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Biomedical subjects

C Tommaso

Publications and source records attributed to C Tommaso.

12 recordsLinked to original sources
PubMed2000

Reduced thrombus burden with abciximab delivered locally before percutaneous intervention in saphenous vein grafts.

BACKGROUND: Existing thrombus can complicate percutaneous saphenous vein graft (SVG) intervention. Local delivery of thrombolytics has been used to reduce the thrombus burden often associated with these interventions. We sought to determine whether local delivery of a platelet glycoprotein IIb/IIIa inhibitor is feasible and can reduce thrombus burden before percutaneous SVG intervention. METHODS: We performed a multicenter pilot study of abciximab (0.25 mg/kg) given by local delivery catheter before percutaneous intervention for de novo SVG stenoses followed by intravenous infusion. All patients (n = 58) had >/=60% stenosis and Thrombolysis In Myocardial Infarction (TIMI) grade >0 flow in an SVG of 3 to 4 mm in diameter. Percent diameter stenosis, TIMI thrombus grade, and TIMI flow grade were measured before and after delivery of abciximab and after intervention. RESULTS: Median percent diameter stenosis improved from 69% to 45% (P =.0001) after local delivery, and TIMI thrombus grade >/=1 incidence reduced from 68% to 34% (P =.0001). TIMI flow grade was not significantly affected (P =.12). All patients had a successful intervention (</=50% residual stenosis). CONCLUSIONS: Local abciximab delivery before percutaneous SVG intervention is associated with significantly reduced thrombus burden, significantly improved percent diameter stenosis, and excellent acute procedural results. Further studies of this approach are warranted to define its clinical utility.

Abciximab↗
PubMed1990

Initial report of the National Registry of Elective Cardiopulmonary Bypass Supported Coronary Angioplasty.

Relative contraindications to coronary angioplasty have been large amounts of jeopardized myocardium and poor left ventricular function. To prevent possible hemodynamic collapse after balloon occlusion or acute vessel closure in such high risk patients, a cardiopulmonary bypass system capable of providing up to 6 liters/min output was employed prophylactically. This technique, termed supported angioplasty, results in reductions of preload and afterload and allows prolonged balloon inflations in critical coronary vessels. A National Registry of 14 centers performing elective supported angioplasty was formed to collate the initial experience with high risk patients. Suggested indications were ejection fraction less than 25% or a target vessel supplying more than half the myocardium, or both. During 1988, the data from 105 patients (mean age 62 years) undergoing supported angioplasty were entered into the Registry. This group included 20 patients whose disease was deemed too severe to permit bypass surgery and 30 patients who had dilation of their only patent coronary vessel. Seventeen patients had stenosis of the left main coronary artery and 15 underwent dilation of that vessel. Chest pain and electrocardiographic changes occurred uncommonly despite prolonged balloon inflations. During the trial, there was a progressive change from cutdown insertion to percutaneous insertion of the circulatory support cannulas. The angioplasty success rate was 95% for the 105 patients, who underwent an average of 1.7 dilations per patient. Morbidity was frequent (41 patients), in most cases due to arterial, venous or nerve injury associated with cannula insertion or removal, or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1988

Factors determining programmed stimulation responses and long-term arrhythmic outcome in survivors of ventricular fibrillation with ischemic heart disease.

The clinical and angiographic features of 38 patients with ischemic heart disease and nonacute infarction pre-hospital ventricular fibrillation (VF) were examined as a function of their drug-free programmed electrical stimulation (PES) responses. Twenty-two patients (58%) had inducible ventricular tachycardia (VT) at drug-free PES (group I) and 16 patients (42%) did not (group II). Group I had more patients with: (1) remote infarction (22 of 22 vs 2 of 16; p less than 0.01; (2) history of congestive failure (16 of 22 vs 0 of 16; p less than 0.01); (3) prior cardiac arrest (11 of 22 vs 0 of 16; p less than 0.01); (4) left ventricular (LV) ejection fraction less than 40% (19 of 22 vs 1 of 16; p less than 0.01); and (5) akinetic or dyskinetic LV wall motion (22 of 22 vs 2 of 16; p less than 0.001). Group II had more patients with: (1) LV segments at "ischemic jeopardy" (16 of 16 vs 14 of 22; p less than 0.01) and (2) factors suggestive of ischemia at the onset of VF (13 of 16 vs 1 of 22; p less than 0.001). Inducible VT (IVT) was suppressed in 16 of the 20 group I patients surviving hospitalization while four were discharged with persistence of IVT despite therapy. At 27 +/- 15 months, all four with persistent IVT had a recurrence of their arrhythmia. In the 16 group II patients, therapy was limited to antiischemic measures: coronary bypass in 12, propranolol in 3, and angioplasty in one. At 38 +/- 9 months, no group II patient has had a recurrence of his arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1983

