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Biomedical subjects

C Macaya

Publications and source records attributed to C Macaya.

At least 109 records · Page 6Linked to original sources
PubMed1993

Percutaneous transluminal coronary angioplasty for post-infarction angina in elderly patients.

To assess the short-term outcome of percutaneous coronary angioplasty (PTCA) for post-infarction angina in elderly patients, we have retrospectively evaluated the results of 88 procedures of PTCA (98 lesions attempted), performed for post-infarction angina (PIA), in 84 patients of > or = 65 years (elderly group), and compared the results obtained with those of 165 PTCAs (200 lesions attempted) in 161 patients of < 65 years old with PIA (young group). Angiographic success was obtained in 91 (93%) vs. 181 (91%) of lesions attempted in the groups, respectively. Complete revascularization was achieved in 54 (61%) patients treated in the elderly group vs. 106 (65%) in the young group. PTCA success was obtained in 78 (89%) procedures vs. 147 (89%) of both groups. No patients required emergency coronary surgery, two patients (2%) had a reinfarction in the elderly group vs. five patients (3%) in the young group, and two patients died (one in the elderly and one in the young group). In conclusion, PTCA for PIA in elderly patients provides a high clinical success rate with a low frequency of complications, similar to the results obtained in young patients.

Age Factors↗
PubMed1993

Percutaneous mitral valvuloplasty.

The widespread use of percutaneous mitral valvuloplasty on the basis of gained experience, technical advances, and a thorough understanding of its pathophysiologic consequences, has generated great clinical enthusiasm and stimulated research efforts. Recent reports provide new insights into a number of topics, including technical issues, the current value of noninvasive techniques, and the results obtained with mitral valvuloplasty in particular clinical and anatomic settings. This review examines the information provided by recent studies.

Catheterization↗
PubMed1992

Predictors, mechanisms and outcome of severe mitral regurgitation complicating percutaneous mitral valvotomy with the Inoue balloon.

During 241 consecutive percutaneous mitral valvotomy (PMV) procedures performed with the Inoue balloon, 16 patients (6.6%) developed severe mitral regurgitation (MR). Baseline clinical, echocardiographic (Doppler mitral valve area and Wilkins' score) and hemodynamic data were not different from those of patients without this complication. Severe MR occurred during the first inflation in 7 patients and after several stepwise inflations in 9. Although maximal balloon size was similar in both groups, unusual indentations and subvalvular inflations were more frequently observed in patients who developed severe MR. Early mitral valve replacement was required in 6 patients. All of them had a leaflet rupture either along the midportion (2 patients), along a commissure (4 patients), or both. Commissural calcium was present in 5 valves and 5 also had severe subvalvular involvement that had been underestimated by echocardiography. Of the 10 nonsurgically treated patients, 4 had chordal rupture by echocardiographic criteria, whereas in the remaining 6 the precise mechanism of MR could not be determined. During follow-up (11.4 +/- 4 months, range 1 to 30), 1 patient required surgery for symptoms and the remaining 9 were symptomatically improved and free of left ventricular dilatation. In conclusion, severe MR complicated 6.6% of PMV procedures with the Inoue balloon, and its mechanism was leaflet or chordal rupture. Although one third of the patients required early mitral surgery, most of the remaining obtained midterm symptomatic benefit.

Adult↗
PubMed1992

Comparison of results of percutaneous transluminal coronary angioplasty with and without selective requirement of surgical standby.

To determine the outcome of percutaneous transluminal coronary angioplasty (PTCA) with the use of 2 different strategies of surgical coverage, the results of 1,283 consecutive PTCAs were analyzed. In 269 procedures (21%) (patients considered at high risk should acute vessel closure occur--standby group) the operating room and the surgical team were ready for an immediate intervention. In the remaining 1,014 procedures (79%) (backup group), although the surgical team was "in house," they were not necessarily ready for an immediate intervention. Mean age of the population was 58 +/- 10 years and 84% of patients were men. Coronary risk factors, medical treatment, clinical indication for PTCA, previous coronary surgery and left ventricular ejection fraction were similar in both groups. Dilatation was more frequently multiple (23 vs 16%, p less than 0.05), or performed in the left anterior descending coronary artery (71 vs 46%, p less than 0.001), in bypass grafts (4 vs 2%, p less than 0.02), in proximal coronary segments (72 vs 57%, p less than 0.001) or in lesions at bifurcation (35 vs 28%, p less than 0.02) in the standby than in the backup group, respectively. PTCAs were less frequently performed during the same diagnostic procedure (15 vs 34%, p less than 0.001) in the standby group. Angiographic success was obtained in 91 and 92% of the attempted lesions and PTCA success in 89 and 88% of the procedures in the standby and backup groups, respectively. The incidence of death (1 vs 0.7%), acute myocardial infarction (2.9 vs 2.7%) and emergency surgery (0.7 vs 0.1%) was also similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Comparison of results of percutaneous mitral valvuloplasty in patients with large (greater than 6 cm) versus those with smaller left atria.

