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Biomedical subjects

G Bellotti

Publications and source records attributed to G Bellotti.

At least 181 records · Page 10Linked to original sources
PubMed1990

[Surgical intervention in patients undergoing a procedure for mitral valvoplasty by balloon catheterization].

PURPOSE: To study the characteristics of patients undergoing catheter-balloon mitral valvoplasty (CBVM) procedure who needed surgical intervention after CBMV. PATIENTS AND METHODS: One hundred and five patients submitted a CBMV were divided in to Group I (GI) of eighteen surgical patients and Group II (GII) of eighty-seven non-surgical patients. The following parameters were analyzed. 1) age; 2) sex; 3) mitral valve area (MVA) and mean transvalvular gradient (G) by echodopplercardiography (2D); 4) Character of CBMV; 6) Relation of time between CBMV and Surgery with surgical indication; 7) Surgical findings; 8) Surgical procedure and 9) Post-operative evolution. RESULTS: Mean age of 34 (17-56) years old in GI and 33 (15-69) years old in GII; 2) Similar distribution of men and women in GI and GII; 3) Similar MVA and G in GI and GII; 4) 100% of elective character in GI and 94% in GII; 5) Transseptal via in 17 (94%) of GI and 87 (83%) of GII, retrograde arterial via in 1 (5.5%) of GI and in another (1%) of GII; 6) immediate: cardiac tamponade (28%); until 30 days: unsuccessful CBMV (39%); mitral insufficiency (MI) post-CBMV (11%), cardiac tamponade (5.5%), between 30 and 60 days: MI post-CBMV (22%), Mitral restenosis post-CBVM (5.5%); 7) Mitral stenosis (72%), MI post-CBVM (22%), hemopericardium (6%); 8) Mitral Commissurotomy (7), Mitral bioprosthesis implant (5), Commissurotomy plus Atrioseptoplasty (1), Mitral plasty (1), Pericardium drainage (1); 9) One (5.5%) death in immediate post-operative of the MI correction, 17 (94%) in functional class I/II (NYHA) 14.3 (8-27) months after surgery. CONCLUSION: Age, Sex, VMA G and Urgency character were not discriminative factors in the formation of GI and GII. The procedures for CBVM didn't interfere with post-operative prognosis.

Adolescent↗
PubMed1990

[Percutaneous transluminal angioplasty of the left main coronary artery in acute myocardial infarction].

Percutaneous transluminal coronary angioplasty is unusual in acute myocardial infarction after left main coronary artery occlusion. We applied this therapy in two cases. The first, a 54-year-old man, submitted to mechanical reperfusion and left main coronary artery angioplasty 145 minutes after the beginning of the symptoms and coronary artery surgery 12 hours later; the second, a 77-year-old woman, submitted to both procedures but not to surgery. In the first case there was a satisfactory follow-up but in the second, the patient died twelve hours later.

Aged↗
PubMed1990

[ST segment as an arterial recanalization indicator after thrombolytic therapy in myocardial infarction].

PURPOSE: To evaluate the importance of the segment ST in the identification of coronary recanalization in patients submitted to intravenous thrombolysis during acute myocardial infarction (MI). PATIENTS AND METHODS: Seventy four patients with MI, 62 male with mean age of 52.6 +/- 10 years. All patients had angiographically demonstrated occlusion of the infarct-related artery (IRA) before the thrombolytic treatment with intravenous "in bolus" infusion of 50 mg, 60 mg and 70 mg of rt-PA. The recanalization of the IRA was assessed 90 minutes later. The real status of the IRA in the angiograms was compared with the ST segment changes between the ECGs obtained before and after the thrombolytic therapy. RESULTS: Fifty six (75.6%) patients presented a significant reduction in the ST segment elevation (groups I and II). Of these, 47 possessed an opened IRA. From the 18 patients who did not show ST segment decrement (group III), 13 had an occluded IRA, and 5 an opened one. The method presented sensitivity of 90.3% and a specificity of 59.1%, positive predictive value of 83.9% and negative predictive value of 72.2%. CONCLUSIONS: The ST segment is an important marker of coronary recanalization or not following intravenous thrombolytic therapy.

Adult↗
PubMed1990

[Endomyocardial fibrosis. Course in patients undergoing clinical and surgical treatment].

