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Biomedical subjects

F Pileggi

Publications and source records attributed to F Pileggi.

At least 163 records · Page 9Linked to original sources
PubMed1992

[Silent ischemia after an uncomplicated myocardial infarct. A study in asymptomatic patients].

PURPOSE: To verify the prognostic value of silent myocardial ischemia (SMI) after an uncomplicated myocardial infarction (MI). METHODS: Forty asymptomatic patients were studied after a first uncomplicated MI. They were submitted to 48 hour ambulatory electrocardiographic monitoring and exercise-testing, during the 2nd and 8th weeks after the acute event. Thirty-nine patients were submitted to cardiac catheterization and coronary arteriography; one patient was submitted to necropsy. The electrocardiographic study identified 11 (27.5%) individuals with SMI (group A); the other 29 patients were considered group B. RESULTS: Groups A and B were similar in relation to clinical characteristics, infarct site and ventricular function. Group A had significantly more extensive coronary artery disease when compared to group B. After a two-year follow-up, patients from group A had significantly more coronary events (36.3%) when compared to group B (3.4%). Kaplan-Meier analysis demonstrated a significantly higher cumulative probability of not experiencing a new coronary event for the group B patients. CONCLUSION: SMI may have a prognostic value after uncomplicated MI, as in other clinical manifestations of coronary artery disease.

Adult↗
PubMed1992

[Pheochromocytoma. Its diagnostic and therapeutic characteristics].

Pheochromocytoma is a cause of hypertension that frequently can be cured by surgery. The aim of this paper, based on 5 cases of pheochromocytoma, is to relate our experience in diagnosis and treatment in this pathology. In four of 5 patients with pheochromocytoma we observed unusual characteristics of the disease. Association with neurofibromatosis in one case, with rheumatic mitral regurgitation in another; and in a third case the tumor was malignant. One patient had catecholamine-mediated electrocardiographic changes which disappeared with treatment. Since symptoms of adrenergic hyperactivity were present in all cases, the rise in the levels of vanilmandelic acid and urinary metanephrines were useful in confirming the diagnosis. Computed tomography and I-131 meta-benzylguanidine for radioisotopic imaging, displayed not only all tumoral masses but also bone metastases in the malignant case. During the follow-up period, from the sixth month to the fourth year after surgery, four patients were asymptomatic, and have normal urinary catecholamine metabolite levels. The patient with a malignant form of pheochromocytoma continued to show elevated catecholamines release and remained hypertensive in spite of adrenal mass resection.

Adrenal Gland Neoplasms↗
PubMed1992

[The surgical treatment of nodal reentry tachycardia. The late results].

PURPOSE: To analyze the long-term results of surgical treatment of atrioventricular nodal reentrant tachycardia (AVNT). METHODS: From March 1987 to March 1990, 20 patients with AVNT were submitted to surgical therapy, 14 female, aged 12 to 70 (42.8 +/- 17) years. All presented crisis of AVNT from 6 months to 60 (18.4 +/- 15.9) years. Ten of them had syncope or near syncope and two with cardiac arrest during reversion of AVNT with antiarrhythmic drugs. They used 1 to 6 (3.75 +/- 1.45) antiarrhythmic drugs before surgery. The electrophysiologic study (EPS) showed the common form of AVNT in all cases. The surgical procedure was anatomically directed to the posterior area of the AV node. Programmed atrial stimulation (PAS) were applied on 18 patients after surgery. The long-term results were analysed by clinical evaluation, EPS and Holter when they were necessary. RESULTS: The postoperative PAS was done in 18 patients and did not induce any AVNT, even after atropine IV. The PR interval was 153 +/- 50 ms before and 152 +/- 38 ms after surgery (p > 0.05). During follow up (26 +/- 10 m) there were not AVNT recurrence. Two patients developed chronic atrial fibrillation after 24 months of surgery. CONCLUSION: The perinodal dissection technique used was safe and successful to treat AVNT, preserving AV nodal conduction.

Adolescent↗
PubMed1992

[The electrocardiogram in endomyocardial fibrosis].

