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Biomedical subjects

E Esplugas

Publications and source records attributed to E Esplugas.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Functional mitral regurgitation. Physiopathology and impact of medical therapy and surgical techniques for left ventricle reduction].

Functional mitral regurgitation is frequently observed in the setting of left ventricular dyfunction. This finding is a marker of poor outcome in patients with either ischemic or dilated cardiomyopathy. The mechanism accounting for this phenomenon is an altered balance of tethering versus coapting forces acting on the mitral valves in the failing heart. Tethering forces represent an anomalous tension on the mitral valves due to displacement of mitral valve attachments secondary to increased left ventricular chamber sphericity associated with systolic ventricular dysfunction. On the other hand, coapting forces are weak and unable to counteract the abnormal tension acting on the mitral valve, which restricts closure and leads to regurgitation. Vasodilators and inotropic drugs are effective in the management of functional mitral regurgitation. Although partial left ventriculectomy or Batista's procedure is still investigational, this new technique seems to provide an optimal control of functional mitral regurgitation and improve functional capacity and survival of some patients with heart failure.

Cardiac Surgical Procedures↗
PubMed1999

[Myocardial infarction after electroconvulsive therapy].

Myocardial infarction is an uncommon complication of electroconvulsive therapy. Because of this, in spite of the existence in psychiatric literature of some studies about this question, the knowledge in this regard by most cardiologists is scarce. We present a patient with an acute myocardial infarction after the application of a electroconvulsive therapy. In the end, we accomplish review of the literature in relation to incidence, physiology, prevention and indication or not of fibrinolytic drugs in acute myocardial infarction after electroconvulsive therapy.

Aged↗
PubMed1999

[Thrombopenia and acute renal insufficiency after treatment with streptokinase. Role of steroids].

Proteinuria is common after streptokinase treatment. An immunological mechanism in the renal glomerulus has been suggested to explain this side effect. However, thrombopenia and acute renal failure streptokinase induced are uncommon. We present a case of thrombopenia and acute renal failure after streptokinase administration for myocardial infarction that improved with steroid therapy. We discuss the probable pathophysiology of these adverse effects of streptokinase and the potential usefulness of steroids in its prevention and treatment.

Acute Kidney Injury↗
PubMed1999

[The treatment of intra-stent restenosis. The current situation and future outlook].

In-stent restenosis is an increasing problem due to the frequent use of coronary stent as a form of percutaneous revascularization. The global incidence is near to 28%, and it is well document that a neointimal hyperplasia is its principal mechanism. The most commonly related factors for its appearance are diabetes mellitus, a longer length of the original lesion, a smaller diameter of the reference vessel, the left anterior descending artery location and a smaller luminal diameter at the end of the procedure. Due to a different long term evolution in-stent restenosis has been classified as focal or diffuse, according to the length of the restenotic lesion (focal < 10 mm and diffuse > or = 10 mm). Some strategies have been proven for its treatment, but no randomized-controlled trials have been published comparing these different treatments. In focal in-stent restenosis the practice of a conventional balloon angioplasty is associated with high initial clinical success with a favourable long term evolution (target lesion revascularization between 11-15%). But on the contrary, in diffuse in-stent restenosis, in spite of a high initial success rate, an elevated target lesion revascularization has been detected at the follow-up (up to 43%). Other proved such as atherectomy or excimer laser are associated with a significant procedural non-Q-wave infarction (near to 9%) and a long term target lesion revascularization during follow-up (23-31%). The implantation of an additional stent has been performed with low procedural complications and with a long term target lesion revascularization near to 27%. Patients treated with intracoronary radiation as a complementary technique seem to have a better long term evolution than those having had the other strategies alone. In conclusion, in-stent-restenosis is a new and progressively more frequent problem, requiring complex treatment and of which as been established. Comparative controlled studies need to be performed in order to determine the best treatment for this new entity.

Angioplasty, Balloon, Coronary↗
PubMed1999

[A complete atrioventricular block and polymorphic ventricular tachycardia as the initial manifestation of secondary amyloidosis].

Cardiac injury is a frequent characteristic in primary, senile and myeloma related amyloidosis, but it is unusual in secondary amyloidosis. We report a patient with complete atrioventricular block and polymorphic ventricular tachycardia as the initial manifestation of secondary amyloidosis. Necropsy demonstrated amyloidosis deposits in the specific conduction system.

Adult↗
PubMed1998

[Wiktor coronary stent for elective placement with an antiaggregation regimen. WINE study. WINE Group Study].