PURPOSE: To follow-up a group of patients during a period of time after either clinical or surgical approach. PATIENTS AND METHODS: A hundred and twenty-one patients were studied retrospectively with endomyocardial fibrosis (EMF) for a period that varied from one month to 11 years (mean = 32 months). Upon entrance, patients had from 5 to 64 years of age (mean = 30), being 41 male and 80 female. Biventricular involvement were present in 70 cases, whereas 36 showed pure left and 15 pure right ventricular involvement. The patients were divided in two groups: 62 treated clinically, and 59 surgically, the latest defined as fibrosis resection added to atrioventricular valve rebuilding or replacement. All surgical cases had a prior III to IV functional class (NYHA). RESULTS: In the clinical group there were 24 fatalities, 21 who were in class IV, 1 in class III, and 2 in class II. In the surgical group there were 18 fatalities, 12 early and 6 late. CONCLUSIONS: (1) All the patients who survived the operation showed functional class improvement; (2) surgical mortality decreased in the latest years; (3) clinical treatment is indicated to patients in classes I and II, groups with low mortality rates; (4) surgical treatment is indicated to patients in classes III and IV, provided that clinical mortality is high in these groups of patients.

Adolescent↗
PubMed1990

[Rupture of the left sinus of Valsalva forming a subepicardial pseudoaneurysm].

A healthy 44 year-old male patient presented a calcified mass in the middle mediastinum on a chest film. During diagnostic investigation cineangiograms showed a rupture of the left sinus of Valsalva forming a large pseudoaneurysm that produced important distortion of the left coronary artery and it's main branches. The patient was submitted to surgical repair through the closure of the orifice of the ruptured left sinus of Valsalva with a bovine pericardium patch. The subepicardium was filled with organized thrombi which were removed. He was discharged from the hospital after uncomplicated postoperative course. Pathological examination of the aortic fragment did not yield the etiology of the rupture.

Adult↗
PubMed1990

[Systemic lytic state as marker of therapeutic success after rt-PA in bolus in myocardial infarction].

PURPOSE: Evaluate the lytic state (LS) expressed by the level of plasmatic fibrinogen (PF) after rt-PA "in bolus" infusion for acute myocardial infarction (MI) and its relation to coronary reperfusion. PATIENTS AND METHODS: Fifty-one patients (38 men, mean age of 53.0 +/- 9.8 years) with demonstrated occlusion of the infarct related artery (IRA) received an intravenous bolus infusion of 70 mg of rt-PA, PF was assessed before and 90 minutes after the treatment and the levels were compared in patients with (group 1) and without (group 2) reperfusion of the IRA. RESULTS: Basal levels of PF were within the normal range in all patients. There was a decrement of 35.1% in the PF dosed at 90 minutes, from 276.8 +/- 55.5 mg/dl to 168.0 +/- 68.2 mg/dl. Both groups were similar in the levels of PF 90 after treatment (145.1 +/- 95.7 mg/dl in group 1 versus 187.0 +/- 53.7 mg/dl in group 2). CONCLUSION: "In bolus" rt-PA treatment for MI significantly reduces the PF, but the LS obtained was similar in patients with or without reperfusion of the IRA.

Adult↗
PubMed1990

[Lymphocytic myocarditis. Response to treatment with immunosuppressive drugs].

PURPOSE: To evaluate immunosuppressive drugs on the treatment of myocarditis. PATIENTS AND METHODS: Right ventricular endomyocardial biopsy was performed in 102 patients with dilated cardiomyopathy. According to histopathologic aspect the patients were divided into two groups: I--with active lymphocytic myocarditis (ALM); II--without ALM: 51 patients. Ten patients from group I (Ib), with moderate or intense myocarditis were treated with prednisone and azathioprine during six months. RESULTS: After six months of observation, in group Ia (41 patients): 41 improved, 22% worsened and 12% died; in group Ib (10 patients): 60% improved, 10% worsened and 30% died; 51 patients in group II: 59% improved, 17% worsened and 10% died. Control biopsy on group Ib showed decrease of myocarditis in 62%. CONCLUSION: Immunosuppressive drugs do not always improve quality of life, or increase the survival, although in more than 50% of the cases it was possible to control inflammatory process.

Adolescent↗
PubMed1990

[Ambulatory cardiologic care: comparison between patients from a referral hospital and from community health centers].

