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Biomedical subjects

E M Tuzcu

Publications and source records attributed to E M Tuzcu.

At least 19 recordsLinked to original sources
PubMed1992

Late (two-year) follow-up after percutaneous balloon mitral valvotomy.

Percutaneous balloon mitral valvotomy (PBMV) compares well with surgical commissurotomy, showing comparable improvement in symptoms and catheterization-proven valve area early after the procedure. This study reports the New York Heart Association class, mitral valve area calculated by echocardiography, and the results of transseptal cardiac catheterization 2 years after PBMV. The data are compared with the status immediately before and after PBMV. Forty-one patients returned to enter the study (mean follow-up time 24 +/- 3 months). All patients were evaluated clinically by the same investigator who had seen them at the time of PBMV. Transseptal cardiac catheterization and echocardiographic analysis (2-dimensional and Doppler echocardiography) were performed on the same day. At follow-up, 17 patients were class I, 20 were class II, and 4 were class III. Although the mitral valve area calculated by cardiac catheterization increased significantly from immediately before to immediately after PBMV there was a decrease in the calculated mitral valve area at 2-year follow-up. Echocardiographic analysis did not show as large an increase in mitral area, immediately after PBMV, and no significant decrease in mitral valve area at 2 years (before PBMV planimetry 1.1 +/- 0.1 cm2; immediately after 1.8 +/- 0.1 [p less than 0.05]; follow-up 1.6 +/- 0.1 [p = not significant compared with immediately after PBMV]). Doppler halftime measurements were similar. PBMV is effective therapy with good midterm results for selected patients with mitral stenosis.

Adult↗
PubMed1992

Immediate and long-term outcome of percutaneous mitral valvotomy in patients 65 years and older.

BACKGROUND: We analyzed the immediate and long-term outcome of percutaneous balloon mitral valvotomy (PMV) in 99 patients who were greater than or equal to 65 years of age (81 women and 18 men; mean +/- SEM age, 72 +/- 0.5 years). METHODS AND RESULTS: There were 84 patients in New York Heart Association (NYHA) class III or IV; 26 patients had previous surgical commissurotomy; 64 had one or more comorbidities; 73 had fluoroscopically visible mitral valve (MV) calcification; and 63 had echocardiographic score greater than 8 (mean +/- SEM score, 9.2 +/- 0.2). There were three procedural deaths, all occurring in our early experience. Pericardial tamponade occurred in five patients, thromboembolism in three, and transient atrioventricular block in one. After PMV, MV area was greater than or equal to 1 cm2 in 86 patients and greater than or equal to 1.5 cm2 in 56. A successful outcome (defined as MV area greater than or equal to 1.5 cm2 without a greater than or equal to 2-grade increase in mitral regurgitation and without left-to-right shunt with a pulmonary-to-systemic flow ratio of greater than or equal to 1.5:1) was achieved in 46 patients. The best multivariate predictor of success was the combination of echocardiographic score, NYHA functional class, and inverse of MV area. Mean follow-up was 16 +/- 1 months. Actuarial survival (79 +/- 7% versus 62 +/- 10%, p = 0.04), survival without MV replacement (71 +/- 8% versus 41 +/- 8%, p = 0.002), and survival without MV replacement and NYHA class III or IV (54 +/- 12% versus 38 +/- 8%, p = 0.01) at 3 years were significantly better in the successful group of 46 patients than in the unsuccessful group of 53 patients. Low echocardiographic score was the only independent predictor of survival. Lack of MV calcification and low NYHA class, low mean left atrial pressure, and low pulmonary artery pressure were the independent predictors of event-free survival. CONCLUSIONS: PMV can be performed safely in selected patients greater than or equal to 65 years old with good immediate and long-term results. In addition to clinical examination, echocardiographic evaluation of the mitral valve and fluoroscopic screening for valvular calcification are the most important steps in patient selection for successful outcome.

Actuarial Analysis↗
PubMed1991

Atrial septal occlusion improves the accuracy of mitral valve area determination following percutaneous mitral balloon valvotomy.