Atrial fibrillation and flutter. Immediate control and conversion with intravenously administered verapamil.

The safety and efficacy of the intravenous (IV) calcium channel blocker, verapamil, in controlling the ventricular response or converting to sinus rhythm patients with atrial flutter or atrial fibrillation were assessed. Seventeen patients (nine with atrial flutter and eight with atrial fibrillation) with these arrhythmias that were difficult to control pharmacologically were chosen for the study. All patients at the time of study were receiving digoxin. Either verapamil or placebo was chosen randomly and a bolus of 0.075 mg/kg (up to 5 mg) was administered. Twelve patients had a marked reduction in their ventricular response after IV administration of verapamil (seven with atrial flutter and five with atrial fibrillation). None of these 12 patients converted (nonconverters). The average reduction in heart rate was from 120 +/- 6 beats per minute to a minimum of 83 +/- 13 beats per minute within 20 minutes after drug administration. Verapamil was found to convert five patients with atrial arrhythmias to sinus rhythm (two with atrial flutter and three with atrial fibrillation) (converters). In addition, three patients with atrial arrhythmias of less than one month who did not convert with parenteral drug therapy converted within 24 hours while receiving the oral drug. Converters had their supraventricular arrhythmias of significantly shorter duration (median, three hours v 30 days) and tended to have smaller left atrial size (3.8 +/- 0.7 cm v 4.3 +/- 1.3 cm) compared with the nonconverters. We conclude that verapamil is safe and effective when administered IV to patients with atrial flutter and fibrillation for control of ventricular response. In short duration atrial arrhythmias, conversion to sinus rhythm is likely once the ventricular response is controlled.

Adult↗
PubMed1982

Asynchronous ventricular pacing: a rare cause of ventricular tachycardia.

Asynchronous cardiac pacing may induce ventricular tachycardia and fibrillation, particularly in patients with ischemic heart disease and possibly other types of myocardial abnormalities. All patients with implanted asynchronous pacemakers, and those whose demand pacemakers operate in asynchronous mode for any reason, are to be considered at risk from this complication. In patients with serious myocardial abnormalities consistent demand pacing should be assured, even if it requires early pacemaker replacement. Anti-arrhythmic agents may prove useful for temporary suppression of pacemaker-induced arrhythmias.

Aged↗
PubMed1981

Cardiac conduction defects in polymyositis: electrophysiologic studies in four patients.

The clinical electrophysiologic findings in four patients with biopsy-proven polymyositis and bifascicular block are described. Atrioventricular (AV) block developed in two of these four patients, and intracardiac electrophysiologic studies documented the site of spontaneous block to be distal to the His bundle in one, whereas in the second marked His-ventricular prolongation was found, and distal block developed at low paced atrial rates. Sinus node and AV nodal function were normal in all four. These electrophysiologic data provide the first documentation of the site of AV block in patients with polymyositis and correlate well with findings of previous pathologic studies that have shown extensive fibrosis of the distal His bundle and bundle branches.

Electrophysiology↗
PubMed1980

Myocardial infarction and coronary ectasia in idiopathipc mitral valve prolapse syndrome.

Angina pectoris and myocardial infarction occurred in two patients with idiopathic mitral valve prolapse in the absence of atherosclerotic coronary artery disease. Instead, both patients showed the presence of coronary artery ectasia on cineangiography. The anatomic localization of ectasia corresponded with segmental derangement of left ventricular wall motion. Repeated thromboemboli from ectatic vessels and/or locally liberated platelet metabolites were considered the probable mechanism of these symptoms.

Angina Pectoris↗