = 0.0217). Multivariate analysis selected only mean right atrial pressure (p = 0.0022), ejection fraction (p = 0.0089), and end-systolic volume (p = 0.0265) as independent determinants of cardiac death. Our results suggest that cardiac catheterization is mandatory for risk stratification of patients with idiopathic dilated cardiomyopathy, since it allows the assessment of hemodynamic, angiographic, and histopathologic features helpful in identifying patients with a poor prognosis.

Adult↗
PubMed1989

Postaxial acrofacial dysostosis or Miller syndrome. A case report.

A case of postaxial acrofacial dysostosis (Miller syndrome) is presented. This rare syndrome is essentially characterized by a Treacher-Collins-like facial appearance together with absence of the fifth digital ray of all limbs and variable forearm hypoplasia.

Abnormalities, Multiple↗
PubMed1989

[Validity of some electrocardiographic criteria in left ventricular hypertrophy].

The aim of the study was the assessment of the sensitivity, specificity and accuracy of some ECG criteria of left ventricular hypertrophy (LVH). Left ventricular mass (LVM) measured on the M-mode echogram of the left ventricle was the reference standard. Ninety-four (94) unselected, consecutive clinical patients (34 women, 60 men, average age 47 years) underwent in the same day, ECG and echocardiogram. Exclusion criteria were the presence of ischemic heart disease, atrial fibrillation and Wolff-Parkinson-White syndrome. The ECG tracings were interpreted independently by 2 investigators following 5 independent criteria of LVH: 1) Sokolow-Lyon voltage criterion (SL); 2) a modified Romhilt-Estes point score (REM); 3) left atrial abnormality (LAA); 4) left ventricular strain; 5) a new voltage criterion RaVL + SV3 corrected by sex and age. The left ventricular M-mode echograms were recorded using a left parasternal approach and were interpreted independently by 2 investigators. LVM was measured using the "Penn convention" and taking the R wave peak as end-diastole. The prevalence of LVH (= LVM 215 g) in the study population was 47%. The following results were achieved (sensitivity, specificity, accuracy): SL: 68.2%, 84%, 76.6%; REM: 63.6%, 90%, 77.7%: LAA: 36.4%, 84%, 61.7%; strain 52.3%, 72%, 62.8%; RaVL + SV3: 54.5%, 82%, 69.1%. Our data suggest: 1) the high sensitivity, specificity and accuracy of Romhilt-Estes point score are confirmed; 2) the sensitivity of Sokolow-Lyon voltage criterion is reevaluated; 3) the most sensitive morphological criterion seems to be the left ventricular strain; 4) a new voltage criterion could be useful.

Adolescent↗
PubMed1989

[Electrophysiologic significance of the electric alternans in supraventricular tachycardia].

To investigate the electrophysiologic significance of QRS alternans during narrow QRS tachycardia, transesophageal atrial pacing and recording was performed in 24 patients with a history of paroxysmal supraventricular tachycardia. Standard electrocardiograms (ECG) showed ventricular preexcitation in 15 patients and normal QRS pattern in 9. The ventriculo-atrial interval during tachycardia, as defined by means of transesophageal electrogram, allowed tentative diagnosis of the tachycardia mechanism. A 12-lead ECG was recorded either during spontaneous or induced tachycardia, as well as during transesophageal atrial pacing at increasing rates. Electrical alternans occurred spontaneously in 8 patients (33%, Group A): 5 with accessory pathway reentry (mean VA: 136 +/- 43 ms), 3 with intranodal reentry (mean VA: 48.3 +/- 43 ms). Tachycardia rate ranged between 170 and 230 b/min (mean 200.7 +/- 16). In 2 patients alternation of the QRS occurred only in the presence of a heart rate exceeding 180 and 190 b/min, respectively. The amplitude of QRS remained stable during tachycardia in 16 patients (67%, Group B): 14 with accessory pathway reentry (mean VA: 137.5 +/- 32 ms), 2 with intranodal reentry (mean VA: 45 +/- 7 ms). In this group, the tachycardia rate ranged from 150 to 210 b/min (mean 175 +/- 12). Incremental transesophageal atrial pacing up to rates equal to that of tachycardia was performed in 5 patients of Group A and in 8 of Group B. Electrical alternans could not be induced in both groups with pacing at progressively increasing rates. In contrast, the phenomenon was elicited in 2 patients of Group A when an abrupt pacing at the same rate that had showed the spontaneous occurrence of QRS alternans was instituted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Asymptomatic pre-excitation. Identification of potential risk using transesophageal pacing].

Noninvasive assessment of the conducting capability of the accessory pathway (AP) in asymptomatic patients with a preexcitation ECG pattern is desirable, since life-threatening arrhythmias and sudden death may be the first manifestation of the Wolff-Parkinson-White (WPW) syndrome. To investigate whether in patients with preexcitation ECG pattern the absence of clinical arrhythmias excludes the potential for rapid ventricular responses, transesophageal atrial pacing (TAP) was performed in 11 subjects (9 male, 2 female), aged 5 to 43 years. The extrastimulus technique was used in order to define the refractory periods and in the attempt to induce reciprocating tachycardia. Incremental TAP up to the occurrence of block in the AP was instituted, and attempts to induce atrial fibrillation (AF) with rapid burst pacing were made. One to one atrioventricular conduction over the AP at progressively increased cycle lengths (CLs), and the shortest R-R interval between pre-excited beats during induced AF were evaluated. The following findings were considered predictors of potential life-threatening arrhythmias: 1) anterograde refractory period of the AP equal to or shorter than 250 ms; 2) one to one AP conduction at CLs shorter than 300 ms; 3) shortest R-R interval, during induced AF, less than 250 ms. Sustained reciprocating tachycardia could not be induced in all patients in spite of the use of the use of an aggressive stimulation protocol. The anterograde refractory period of the AP could not be defined in 9 patients. In the remaining 2 this parameter was longer than 250 ms. In 8 patients (72%), the shortest CL maintaining 1:1 AP conduction ranged from 220 to 280 ms (mean 253 +/- 19).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Quantitation of renal blood flow by contrast ultrasonography: preliminary results.