PURPOSE--Comparison between patients from a cardiology referral center and those from community health facility. PATIENTS AND METHODS--564 (5.3%) of 10667 patients from the referral center--Instituto do Coração (InCor) and 105 (58.6%) of 169 from community health facility--Centro de de Santo Amaro (CSSA), São Paulo. RESULTS--217 (35.8%) patients in InCor and 27 (25.5%) in CSSA were younger than 40 years of age. Female patients were more frequent: 316 (56%) in InCor and 70 (66.7%) in CSSA. In InCor, 317 (56.2%) patients lived in São Paulo City and in CSSA all the patients live in the surroundings. Forty-three percent of the patients sought for medical attention in InCor by themselves, without medical referral. The diagnosis of heart disease was established in 81% of the patients in InCor and in 92.5% of the patients in CSSA. Other tests (besides electrocardiogram and chest roentgenogram) were considered to be indicated in 35% of the patients from InCor. The diagnoses were: a) coronary heart disease in 92 (20.1%) cases (InCor) and in 8 (8.2%) cases (CSSA); b) valvular heart disease in 46 (10.1%) cases (InCor) and in 9 (9.2%) cases (CSSA); c) mitral valve prolapse in 31 (6.8%) cases (InCor) and in 7 (7.1%) cases (CSSA); d) congenital heart disease in 10 (2.2%) cases (InCor) and in 1 (1%) case (CSSA); e) systemic arterial hypertension in 161 (35.2%) cases (InCor) and in 55 (56.1%) cases (CSSA); f) Chagas' infection or Chagas' heart disease in 44 (9.6%) cases (InCor) and in 8 (8.2%) cases (CSSA); g) cardiac rhythm disorders in 38 (8.3%) cases (InCor) and in 8 (8.2% cases (CSSA); h) other diseases in 33 (7.2%) cases (InCor) and in 1 (1%) (CSSA); i) diseases of the aorta in 2 (0.4%) cases (InCor) and in 1 (1%) (CSSA). Medical treatment was recommended to 71.5% of the patients from the InCor and to 92.5% of the patients from CSSA. CONCLUSION--Our data suggest a degree of similarity between the groups of patients cared for in a cardiology referral center in our city in relation to a community health facility. These data may be useful in planning optimal use of referral hospitals facilities in our city.

Adult↗
PubMed1990

[Pacemaker with mechanical sensors. Accumulated experience in long-term follow-up].

PURPOSE: To evaluate the behavior of single chamber stimulation system, rate responsive with vibration sensing, taking into consideration the results of long term clinical follow-up. PATIENTS AND METHODS: From september 1986 to april 1989, 70 patients received pacemakers with vibration sensing. Sixty four patients (91.9%) implanted Activitrax I model and six (8.1%) Activitrax II. Thirty-one (44.3%) were men and the mean age was 51.2 years. Fifty-one patients (72.9%) had complete atrioventricular block, 11 (15.7%) sinus node dysfunction, one (1.4%) sinus node and atrioventricular disease, and one (1.4%) for therapeutic support of arrhythmia. The etiology of these dysfunctions were Chagas' disease in 31.4%, myocardiosclerosis in 35.7%, post-operative in 15.6%, post-av node fulguration in 5.8% and idiopathic in 11.5%. The group was submitted to clinic and electronic evaluation and laboratory examinations: echocardiogram, dynamic ECG, stress test and ergoespirometric test. The mean follow-up as 19.6 months. RESULTS: Clinic evaluations: decrease in congestive heart failure functional class in 86% of the patients. No recurrence of syncopes and no cardiac deaths. Echocardiogram: increase in ejection fraction in 42% of patients. Dynamic ECG: appropriate rate response in 94.3% of patients (good cronotropic response). Ergoespirometry: increase in oxygen consumption in 75% of studied cases, Electronic evaluation: absence of generator dysfunction; complications in 18% of cases, all corrected by reprogramation. CONCLUSION: The single chamber cardiac stimulation system with vibration sensing showed safety, efficacy and low rate of complications.

Adolescent↗
PubMed1990

[Acute pulmonary edema as an early manifestation of systemic lupus erythematosus].

A 36 year-old male patient developed acute pulmonary edema due acute mitral insufficiency as early manifestation of systemic lupus erythematosus. The patient was treated with supportive measures, oxygen, furosemide, and isosorbide dinitrate. He was started on prednisone 60 mg daily 14 days later, after the diagnosis of lupus was established. The patients is asymptomatic with mitral systolic murmur 5 months after hospital discharge.

Adult↗
PubMed1990

[Cerebral malformation of the conceptus associated with maternal bacterial endocarditis and with aortic valve replacement during pregnancy].