We investigated the impact of the atrial communication on the mitral valve area calculation after percutaneous mitral balloon valvotomy in 17 patients (15 women, 2 men; mean age 56 +/- 4 years). The hemodynamic measurements and mitral valve area calculations were performed with and without balloon occlusion of the atrial septal puncture site. The mitral valve area determined with balloon occlusion was significantly smaller than the mitral valve area determined without occlusion (1.6 +/- 0.1 vs. 1.9 +/- 0.1 cm2, P less than 0.01), and was similar to the echocardiographically determined valve area (1.6 +/- 0.1 cm2). This decrease in the calculated mitral valve area with occlusion was associated with a decrease in the measured cardiac output, without a change in the mitral valve gradient or the diastolic filling period. Occlusion of the atrial septal puncture site may permit more accurate determination of the mitral valve area and thus provide a better reference point for future comparison should the question or restenosis arise.

Cardiac Catheterization↗
PubMed1991

Percutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade.

We performed percutaneous balloon pericardial window (PBPW) in 8 patients (age 40 to 70 yrs; 4 men, 4 women) with malignant pericardial effusion and tamponade. Pericardial window was indicated because they continued to drain greater than 100 ml/day of pericardial fluid through the pigtail catheter for greater than or equal to 3 days. A 0.038 inch guidewire was advanced through the pigtail catheter into the pericardial space and then the catheter was removed. A 20 mm diameter, 3 cm long balloon dilating catheter was advanced to straddle the parietal pericardium. Manual inflations were performed until the waist produced by the pericardium disappeared. All patients tolerated the procedure well with minimal discomfort and with no complications. A left or bilateral pleural effusion occurred in all patients after PBPW. No patient developed recurrent pericardial tamponade at a mean follow-up of 6 +/- 2 months. Thus, PBPW is a useful and safe technique to avoid surgery in patients with malignant pericardial effusion and tamponade.

Balloon Occlusion↗
PubMed1991

Comparison of early versus late experience with percutaneous mitral balloon valvuloplasty.

The immediate outcome of the first 150 patients (Group 1) and the last 161 patients (Group 2) who underwent percutaneous mitral balloon valvuloplasty was compared. There was no difference between the two groups in age, gender, New York Heart Association functional class, presence of calcification, atrial fibrillation, degree of mitral regurgitation, mean pulmonary artery pressure, left atrial pressure, cardiac output, pulmonary vascular resistance, mitral valve gradient and mitral valve area. Fewer patients in Group 1 than Group 2 had an echocardiographic score less than or equal to 8 (62% versus 69%, respectively, p = 0.02). The atrial septum was dilated with an 8 mm balloon in 74% of patients in Group 1 and with a 5 mm balloon in all patients in Group 2. Ratio of effective balloon dilating area to body surface area was larger in Group 1 than in Group 2 (4.05 +/- 0.07 versus 3.7 +/- 0.03 cm2/m2, p = 0.0001). A good result (mitral valve area greater than or equal to 1.5 cm2) was obtained in 77% and 75% in Groups 1 and 2, respectively (p = NS). After percutaneous mitral valvuloplasty, a greater than or equal to 2 grade increase in mitral regurgitation was noted in 12% of Group 1 and 6% of Group 2 (p = 0.02) and a left to right shunt was detected in 22% of Group 1 and 11% of Group 2 (p = 0.0001). There were three procedure-related deaths in Group 1, but none in Group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗
PubMed1991

Percutaneous mitral balloon valvotomy.

Percutaneous balloon mitral valvotomy is a technique that allows relief of mitral stenosis without thoracotomy. Commissurotomy of the mitral valve with proper sized balloons that are placed antegrade by means of a transseptal catheterization results in good immediate and midterm results in most patients. Younger patients with echocardiographic scores of 8 or lower and who are without atrial fibrillation, mitral regurgitation or valvular calcification, and histories of surgical commissurotomy are the best candidates for PMV. Nevertheless, many patients who are not ideal candidates for PMV also derive substantial relief from this procedure. Mortality and morbidity related to the procedure are low in most experienced centers. Complications include pericardial tamponade, thromboembolism, rhythm abnormalities, left to right shunting, and mitral regurgitation. The survival with freedom from mitral valve replacement at 2 years after PMV is 84%. In addition to history and physical examination, echocardiography has a central role in the selection of patients for PMV.