INTRODUCTION AND OBJECTIVES: The main problems associated with coronary stent implantation are subacute thrombosis and vascular and hemorrhagic complications due to the intensive anticoagulant regime. We studied the complications and the six-month restenosis rate after the elective implantation of a Wiktor stent in patients treated only with antiplatelet drugs. PATIENTS AND METHODS: The WINE study is an open, observational, multicenter study that included 368 patients (380 lesions) from 11 Spanish hospitals. All patients were treated with aspirin (125-325 mg/day) and ticlopidine (250 mg/12 h for 4 weeks). After hospitalization, a clinical control and clinical and angiographic controls were performed at one and six months respectively. RESULTS: 27 patients were excluded after the procedure because of failed delivery of the stent (5 cases), suboptimal angiographic result (15 cases) or lack of adherence to the antithrombotic regime (7 cases). Among the 341 patients with an adequate result most lesions (76.2%) were type B, including 39.1% type B2 and 8.5% type C. Subacute stent occlusion occurred in two patients (0.6%). Seven patients (2.1%) had vascular complications related to the arterial puncture. No major hemorrhagic complications needing transfusion were found. At six months 64 patients (19.8%) showed angiographic restenosis. CONCLUSIONS: When the angiographic result after Wiktor stent placement is adequate, the therapy with aspirin and ticlopidine is associated with a very low stent thrombosis rate as well as with a low rate of vascular complications and 6 month angiographic restenosis.

Adult↗
PubMed1998

[Angioplasty versus surgery in proximal stenosis of the anterior descending artery].

The points of view of the cardiac surgeon and the interventional cardiologist on their personal approach to the treatment of the significant lesions of the proximal left anterior descending coronary artery are still a matter of controversy. Two randomized studies have compared the efficacy of PTCA vs CABG in the treatment of patients with isolated proximal left anterior descending (LAD) coronary artery stenosis. After a mean follow-up of 3 years these studies concluded that the incidence of events was significantly reduced in the CABG group. However, this conclusion requires a cautious interpretation because of methodological limitations of these studies. On the other hand, a recent randomized study has shown a reduction in the restenosis rate when an intracoronary stent is electively implanted after PTCA in proximal LAD stenosis. Similarly, surgical modifications in material and in technical aspects will probably result in a reduction of the morbidity sometimes associated with surgical procedures. Presented with favourable anatomy, PTCA with elective stent implantation may be the initial option in the treatment of proximal LAD stenosis, especially if another revascularization procedure is contemplated in the future. However, CABG is preferred when the LAD lesion suggests a complicated anatomy (chronic obstructions, ostial lesions or proximal bifurcations with a significant diagonal). Depending on the particular results for both procedures in each Institution, an individual evaluation seems to be mandatory in the vast majority of patients.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Intracoronary stents in the treatment of angioplasty complications].

Acute or subacute occlusion of the dilated artery is the main cause of complication after percutaneous transluminal coronary angioplasty. The occlusion incidence ranges between 2 and 10% of the procedures and the mechanisms include dissection, subintimal hemorrhage, thrombosis, vasospasm and elastic recoil. Intracoronary stent is a metallic support which may seal dissection due to angioplasty, resists elastic recoil and geometric remodeling and prevents other occlusion mechanisms. Data from recent studies demonstrate the benefit of stenting acute occlusive coronary dissection in a large artery with extensive myocardium at risk. The election of the type of stent in the treatment of the acute coronary occlusion depends on the clinical status, the coronary anatomy and the stent characteristics. The major limitation of stent is the apparition of subacute thrombosis. The mechanisms of stent thrombosis are not well known. However, some factors related to complicated angioplasty, such as the presence of important dissection, intracoronary thrombus and vessels of small diameter have been involved. For this reason, the major incidence of subacute thrombosis is observed in bail-out situations. New techniques using intravascular ultrasound and high pressure dilatation after stent placement and new approaches in antiplatelet treatment have been recently described in order to reduce the incidence of subacute occlusion and the hemorrhagic events associated to previous anticoagulant therapy.

Angioplasty, Balloon, Coronary↗
PubMed1994

[The mechanism producing nausea during ventriculography performed with ioxaglate: the implications of a randomized study].