To determine whether the presence of an aneurysmatic (severely enlarged) left atrium (greater than 60 mm on echocardiography) influences results of percutaneous mitral valvuloplasty (PMV), the clinical, echocardiographic and hemodynamic characteristics and the results of this technique were compared in 46 consecutive patients with aneurysmatic left atrium (group I) and 125 consecutive patients without such echocardiographic finding (group II). Left atrial size was 70.5 +/- 8 vs 50.1 +/- 6 mm (p less than 0.005) in groups I and II, respectively. Patients in group I were older (57 +/- 12 vs 48 +/- 12 years, p less than 0.025), more symptomatic (New York Heart Association functional class greater than or equal to III or IV: 67 vs 42%, p less than 0.05), and had atrial fibrillation more frequently (91 vs 44%, p less than 0.001). The echocardiographic score (8.9 +/- 1.9 vs 7.5 +/- 2, p less than 0.005) and the incidence of mild mitral regurgitation on angiography before PMV (54 vs 30%, p less than 0.01) was also higher in group I patients. Hemodynamic parameters before PMV were similar in both groups, but after the procedure, final mitral valve area (1.61 +/- 0.5 vs 1.95 +/- 0.4 cm2, p less than 0.05) and the absolute increase in mitral area (0.81 +/- 0.3 vs 1.02 +/- 0.3 cm2, p less than 0.05) were lower and mean pulmonary artery pressure (35 +/- 10 vs 28 +/- 9 mm Hg, p less than 0.025) was higher in group I.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Comparison of Inoue single-balloon versus double-balloon technique for percutaneous mitral valvotomy.

The results of percutaneous mitral valvotomy by means of the Inoue single-balloon (N = 85, group 1) and the double-balloon (N = 322, group 2) techniques were compared in a nonrandomized study. The groups were not significantly different with regard to age, sex, calcification, or hemodynamic values before percutaneous mitral valvotomy. After percutaneous mitral valvotomy, patients in both groups had significant hemodynamic and clinical improvement. The increases in mitral valve area and cardiac output and the decreases in mitral valve gradient, mean pulmonary artery pressure, and mean left atrial pressure were greater in group 2. Mitral valve area determined by the Gorlin method increased 191% in group 2 and 106% in group 1; Doppler-determined mitral valve area increased 133% in group 2 and 98% in group 1. Optimal results were achieved in 93% of the patients in group 2 and 76% in group 1 (p less than or equal to 0.0001). In group 1, 6% of patients had a left-to-right shunt as shown by angiography versus 14% in group 2 (p less than or equal to 0.05). In group 2, 46% of patients had at least a 1+ increase in mitral regurgitation versus 52% in group 1. Among the patients who had an increase in mitral regurgitation, 36% of those in group 1 versus 9% in group 2 had a 2+ or more increase (p less than or equal to 0.001). The mean balloon diameter to anulus ratio was larger in group 2, and the larger the balloon diameter to anulus ratio, the greater the increase in mitral valve area.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗
PubMed1992

Midterm outcome of patients with asymptomatic restenosis after coronary balloon angioplasty.

Although many patients with restenosis after balloon coronary angioplasty have recurrence of angina, others remain asymptomatic. To assess the clinical implications of asymptomatic coronary restenosis, we analyzed clinical and angiographic characteristics of 277 consecutive patients with restenosis, 133 (48%) of whom were asymptomatic (group I) and 144 (52%) symptomatic (group II). Restenosis was documented 6 to 9 months after the index procedure, or earlier if angina recurred, and was defined as a greater than 50% lumen narrowing (visual estimation). Group I (asymptomatic group) included fewer female (9% vs. 18%, p less than 0.05) and hypertensive patients (38% vs. 56%, p less than 0.005) and more patients with a previous myocardial infarction (48% vs. 28%, p less than 0.05) and single-vessel disease (67% vs. 55%, p less than 0.05). Before angioplasty, symptoms had lasted for a shorter period (10 +/- 25 vs. 23 +/- 42 months, p less than 0.001), ischemia after a recent infarction was a more frequent indication (21% vs. 10%, p less than 0.05) and total revascularization more frequently obtained (74% vs. 63%, p less than 0.05) in group I than in group II patients. Only a normal blood pressure, previous myocardial infarction, single-vessel disease and a shorter duration of symptoms were independent correlates of asymptomatic restenosis. No differences were found in stenosis severity before angioplasty (90% in both groups) or after angioplasty (22% +/- 12% vs. 24% +/- 16%).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1992

[Elective coronary angioplasty in recurrent ischemia after successful fibrinolysis in myocardial infarction. Comparison with results of angioplasty in the acute phase].