Adult↗
PubMed1990

Incidence and prognostic significance of intraventricular conduction abnormalities after coronary bypass surgery.

To determine the incidence and prognostic significance of new postoperative conduction disturbances, 2,000 consecutive patients who underwent primary elective coronary bypass surgery were evaluated. One hundred eleven (5.5%) of the 2,000 patients developed a new intraventricular conduction defect that persisted to hospital discharge. Right bundle branch block occurred in 86 (85%), left bundle branch block in 5 (4%) and nonspecific intraventricular conduction defect in 9 (11%). One hundred of these 111 patients were successfully matched with others in the study population who had maintained normal intraventricular conduction during the operative period. Patients were matched on the basis of age, gender, absence of preoperative conduction disturbances, left ventricular function and bypass grafts to the same vessels. Follow-up of the two groups for a period of 1 to 76 months (mean 60 months) failed to show any difference in survival or cardiac events such as myocardial infarction, repeat coronary bypass surgery, coronary angioplasty and permanent pacemaker implantation. The appearance of right or left bundle branch block or a nonspecific intraventricular conduction defect after coronary bypass surgery does not appear to have an unfavorable impact on the long-term prognosis of these patients.

Bundle-Branch Block↗
PubMed1990

Percutaneous transluminal coronary angioplasty in silent ischemia.

The short- and long-term outcome of percutaneous transluminal coronary angioplasty were analyzed in 34 patients who had documented coronary artery disease without symptoms. Of the 34 patients, 33 had abnormal stress tests before angioplasty. Angioplasty was successful in 31 patients (91%). Follow-up was 100% for a mean period of 36 +/- 15 months. Follow-up exercise test was normal or improved in 29 of the 31 patients who had successful angioplasty. Follow-up catheterization was performed in 24 of the 31 patients (77%). Restenosis of the previously dilated segment was found in seven patients. Actuarial cardiac survival at 3 years was 100%. Freedom from myocardial infarction, bypass surgery, angioplasty for a new lesion, and death was 87%. We conclude that although the most effective treatment for silent ischemia remains to be determined, our data suggest that coronary angioplasty is a therapeutic option in these patients.

Actuarial Analysis↗
PubMed1989

Left ventricular hypertrophy in persons age 90 years and older.

Clinical, electrocardiographic and echocardiographic findings of 32 patients age 90 years or older were analyzed to assess the prevalence, characteristics and correlates of left ventricular (LV) hypertrophy. All patients (mean age 92 years, range 90 to 98; 21 women and 11 men) were referred to the echocardiography laboratory with a definite or suspected cardiovascular diagnosis. LV hypertrophy, echocardiographically diagnosed by high LV mass index, was present in 28 patients. The LV mass index ranged from 105 to 215 g/m2 in men and 140 to 262 g/m2 in women. Electrocardiographic evaluation showed LV hypertrophy in only 5 patients. Five patients had low voltage on the electrocardiogram. There was no correlation between the LV mass index and presence of electrocardiographic LV hypertrophy or presence of low voltage on the electrocardiogram. LV hypertrophy was concentric in 19 and eccentric in 9. There was no correlation between types of LV hypertrophy and underlying cardiovascular disease or presence of electrocardiographic LV hypertrophy. It is concluded that LV hypertrophy is frequently present and has a wide range and heterogeneous character in very elderly patients with cardiovascular disease. In the tenth decade of life, echocardiography is a sensitive method for detecting, characterizing and classifying LV hypertrophy, whereas electrocardiography lacks sensitivity in detecting it.

Aged↗
PubMed1989

Changing patterns in percutaneous transluminal coronary angioplasty.

