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Biomedical subjects

Atman P Shah

Publications and source records attributed to Atman P Shah.

7 recordsLinked to original sources
PubMed2006

Coronary sinus is dilated and outwardly displaced in patients with mitral regurgitation: quantitative angiographic analysis.

OBJECTIVES: Our aim was to define the anatomy of the coronary sinus (CS) by venography. These measurements are essential in the selection of physical characteristics of percutaneous annuloplasty devices for mitral regurgitation (MR). BACKGROUND: Clinical trials of percutaneous annuloplasty of the CS for MR are now underway. Although the CS is in close proximity to the mitral annulus, there is as yet no published quantitative data defining the magnitude of change in CS dimensions in MR, and how these changes might reflect the magnitude of MR. METHODS: We studied 57 patients (27 patients with MR and 30 patients with no MR) who were referred for cardiac resynchronization therapy and underwent CS venography. Echocardiography was used to assess the degree of MR, cardiac dimensions, and right heart filling pressures. The diameter of the ostial and proximal CS and perimeter of the CS-great cardiac vein (GCV) were assessed by quantitative coronary analysis. RESULTS: Patients with MR had a larger ostial CS diameter (19.4+/-3.9 mm vs. 16.9+/-4.6 mm, P=0.02) and proximal CS diameter (8.2+/-1.7 mm vs. 7.4+/-2.3 mm, P=0.05) and larger CS-GCV perimeter (104.4+/-15.6 mm vs. 86.5+/-15.3 mm, P=0.005) compared with patients with no MR. The CS-GCV perimeter is positively correlated to the severity of MR (P=0.02) and pulmonary artery pressure (r=0.32, P<0.05). CONCLUSIONS: Patients with MR have a dilated and outward displacement of the CS. The CS-GCV perimeter is positively correlated with the degree of MR and pulmonary artery pressure.

Analysis of Variance↗
PubMed2005

Drug-eluting stenting is superior to bare metal stenting in saphenous vein grafts.

This study compared the outcomes of percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) with drug-eluting stents (DES) with bare metal stents (BMS). PCI of degenerated SVG is associated with worse outcomes and high incidence of in-stent restenosis compared with PCI of native coronary arteries. There is a paucity of data on the outcomes of PCI of SVG with DES. Data from 223 consecutive patients who underwent PCI of SVG were imputed into a dedicated clinical database. We assessed the clinical outcomes at a mean follow-up of 9.1+/-2.1 months. A total of 139 patients underwent PCI of SVG with DES and 84 patients with BMS. The mean age of the SVG was 7.6+/-3.8 years in the DES group and 7.7+/-2.8 years in the BMS group (P=0.38). Procedural success was achieved in all patients except for one patient in the BMS group who underwent emergent coronary artery bypass graft surgery for SVG dissection. There were no other in-hospital cardiac events in both groups. There was one cardiac death in the DES group and three deaths in the BMS group (P=0.03). When compared to the BMS, PCI of SVG with DES was associated with a lower incidence of myocardial infarction (4.3% vs. 20.2%; P=0.04) and target vessel revascularization (10.1% vs. 36.9%; P=0.035). When compared with BMS, PCI of SVG with DES was associated with a lower incidence of death, myocardial infarction, and target vessel revascularization.

Aged↗
PubMed2004

Sinus node dysfunction secondary to hyperparathyroidism.

We present two patients who were diagnosed with symptomatic sinus node dysfunction in the setting of hypercalcemia secondary to hyperparathyroidism. An extensive review of the literature has not revealed previous reports of this pathologic process.

Calcium↗
PubMed2004

Lipid-lowering therapy in patients with peripheral arterial disease.

Peripheral arterial disease (PAD) is a prevalent, chronic, and progressive atherosclerotic disease process involving the conduit vessels of the extremities. Most patients who present with objective signs of PAD are asymptomatic. These patients are at an increased risk of dying from cardiovascular events. Lipid management is the mainstay of risk-factor modification for patients with cardiovascular disease. Some evidence suggests that hypocholesterolemic drugs may halt the progression of atherosclerotic peripheral vascular disease. More recently, treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) inhibitors have demonstrated improved function in patients with symptomatic peripheral vascular disease. This paper reviews the role of lipid therapy in patients with peripheral arterial disease with focus on functional improvement and symptomatic relief based on the available data.

Cardiovascular Diseases↗
PubMed2003

Antirestenotic effects of a locally delivered caspase inhibitor in a balloon injury model.

BACKGROUND: The precise role of arterial barotrauma-mediated apoptosis in causing restenosis is unclear. The purpose of this study was to determine if a link exists between angioplasty-mediated medial smooth muscle cell apoptosis and subsequent neointimal hyperplasia. METHODS AND RESULTS: Bilateral iliac artery angioplasty was performed in 25 male New Zealand White rabbits. Simultaneous with balloon injury, each artery was treated locally with either the caspase inhibitor N-benzyloxycarbonyl-Val-Ala-Asp(Ome)-fluoromethylketone (ZVAD-fmk) or control. In the acute cohort that was survived to 4 hours (n=10, 7 high dose and 3 low dose), an apoptotic index was calculated using the terminal deoxynucleotidyl TUNEL method. In the intermediate cohort that was survived to 2 weeks (n=5), luminal reendothelialization was measured via CD-31 staining. In the chronic cohort that was survived to 4 weeks (n=10), neointimal area was measured. In the acute cohort, there was a 40% reduction in the apoptotic index with high-dose ZVAD-fmk (P=0.008) and a 33% reduction with low-dose ZVAD-fmk (P=0.08). At 2 weeks, there was no significant difference in the degree of luminal reendothelialization. However, at 4 weeks, there was a 33% (0.33+/-0.23 versus 0.22+/-0.20 mm2) (P<0.005) reduction in neointimal area in ZVAD-fmk-treated arteries. CONCLUSIONS: The local delivery of ZVAD-fmk during balloon injury inhibits smooth muscle cell apoptosis. This corresponds to a significant reduction in neointimal proliferation seen at 4 weeks without a significant change in the degree of reendothelialization at 2 weeks.

Amino Acid Chloromethyl Ketones↗
PubMed2003

Right atrial and ventricular thrombus infiltrated with osteoblastic osteosarcoma.

The presenting signs of osteogenic osteosarcoma are commonly pain, local swelling, local warmth, pathologic fracture, and metastatic disease. Deep venous metastasis of osteoblastic osteosarcoma is most often a postmortem diagnosis. This paper describes the case of a previously healthy 18-year-old woman who presented with dyspnea and lower extremity edema. This is a rare, and to our knowledge, a previously unreported case of right atrial and ventricular tumor thrombus infiltrated with osteoblastic osteosarcoma.

Adolescent↗