To assess the initial and long-term results of 149 percutaneous transluminal coronary angioplasty (PTCA) procedures performed within 1 month of an acute myocardial infarction (AMI), 83 of them because of recurrent ischemia (post-infarction angina) after thrombolytic therapy with initial reperfusion success in the AMI (100 lesions attempted) (group I) and 66 PTCAs (69 lesions) performed during the acute phase of the AMI (group II). Mean age was 56 +/- 14 and 127 (85%) patients were male. Although successful dilation was obtained in 151 (89%) of the 169 attempted lesions, (96[96%] in group I vs 55[78%] in group II), clinical success was obtained in only 123 (82%) (76[92%] vs 64[77%] in both groups, respectively). Late occlusion occurred in 14 (9%) of the 151 lesions successfully dilated (6[6%] and 8[15%], respectively) and reinfarction was documented in 7 (5%) patients (5[5%] and 2[3%]). One patient in group I underwent coronary bypass surgery. There were 4 (3%) hospital deaths (1[1%] and 3[4%]) in group I and II, respectively). Event-free (no occurrence of death, AMI, coronary surgery, repeat PTCA or angina recurrence) survival rate was 76%, 73% and 67% in group I versus 62%, 57% and 40% in group II, at 1, 2 and 4 years respectively. During follow-up, 1 (1%) patient of the group I and 4 of the group II died. At last follow-up, 63 (78%) of the 81 patients alive vs 33 (67%) of the 59 patients in the group I and II respectively remained asymptomatic. In conclusion, in our experience elective PTCA performed in the subacute phase after an AMI provides better initial and long-term outcome than that performed in the acute phase. Therefore, the procedure would be delayed whenever possible.

Adult↗
PubMed1992

[Conventional and color Doppler echocardiography in mitral balloon valvotomy].

With the aim of assessing the value of conventional echocardiography and Doppler and colour Doppler during and in the follow-up of percutaneous mitral valvotomy we have studied prospectively 100 consecutive patients with 1 (90%), 6 (69%) and 12 (53%) months follow-up. Age was 50 years and 80% were women. The single balloon technique was used in 68%, mitral valve area increased from 0.9 +/- 0.2 to 1.8 +/- 0.3 cm2 and decrease in pulmonary artery pressure was 10 +/- 0.05 mmHg. We found that: 1) percutaneous mitral valvotomy produced and acute and transient decrease in left ventricular ejection fraction (pre 69 +/- 9%, post 61 +/- 10% p less than 0.001; 1 month 70 +/- 10; 2) a severe mitral regurgitation appeared in 4% of patients and 17% of patients had a moderate degree of regurgitation after valvotomy; 3) after valvular dilation an increase in the width of the aliasing greater than 29% predicted a successful procedure (final area greater than 1.5 cm2) with a sensibility 80% and specificity 94%, and 4) colour Doppler detected an atrial septal defect immediately after valvular dilation in 77% of patients, and permitted non invasive follow-up of the left to right shunt. At one year a left to right shunt at the atrial level persisted roughly in 1/3 of patients. We conclude that colour Doppler Echocardiography during percutaneous mitral valvotomy is useful for a rapid assessment of the increase in valve area, the detection and quantification of mitral regurgitation induced by valvular dilation and the follow-up in these patients.

Aortic Valve Insufficiency↗
PubMed1992

[The usefulness of intravascular echography during the percutaneous dilatation of aortic coarctation].

An intravascular ultrasound study was performed in a patient, to assess the anatomy of aortic coarctation and the results obtained after percutaneous dilation with a balloon catheter. Intravascular ultrasound imaging provides important additional information, not obtainable with other diagnostic procedures, regarding aortic wall structure and thickness. After balloon dilation, aortic disruption was clearly observed, accounting, together with the stretching of the outer layers of the aortic wall, for the increase in aortic luminal area. Intravascular ultrasound permitted also the accurate assessment of the improvement obtained. Intravascular imaging was clearly superior not only to conventional angiography, but also to transesophageal echocardiography in detecting the mechanism of dilation. We conclude that ultravascular ultrasound, with the additional information that it provides, may help in the selection of patients for percutaneous dilation of the coarctation as well as contributing to the identification of the mechanism of dilation.