We analyzed the impact of evolving technology on percutaneous transluminal coronary angioplasty in 2677 patients. There were 168 patients in period 1 when fixed-wire catheters were used, 1117 patients in period 2 when steerable catheters were available, and 1392 patients in period 3 when low-profile systems were utilized. The age of patients (55 to 57 to 59 years) and the proportion of patients with severe angina increased over the three periods (25% to 36% to 54%). The percentage of high-grade stenosis and the proportion of distal lesions also increased. Primary success rate improved from 73% in period 1 to 94% in periods 2 and 3. Emergency bypass surgery decreased (8.3% to 4.2% to 2.5%), as did the incidence of myocardial infarction (7.1% to 3.3% to 2.4%). Mortality was 0% in period 1, 0.2% in period 2, and 0.4% in period 3. These results indicate that technological advancements and increased operator experience significantly improved the primary success rate and decreased the incidence of major complications.

Angioplasty, Balloon↗
PubMed1989

The usefulness of amiodarone in management of refractory supraventricular tachyarrhythmias.

The efficacy of amiodarone was evaluated in 85 patients with supraventricular tachycardia (SVT) refractory to several antiarrhythmic agents (mean 3.8 +/- 1.0). All but six patients had organic heart disease. Patients were followed for 19 months (range 2-60 months). Response to amiodarone treatment was considered excellent (no recurrence of SVT) in 22 of 52 patients with paroxysmal atrial fibrillation (PAF), in four of 13 patients with chronic atrial fibrillation (CAF), and in three of 15 patients with Wolff-Parkinson-White syndrome-related circus movement tachycardia (WPW-CMT). Response was improved (marked improvement in symptoms with partial suppression of SVT) in 22 patients with PAF, in seven patients with CAF, in 10 patients with WPW-CMT, and in four patients with atrioventricular nodal reentry tachycardia. Response was considered poor (insignificant or no suppression of SVT) in three patients with PAF, in one patient with CAF, and in one patient with WPW-CMT. Seven patients required discontinuation of amiodarone due to adverse effects. We conclude that amiodarone is efficacious and relatively safe for control of SVT refractory to conventional antiarrhythmic agents irrespective of the underlying electrophysiologic mechanism.

Adult↗
PubMed1989

Percutaneous transluminal coronary angioplasty in the young adult.

A total of 33 patients age 35 years or younger underwent percutaneous transluminal coronary angioplasty (PTCA) at The Cleveland Clinic Foundation between January 1981 and October 1987. Arteriography showed one-, two-, and three-vessel disease in 16, 12, and 5 patients, respectively. Twenty-four patients (73%) had functional Class 3 or 4 angina and 17 (52%) had unstable angina. PTCA was performed in one vessel each in 22 patients and in multiple vessels in 11 patients. Of 47 vessels, 44 (94%) were successfully dilated. There were no deaths, emergency bypass procedures, or myocardial infarctions during hospitalization. At a mean follow-up of 30 months, there were two late deaths, nine repeat PTCA procedures, one coronary bypass, and one nonfatal myocardial infarction. Due to the progressive nature of coronary artery disease in the young adult, PTCA appears to be a good therapeutic modality for selected patients in this age group.

Adult↗
PubMed1989

Long-term follow-up of PTCA of the right coronary artery with shepherd's crook morphology.

The authors evaluated the long-term outcome of percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery in patients with shepherd's crook morphology (51 patients) compared to a control group (53 patients) matched for lesion location, date of procedure, age, and gender. The primary success rate was lower (86% v 98%; P = .03) in the shepherd's crook group than in the control group. At a mean follow-up of 29 months, there was one death in each group. The restenosis rate was 18% in the shepherd's crook group and 21% in the control group; repeat PTCA (14% v 15%) and bypass surgery (2% v 6%) rates were also similar in both groups. The data suggest that PTCA of right coronary arteries with shepherd's crook morphology has a significantly lower primary success rate but similar long-term outcome when compared to PTCA of right coronary arteries without this anatomic variation.

Angioplasty, Balloon, Coronary↗
PubMed1989

Ebstein's anomaly: natural and unnatural history.