PURPOSE: To detail the most common electrocardiographic findings on the endomyocardial fibrosis and to correlate with the ventricular form. METHODS: One hundred patients with endomyocardial fibrosis (68 female) with ages between 5 and 64 years old (mean 34 years). According to ventriculographic aspect the patients were divided in three groups: group I--11 patients with predominant right ventricular compromise; group II--58 patients with biventricular involvement, but not necessarily similar in intensity; group III--31 patients with predominant left ventricular compromise. RESULTS: On patients with predominant right ventricular compromise, the electrocardiographic pattern was of QRS complex of low voltage in the frontal plane, presence of incomplete right bundle block and QRS complex with low voltage and with qr or qs aspect in V1 contrasting with QRS complex of great amplitude on V2 and V3. Left anterior hemiblock, aspect of inactive area, and R waves of high voltage on left precordial leads were observed on patients with predominant left ventricular involvement. CONCLUSION: The electrocardiogram of endomyocardial fibrosis, in spite of inespecific, may help in the identification of ventricular involvement.

Adolescent↗
PubMed1992

[The effect of intravenous furosemide on the hemodynamic parameters and colloid osmotic pressure in patients with pulmonary edema].

PURPOSE: To evaluate the effects of intravenous furosemide over hemodynamics variables and colloid osmotic pressure in patients with pulmonary edema. METHODS: Eight patients with pulmonary edema, mean age of 58.3 +/- 7.5 years, 6 men, were evaluated. Hemodynamic monitoring was performed by Swan-Ganz catheter in pulmonary artery to obtain RAP and PAWP, in mmHg, and HR, in bpm. Cardiac output (CO) was obtained by thermodilution method. Cardiac index (CI) in L/min/m2, and systolic index, in ml, arose from variables above. Mean arterial pressure (MAP), in mmHg, was obtained through catheterization of radial artery. patients were treated with 20 mg of intravenous furosemide, and hemodynamic variables were measured before and after 5, 15, 30, 60 and 120 minutes. COP was measured in Weil oncometer (IL 196) at same intervals. RESULTS: A significant reduction of RAP (p = 0.002) and PAWP (p < 0.0001), HR (p = 0.02), COP (p < 0.0001) and gradient between PAWP-COP (p < 0.0001) were observed. RAP and PAWP reduction was greater in the first five minutes and, otherwise, COP reduction was gradual in 120 min. PAWP-COP gradient initially positive, stayed negative during all study. MAP, CI, SI and SVR did not show statistical differences. CONCLUSION: Furosemide administration reduced RAP, PAWP, HR, COP and PAWP-COP gradient, probably by a redistribution of fluid excess in the interstitial to intravascular space, through changes in driving fluid forces, with predominance in colloid osmotic pressure, which reverse fluid from intravascular to interstitial observed in pulmonary edema.

Acute Disease↗
PubMed1992

[Dextrocardia in situs inversus totalis with obstructive coronary disease. Its treatment by coronary angioplasty by the brachial approach].

Dextrocardia in "situs inversus totalis" with obstructive coronary disease is a rare clinical situation, with few cases treated by coronary angioplasty using the femoral approach being reported. In this report we describe the case of a 61-year-old male patient who underwent successful dilatation of two arteries by the brachial approach. We discuss technical aspects related to the procedure, which may be easily performed when proper equipment is available.

Angioplasty, Balloon, Coronary↗
PubMed1992

[Valvular surgical treatment concurrent with myocardial revascularization].