Aorta, Thoracic↗
PubMed1992

[The evaluation of the results after coronary angioplasty by intracoronary Doppler and quantitative angiography. The correlation of both methods].

To study the importance of measuring coronary flow reserve immediately after coronary angioplasty we have analysed the results obtained after 28 angioplasties performed in 21 patients. Coronary flow reserve was measured with a 3F intracoronary catheter selectively placed in the dilated artery. Corresponding coronary angiography was analysed with an automatic edge detection program (ARTREK) and visual estimation. Coronary flow reserve increased in 26/27 cases after angioplasty from 2.4 +/- 1.3 to 4.1 +/- 2.7 (p less than 0.001). A correlation was found between minimal luminal area and minimal luminal diameter after coronary angioplasty, and coronary flow reserve (r = 0.46; p less than 0.05 and r = 0.47; p less than 0.05, respectively). The finding of a normal coronary flow reserve (greater than or equal to 3.5), had a 100% specificity but only 56% sensitivity to detect angiographic success (residual stenosis less than 50%). However 47% of patients with angiographic success did not reach normal values of coronary flow reserve. Visual estimation of the stenosis had a good correlation with automatic evaluation but significant scattering was observed at visual levels less than or equal to 25%. Visual assessment underestimated residual stenosis in all but one of the procedures. We conclude that coronary flow reserve is a potentially useful index for assessing the results after angioplasty that may complement coronary angiography. Nonetheless substantial differences between both methods exist in a significant number of cases. The relative merits of both methods, as well as the particular circumstances in which coronary flow reserve should be used, require further studies.

Angioplasty, Balloon, Coronary↗
PubMed1992

[The correlation between measurements performed by intravascular echography and quantitative digital angiography in large- and small-caliber arteries].

Intravascular ultrasound is a new promising technique that appears as a very useful complement to standard angiography in the study of atherosclerosis. Specifically, intravascular ultrasound provides by itself, information of great value concerning vessel wall characteristics. Nevertheless, before taking any decision with the results provided by this new technique, we must validate this information with that provided by other more conventional techniques like standard angiography. Accordingly, we have analyzed in 25 patients, 50 images of the abdominal aorta and 77 images of the coronary arteries taken from arterial segments free of atherosclerotic involvement. With the use of a calibrated small grid located over the patient's thorax, we have analyzed "in the same points" the images obtained with intravascular ultrasound and those provided by contrast angiography using a quantitative angiographic analysis. In the abdominal aorta the vessel diameter measured by intravascular ultrasound and angiography was 17.8 +/- 0.39 mm vs 18.6 +/- 0.42 mm (NS), whereas in the coronary arteries it was 2.76 +/- 0.39 mm vs 2.98 +/- 0.37 mm (NS), respectively. The correlation between both techniques was good for both types of arteries (r = 0.93 in the abdominal aorta and r = 0.87 in the coronary arteries). We conclude, that in our experience and with the methodology used, there is a good correlation between the measurements of the vessel diameters obtained by both intravascular ultrasound and digital angiography in arteries of different sizes, being the correlation even better in large arteries.

Adult↗
PubMed1992

[Transluminal percutaneous coronary angioplasty of the left coronary artery].

This paper describes our preliminary experience with left main coronary angioplasty in 8 patients (9 procedures). In 6 patients the left main coronary artery was "protected" either by previous by-pass surgery (4 patients) or by collateral vessels from the right coronary artery (2 patients). Three patients had a total occlusion of the left main coronary artery and 2 of them had a recent or acute myocardial infarction and the coronary angiogram suggested a thrombotic occlusion of the infarct-related artery. Three patients were not considered surgical candidates and an additional patient, who was in cardiogenic shock, required an emergency coronary angioplasty as "rescue" procedure. A successful dilatation was achieved in 6 patients (including a patient with successful deployment of a Palmaz-Schatz stent) but, unfortunately, one them eventually died 7 days later from a femoral sepsis related to the procedure. However in the 2 remaining patients--with a total occlusion of the left main coronary artery in relation with a myocardial infarction--the dilatation procedures were unsuccessful. One patient underwent a successful repeat coronary angioplasty for restenosis of left main coronary artery. Our preliminary experience confirms previous reports suggesting the value of coronary angioplasty in patients with left main coronary artery disease providing a careful selection of possible candidates is performed prior to the procedure.

Adult↗