INTRODUCTION: The mechanism of ioxaglate-induced nausea has not been fully elucidated. Recent studies have demonstrated that serotonin is one of the principal neurotransmitters of emesis in humans. On the other hand, the greater capacity of ioxaglate to stimulate vomiting has been ascribed to its great ability to inhibit cholinesterase. METHODS: To determine if oral metoclopramide (a serotonin receptor-blocker) is effective in the prophylaxis of ioxaglate-induced nausea during left ventriculography, 637 of 711 consecutive eligible patients were included in a prospective study. Patients were randomized to receive, 60-90 minutes before the procedure, either diazepam 10 mg p.o. (control group [n = 315]) or diazepam 10 mg p.o. plus metoclopramide 10 mg p.o. (metoclopramide group [n = 322]). RESULTS: The two randomized groups were similar in relation to baseline clinical and hemodynamic characteristics. Nausea was documented in 103 patients (16.1%) with similar incidence in the two groups (control group: 16.8%, metoclopramide group: 15.5%; p = NS). Nausea duration was also similar (56 +/- 63 s vs 52 +/- 63 s; p = NS). When patients with and without nausea were compared, the following variables showed a significant difference between the two groups: male gender (86% vs 76%; p < 0.05), age (53 +/- 10 yrs vs 56 +/- 9 yrs; p < 0.05) and body surface area (1.84 +/- 0.2 m2 vs 1.78 +/- 0.1 m2; p < 0.01). Stepwise multiple regression analysis identified low age (p = 0.02) and male gender (p = 0.06) as independent predictors of nausea. The incidence of nausea was 24% in males < or = 45 yrs vs 9% in females > 45 yrs (p < 0.05). CONCLUSIONS: Prophylaxis with oral metoclopramide did not reduce the incidence of ioxaglate-induced nausea during left ventriculography. This data do not support a role of serotonin in the production of nausea by ioxaglate. Low age an male gender are independent predictors of nausea apparition during left ventriculography. A cholinergic mechanism is probably involved in the capacity of ioxaglate to stimulate vomiting.

Administration, Oral↗
PubMed1994

[Penetrating aortic ulcer: clinical and angiographic characteristics].

BACKGROUND: "Penetrating aortic ulcer", an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows haematoma formation within the aortic wall, is rarely considered in the differential diagnosis of patients with sudden onset of severe chest or back pain. It has been suggested that it is a pathologic process that involves elderly hypertensive patients with severe atherosclerosis and rarely has been observed in the ascending aorta. METHODS: To determine the characteristics of this process, 11 clinical, 2 hemodynamic, 3 angiographic and 4 surgical variables were compared between 10 consecutive patients with penetrating aortic ulcers and 20 matched patients with classic acute aortic dissection. RESULTS: Clinical and hemodynamic variables were similar in both compared groups. In the group of patients with penetrating ulcer mean age was 58 +/- 6 years, previous hypertension was observed in 6 patients and the penetrating ulcer was located in the ascending aorta in 6 cases. In comparison to patients with aortic dissection, more angiographic projections were necessary to obtain the diagnosis in the group of patients with penetrating ulcer (2.4 +/- 0.8 vs 1.7 +/- 0.6; p < 0.05). In addition, the presence of angiographic aortic valve regurgitation was only observed in the group of patients with acute dissection (60% vs 0%; p < 0.001). Severe atherosclerosis was not present angiographically in any patient with penetrating ulcer. CONCLUSIONS: Penetrating aortic ulcer can also affect middle age patients without severe atherosclerosis and is frequently observed in the ascending aorta. Its form of presentation and clinical characteristics are similar to classic aortic dissection. The lack of angiographic confirmatory evidence of dissection with suggestive clinical history, should raise the possibility of penetrating aortic ulcer.

Aortic Diseases↗
PubMed1993

Cyclic changes in pulmonary wedge v waves in dilated cardiomyopathy.

Right and left cardiac catheterization was performed in a 29-year-old male with dilated cardiomyopathy. During the procedure, prominent v waves appeared spontaneously in the pulmonary capillary wedge pressure recording with a simultaneous decrease in left ventricular systolic pressure. Left ventricular angiography showed moderate to severe mitral regurgitation and an ejection fraction of 22%. The right ventricular endomyocardial biopsy revealed histological findings consistent with dilated cardiomyopathy. Cardiac catheterization was repeated 9 months later, after a period of clinical improvement and a reduction in the right and left ventricular filling pressures was documented. The cyclic swings in the pulmonary capillary wedge pressure and in the left ventricular systolic pressure were not observed. Left ventriculography showed mild mitral regurgitation with an ejection fraction of 37%. Right ventricular endomyocardial biopsy documented a reduction in myofibrillar and nuclear hypertrophy. Thus, cyclic changes in pulmonary wedge v waves may be observed in dilated cardiomyopathy. This finding is consistent with cyclic variations in the degree of mitral regurgitation. Disappearance of this factor seems to be related to improvement in left ventricular contractility.

Adult↗