PURPOSE: To study the morbidity and mortality due to valvar surgical treatment performed concomitantly to myocardial revascularization. METHODS: From 1650 patients submitted to mitral or aortic valve surgical treatment, 103 (6.24%) had it associated to myocardial revascularization. Coronary insufficiency was associated to aortic valvar lesion in 66 (64.0%) patients, group I, with mean age of 62.3 +/- 8 years; and in 37 (35.9%) patients with mitral valve lesion, group II, with mean age of 57.8 +/- 5.8 years. Diagnosis was based upon the anamnesis, physical examination and confirmed by cine-coronarographic findings. RESULTS: I-Complications at the immediate postoperative; a) mortality 11 (10.6%) patients, 6 (9.09%) from group I: by low cardiac output 3, uncontrolled arrhythmia 1, mediastinitis 1; acute infarction with cardiogenic shock 1, and 5 (134.5%) of group II: uncontrolled hemorrhage 2, sudden death 1, saphenous vein graft occlusion, respiratory insufficiency and sepsis 2; b) controlled intercurrences that increased the time of hospitalization: mental disorder 5 patients; CVA 7, diabetes decompensation 2, worsening of chronic renal insufficiency 1, upper level digestive hemorrhage 1 and respiratory insufficiency 3 patients. II-late postoperative complications of 77 (83.6%) patients which could be followed up during a period of 60 months: 1) mortality: 3 (3.89%) patients; 2 due to cardiomyopathy and 1 by acute myocardial infarction; 2) late evolution-functional capacity III (NYHA) by cardiomyopathy 6; I/II 68 patients; mild angina 6 patients, 2 underwent revascularization at the end of final 36-42 months. CONCLUSION: The clinical improvement and mortality indexes statistically similar to the isolate surgical acts stimulate us to keep up with such associate procedures.

Adult↗
PubMed1992

[The late results of fulguration of the atrioventricular node using high-energy shocks in patients with supraventricular tachycardias].

PURPOSE: To evaluate the long-term efficacy and safety at long term after atrioventricular junction fulguration (complete AV block induction, using high energy shocks, to control drug-resistant supraventricular tachyarrhythmias. METHODS: Twenty-eight patients, 17 (60.7%) men, with mean age 48.1 years, were submitted to one up to six ablation sessions with high energy shocks. The total delivered energy per patient was 1304 +/- 868 J. Each shock ranged from 100 to 400 J. RESULTS: After 12 months, at least, 60.6% of patients were in complete atrioventricular block; three (10.8%) were asymptomatic without complete AV block, and in five (17.8%) the ablation was unsuccessful. CONCLUSION: AV junction ablation with high energy shocks is safe and efficient in long-term follow-up.

Adult↗
PubMed1992

Acute hemodynamic effects of hypertonic (7.5%) saline infusion in patients with cardiogenic shock due to right ventricular infarction.

The hemodynamic effects, after infusion of 4 ml/kg of hypertonic (7.5%) saline solution (HS), were evaluated in six patients (mean age = 56.6 years) with cardiogenic shock (CS) due to right ventricular infarction (RVI). Basal condition data (mean +/- SEM) were as follows: cardiac index (CI) = 1.9 +/- 0.1 1/min/m2, arterial pressure (AP) = 66.5 +/- 0.9 mmHg, and systemic vascular resistance (SVR) = 31.3 +/- 1.0 mmHg/1/min/m2. Five- and 240-minute post-HS infusion data (respectively) revealed: CI = 3.3 +/- 0.1* and 2.9 +/- 0.1* 1/min/m2, AP = 87.7 +/- 1.6* and 80.7 +/- 2.2* mmHg, and SVR = 22.5 +/- 0.6* and 24.5 +/- 1.1* mmHg/1/min/m2 (*P less than 0.05 compared to baseline values). These data suggest that small-volume infusion of HS induced an important acute and sustained hemodynamic improvement in these patients with CS due to RVI.

Hemodynamics↗
PubMed1992

Effects of dynamic cardiomyoplasty on regional wall motion, ejection fraction, and geometry of left ventricle.

BACKGROUND: Dynamic cardiomyoplasty may provide functional and hemodynamic improvement in patients with heart failure. The purpose of this study was to investigate the effects of cardiomyoplasty on global ejection fraction, regional wall motion, and geometry of the left ventricle. METHODS AND RESULTS: These parameters were determined in 10 patients submitted to cardiomyoplasty for treatment of refractory heart failure by left ventricular (LV) angiography. The studies were performed before and 16.5 +/- 4.8 months after cardiomyoplasty with the myostimulator turned on. They were repeated 24 +/- 1 hours with the myostimulator turned off in eight patients. LV ejection fractions were determined by the area-length method, and the centerline method was used for assessment of regional wall motion. LV geometry was studied by LV major-to-minor axis ratio and sphericity index. A LV ejection fraction improvement from 15 +/- 8% to 30.9 +/- 8.3% (p < 0.01) was demonstrated with the myostimulator turned on after cardiomyoplasty. The values with the myostimulator turned off were 23 +/- 13%, remaining higher than the values observed before surgery (p < 0.05). Regional wall motion analysis showed an improvement in all studied regions. Regarding the LV shape, the left ventricle became markedly more spheric in the diastole. CONCLUSIONS: Dynamic cardiomyoplasty may improve LV function in selected patients. The analysis of LV wall motion corroborated these results, and these changes were associated with modifications in the LV geometry.