Clinical features and natural history were analyzed in 30 patients with Ebstein's anomaly (mean age 26 years, range 1.5-58 years, 53% females). The main presenting symptoms were dyspnea and fatigue (83%). At presentation, there were six patients (20%) in New York Heart Association Functional Class (NYHAFC) I, nine (30%) in NYHA-FC II, and 15 (50%) in NYHA-FC III or IV; 12 patients (40%) were cyanotic. Common auscultatory findings were widely split second heart sound in 21 (70%), third heart sound in 14 (47%), fourth heart sound in 16 (53%), and a systolic murmur in 22 (73%). Right bundle branch block was present in 21 (70%), documented supraventricular tachycardia in seven (23%), and Wolff-Parkinson-White syndrome in three (10%). Catheterization was performed in 93% without complications. Fourteen patients were treated surgically (12 [86%] in NYHA-FC III or IV, 10 [71%] with associated anomalies); tricuspid valve replacement was performed in eight, atrial septal defect repair in two, accessory pathway ablation in two, right atrial plication in one, and automatic cardioverter defibrillator implantation in one. Surgical treatment improved 10 patients from NYHA-FC III or IV to NYHA-FC I or II. Death occurred in nine patients (five treated surgically and four medically); four of these deaths were sudden. In the eight patients who had tricuspid valve replacement, there were one operative and two late deaths. The authors conclude that surgical therapy with tricuspid valve replacement improves the clinical status of patients who are severely ill. Risk of sudden death remains an important problem in patients with Ebstein's anomaly regardless of severity of the disease and mode of treatment.

Adolescent↗
PubMed1989

Intra-aortic balloon-pump rupture and entrapment.

The authors report a case of intra-aortic balloon rupture and entrapment in a patient with extensive vascular disease. The balloon was subsequently removed percutaneously. A review of the diagnosis and management of this unusual complication is presented.

Equipment Failure↗
PubMed1988

Determinants of primary success in elective percutaneous transluminal coronary angioplasty for significant narrowing of a single major coronary artery.

Clinical and angiographic characteristics, procedural details and outcome were analyzed in 2,677 consecutive patients who underwent elective single-artery, single-lesion percutaneous transluminal coronary angioplasty (PTCA) between December 1980 and May 1987. Primary success was achieved in 2,479 (93%) patients. The primary success rate was significantly lower during the first period, when nonsteerable systems were used (73%), than in later periods (94%) (p less than 0.0001), when steerable and low-profile systems became available. Univariate analysis revealed the following variables as predictors of lower primary success: totally obstructed arteries (p less than 0.0001), presence of calcium in the narrowing (p = 0.002), prior myocardial infarction (p = 0.005), stenoses located in the right coronary artery (p = 0.02), narrowings between 90 and 99% in diameter (p = 0.02) and patients older than 60 years of age (p = 0.07). Multivariate analysis revealed the following 4 independent predictors of lower primary success: 100% obstruction (p less than 0.0001), calcium (p = 0.005), previous myocardial infarction (p = 0.029) and patients older than 60 years of age (p = 0.036). With present technology, single-narrowing elective PTCA can be performed with a high success rate in most patients. Although total occlusion, presence of calcium, older age and history of myocardial infarction influence the outcome unfavorably, PTCA can still be performed with acceptable primary success rates.

Adult↗
PubMed1988

Percutaneous transluminal angioplasty for shepherd's crook right coronary artery stenosis.

Angiograms from 1,043 consecutive patients undergoing right coronary artery angioplasty were reviewed to determine the incidence of "shepherd's crook" origin of the right coronary artery. Primary results, complications, and technical difficulties were compared with a control group. Fifty-one patients (4.9%) were found to have this anatomic variation. Compared with a control group, the primary success rate was lower (86% vs. 98%) and the incidence of procedural difficulties was higher (33% vs. 13%). Technical problems led to the use of more guiding catheters and more guidewires per patient than in the control group. Thus, coronary angioplasty of shepherd's crook right coronary artery imposes technical problems and is associated with less than an optimal primary success rate.

Angiography↗