Contrast ultrasonography, employing tracers behaving like red blood cells, is a promising technique to study regional blood flow distribution. Aim of this note is to quantitate renal blood flow in the dog using contrast ultrasonography. Mathematical formulae derived from the classical dye-dilution theory are applied. Ten different renal blood flow levels (ranging from 16 to 125 ml/min) were obtained by means of mechanical (stenosis and reperfusion) and pharmacological interventions (iv infusion of adrenaline, noradrenaline and fenoldopam). Renal blood flow was measured by electromagnetic flow-meter and contemporary calculated by contrast ultrasonography. The correlation coefficient between measured and calculated flow was 0.92 (p less than 0.01). Contrast ultrasonography is a technique capable of measuring renal blood flow at a wide range of different flow levels.

Albumins↗
PubMed1989

[Idiopathic dilated cardiomyopathy: clinical and prognostic significance of the morpho-functional involvement of the right heart].

Aim of this study was to evaluate whether different severity of clinical and functional impairment of right heart in patients with idiopathic dilated cardiomyopathy (IDC) might condition distinct clinical features and prognosis. From 104 consecutive patients with hemodynamically assessed diagnosis of IDC studied between 1977 and 1987 in our Institute, 39 patients (28 males and 11 females, mean age 41 +/- 14 years) were selected on the basis of ejection fraction ranging from 35 to 50%, left ventricular end-diastolic pressure ranging from 13 to 20 mmHg and left ventricular end diastolic volume less than or equal to 150 ml/m2. A significant involvement of right heart (diagnosed according to a mean right atrial pressure greater than or equal to 9 mmHg, a right ventricular end-diastolic pressure greater than or equal to 9 mmHg and a right ventricular end-diastolic diameter greater than or equal to 30 mm) was assessed in 16 patients (41%), 11 males and 5 females, aged 40 +/- 15 years (Group A). On the contrary the remaining 23 patients (59%), 17 males and 6 females, aged 42 +/- 12 years, had a normal right heart (Group B). At entry into the study, clinical features appeared similar in the 2 groups of patients whereas patients of Group A had significantly higher incidence of atrial fibrillation (25% vs 4%, p less than 0.01) and complex ventricular arrhythmia (greater than or equal to 4 Lown class) (25% vs 4%, p less than 0.01) compared with patients of Group B. With respect to conduction defects no difference was found between Group A and Group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Predictive value of myocellular hypertrophy in idiopathic dilated cardiomyopathy].

The role of endomyocardial biopsy (EMB) in assessing of idiopathic dilated cardiomyopathy (IDCM) is a well-recognised one. On the contrary, the value of correlating histological features, such as myocellular hypertrophy, with functional evaluation and outcome is still controversial. It was the purpose of the present study to appraise the correlation with hemodynamic data and the predictive role of histological features in 32 consecutive patients affected by IDCM who underwent left ventricular EMB between January 1984 and December 1986. Light microscopy findings were graded by means of a semiquantitative score system. In comparison with the 19 patients with mild myocellular hypertrophy, the 13 patients with marked hypertrophy showed significantly lower right ventricular end-diastolic pressure (10.4 +/- 5.8 vs 6.6 +/- 3.6 mmHg, p less than 0.05) and left ventricular end-diastolic pressure (26.9 +/- 9.0 vs 16.5 +/- 8.8 mmHg, p less than 0.01). On the contrary, different degrees of interstitial fibrosis, as well as of the other morphologic findings, could not identify patients with distinct hemodynamic patterns. However, there was a direct correlation between the amount of myocellular hypertrophy and interstitial fibrosis (p less than 0.01). During a mean follow-up period of 32 +/- 11 months (range: 12-48 months), 6 patients died and 3 further patients underwent heart transplantation. Univariate analysis of histological features (log-rank test) showed a mild degree of hypertrophy alone to be significantly related to a poor outcome (p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Angulated transverse tomographic sections to measure cardiac dimensions by magnetic resonance imaging: a comparison with 2D-echocardiography.

Magnetic resonance imaging (MRI) has shown low accuracy in measuring cardiac dimensions in normal subjects, when transverse tomographic sections are used in comparison with 2D-echocardiography. The rationale of this study was to compare cardiac dimensions in 19 volunteers based on angulated (30 degrees caudo-cranial) transverse tomographic sections both in MRI and 2D-echo. Since the planes investigated by both techniques are superimposable, highly significant correlated Ao, LA, IVS, LW, LV, and RV dimensions are observed. Standardized MRI tomography permits reduction of total examination time and assures repeatability. Thus, using the method reported here, cardiac dimensions in humans might be obtained accurately by MRI.

Adult↗