Assisted Circulation↗
PubMed1992

[Mapping with Technetium-99 methoxy-isobutyl isonitrile at the bedside after coronary thrombolysis].

PURPOSE: To evaluate the feasibility of bedside Technetium99-methoxy-isobutyl-isonitrile (99mTc-MIBI) cardiac imaging to assess perfusion after thrombolytic therapy (TT) for myocardial infarction (MI). METHODS: We studied 9 patients (mean age 59 +/- 9 years) submitted to TT with 100 mg of rt-PA in 90 minutes within the 6 hours of the onset of MI with subsequent angiography. 99mTc-MIBI was injected intravenously in a doses of 740 MBq immediately before TT start. Imaging was performed in three moments: study 1--as soon as the TT finished, study 2--3-18 hours after TT; study 3--7-10 days after TT. A perfusion score was established in each study and then compared to determine the perfusion patterns after TT. We compared through linear regression, the perfusion score with left ventricle ejection fraction, and with CKMB enzymatic peak. RESULTS: All patients had a patent infarct related artery. The perfusion score of study 1 varied from 12 to 22, mean 15.8 +/- 3.7, and correlated with ejection fraction (r = 0.9, p < 0.01) and peak CKMB (r = 0.78, p = 0.03). Four (44%) patients presented perfusion score improvement in study 2 (varied from 12 to 23, mean 16.8 +/- 4.3) and 8 (88%) in study 3 (varied from 12 to 28, mean 19.0 +/- 4.3). CONCLUSION: Bedside 99mTc-MIBI cardiac imaging is useful to quantify myocardial area under risk before TT, and to identify the late (7 to 10 days) benefit of TT.

Adult↗
PubMed1992

Recurrent ventricular tachycardia associated with postinfarction aneurysm. Results of left ventricular reconstruction.

Left ventricular reconstruction was used to control recurrent ventricular tachycardia in 19 patients (16 male), mean age of 56 years, with postinfarction anteroseptal aneurysms. The "origin" of recurrent ventricular tachycardia was not determined because the ventricular tachycardia induced by programmed stimulation produced hemodynamic deterioration in all patients. The average ejection fraction was 30.7% +/- 10.1%. In the left ventricular reconstruction technique, the plication of the aneurysmal septum and the reduction of the orifice of the left ventricular cavity after aneurysmal resection with a purse-string suture appear important to prevent the functioning of the reentry circuits. There was one death in the immediate postoperative period. The mean ejection fraction was 47.8% +/- 8.1% (p less than 0.001). The postoperative programmed stimulation induced ventricular tachycardia in only one patient. There were two late deaths. The other 16 patients are asymptomatic (five with antiarrhythmic drugs) in functional class I and without recurrence of ventricular tachycardia. Left ventricular reconstruction is an acceptable technique that changes the spatial orientation in eventual tachycardia circuits. Hence this technique is an alternative for long-term control of the right ventricular tachycardia associated with postinfarction anteroseptal aneurysm without previous electrophysiologic mapping.

Bundle-Branch Block↗
PubMed1991

Atresia of the left atrioventricular valve with patency of the aorta: anatomico-functional analysis of 23 patients.

We analyzed the findings in 23 patients with atresia of the left atrioventricular valve and a patent aorta seen in the period from January 1980 to July 1989. Having divided the cases according to the anatomical findings, we made a subsequent analysis of the clinical and surgical results with the aim of establishing the management most likely to diminish risks, still high, in treatment of this complex anomaly. From the anatomical viewpoint, three variants were observed. In the first, made up of 15 cases, there was absence of the left atrioventricular connexion. The characteristic finding in the second group, with five cases, was an imperforate left atrioventricular valve in the setting of concordant atrioventricular connexions. The third group, of these cases, was dominated by the presence of isomerism of the atrial appendages, both appendages being of left morphology in one case, and of right morphology in the other two. Further anatomical variation was then found in each group. Nine of the 15 with absence of the left atrioventricular connexion had the right atrium connected to a dominant left ventricle in presence of a rudimentary and incomplete right ventricle associated with discordant ventriculo-arterial connexions, all of them being in usual atrial arrangement and three with pulmonary stenosis. The remaining six in this first variant had the right atrium connected to a dominant right ventricle. In the five patients with imperforate left atrioventricular valves, two had discordant and three had concordant ventriculo-arterial connexions. In the three cases with isomerism, two had absence of the left atrioventricular connexion, with a dominant right ventricle. The last patient had an imperforate left atrioventricular valve and a discordant ventriculo-arterial connexion. From the functional viewpoint, there were 14 patients (10 with absence of an atrioventricular connexion, four with imperforate atrioventricular valve) with congestive heart failure and nine patients (five from the first, one from second, and three from the third variant) with hypoxia. Long-term follow-up (median 16.4 months--varying from 1 to 41 months--in the group with congestion and 27.7 months--varying from 12 to 57 months--in those with hypoxia) showed favorable clinical evolution in 11 (91%). We conclude that an anatomico-functional division can point towards the most appropriate management in this complex anomaly.

Aorta↗
PubMed1991

Incessant ectopic atrial tachycardia and sudden death.

A patient with refractory and incessant ectopic atrial tachycardia (IEAT) is reported in whom it was possible to document, during ECG (Holter) the occurrence of aborted sudden death by spontaneous ventricular fibrillation (VF). Following the second of two attempts at surgical ablation of the origin of the IEAT, the patient has been asymptomatic without antiarrhythmic drugs and in sustained sinus rhythm for 24 months. Although we cannot exclude the residual action of amiodarone and flecainide (proarrhythmia) or the residual peripartum cardiomyopathy it is probable that the observed VF was a true complication of a cardiomyopathy induced by a chronically increased heart rate (HR). Although unclear, this VF might be considered as a form of adrenergic-dependent long QT syndrome due to early afterdepolarization in the presence of predisposing myocardial conditions.

Adult↗
PubMed1991

[Spontaneous variability of ventricular extrasystole in chronic Chagas cardiopathy].

PURPOSE: To study the spontaneous variability of single (VPCs) and coupled (CVPCs) in patients with chronic Chagas' disease (CCD). PATIENTS AND METHODS: Twenty patients with CCD, 14 male, in class I and II NYHA, with frequent VPCs and VCPCs, free of drug therapy were studied. 21 hour Holter monitoring was done for 4 subsequent days. The data analysis assessed the variation in the frequency of VPCs and CVPCs between patients, seven hour periods one hour periods in a hierarchical model by a Poisson process. RESULTS: a) the frequency of VPCs follows a circadian rhythm, closely related to the hourly variations of the mean heart rate; b) disregarding the heart rate influence on the variability of the ventricular arrhythmia, its behavior was at random and unpredictable; c) the minimal percentual reduction in VPCs/h that discriminated between antiarrhythmic effect and spontaneous between antiarrhythmic effect and spontaneous between antiarrhythmic effect and spontaneous variability was 121.86% for seven-hour, 58.42% for 21-hour and 38.45% for 42-hour electrocardiographic monitoring periods; d) the same approach for the VCPCs revealed values of 133.6%, 63.21% and 41.3% respectively. CONCLUSION: The large variability of ventricular arrhythmia in CCD during a 24 hour period makes necessary observations always longer. The minimal percentual reduction in VPCs/h that discriminated between antiarrhythmic effect and spontaneous variability might be 58.42% for two 21-hour electrocardiography monitoring periods.

Adult↗