A twenty-three years old woman, without previous heart disease developed endocarditis with negative bloods cultures on the fourth month of her third pregnancy. Fever was controlled through antibiotics, however she developed cardiac insufficiency and was submitted to surgery for replacement of aortic valve with a bioprosthesis. The post operative period showed no problems and the patient was discharged on the forty second day after admission. On the thirty ninth week of pregnancy she gave cesarean birth, without complications. The newly born, apgar 5 (1 min.) and 7 (5 min) presented signs of neurological problems, characterized on the second month as a cerebral atrophy. Among various possible factors, the most likely would be cardiopulmonary bypass circulation as the cause of the neurological malformation.

Adult↗
PubMed1990

[Mitral valve prolapse in infective endocarditis. Incidence and characteristics].

UNLABELLED: PURPOSE valve prolapse (MVP) cases, complicated with infective endocarditis (IE), seen at a cardiologic reference hospital. METHODS: The MVP cases were diagnosed within a series of 276 cases of IE without previous cardiac surgery with clinical-echocardiographic criteria. We emphasised in our study; a) incidence; b) age and sex distribution; c) risk factors for IE; d) clinical-bacteriological data; e) echocardiographic features; f) therapeutic aspects; f) evolution and complications. RESULTS: a) We diagnosed 40 (14.4%) cases of MVP; b) mean age of 40.6 years, with 29 men (72.5%); c) dental procedures without prophylactic antibiotic-therapy in seven patients (17.5%), mitral regurgitation in 33 (82.5%), mitral valve redundancy in six (15%); d) fever was found in all patients (100%), cachexia was diagnosed in eight (20%), polyarthritis in six (15%) and congestive heart failure in six (15%). A systolic murmur of mitral regurgitation was found in all the patients and a nonejective click was encountered in four (10%), a Streptococcus was cultivated in 30 (75%), Staphylococcus in three (7.5%) Haemophilus sp in three (7.5%) Peptostreptococcus products in one (2.5%) and negative in three (7.5%) patients; e) echocardiographic signs of vegetation in 23 (57.5%), mitral regurgitation in 33 (82.5%), rupture of mitral chordae in 11 (27.5%) and mitral redundance in six (15.2%); f) 37 (92.5%) patients were medically treated and three (7.5%) required surgery; g) we registered in the hospital evolution: stroke in 10 (25%) and noncerebral mycotic aneurysm in 2 (5%) cases, two patients died (5%), one due to a hemorrhagic complication after surgery of bioprosthesis implantation and another of rupture of a cerebral mycotic aneurysm. CONCLUSION: The MVP was frequent in the population of patients with IE with of patients with mitral regurgitation, and male with mean age greater than the other cases. We observed low incidence of surgical need (7.5%) and lethal outcome (5%) but frequent (25%) neurological complications.

Adolescent↗
PubMed1990

[Predictive value of programmed ventricular stimulation after myocardial infarction].

PURPOSE: To find out whether is there a relation between electrophysiology laboratory ventricular arrhythmias through programmed ventricular stimulation, and the occurrence of relevant clinical events, particularly, sudden death, in patients victims of first episode of myocardial infarction. PATIENTS AND METHODS: Twenty-seven patients (all males) who suffered non-complicated first myocardial infarction, with age varying from 47 to 70 (mean 54 +/- 6) years were prospectively and consecutively studied. Upon consent, patients were at first submitted to conventional cinecoronaryography and to programmed ventricular stimulation utilizing the S2, S3, S4 protocol, 30 days after infarction. Moreover, patients were submitted to continuous electrocardiographic (Holter system), exercise test, and radioisotopic studies for left ventricle ejection fraction (phase I). The last three studies were subsequently repeated at 6 and 12 months (phases II and III), respectively. RESULTS: All patients had ventricular arrhythmia induced, and according to the kind of response, patients were grouped into: group I--repetitive ventricular response, RVR, nine (33.5%) patients; group II--non sustained ventricular tachycardia. NSVT, eight (29.5%) patients; group III--sustained ventricular tachycardia SVT, ten (37%) patients. The patients of three groups, when submitted to electrocardiographic exercise test and Holter system studies, revealed complex arrhythmias in all phases. One patient of group II suddenly died at home, and another was injured with syncope, whereas in group III, two suddenly died, one at home and the other at the admission to the hospital, after an acute myocardial infarction. All patients but one of group I, who had a non-fatal reinfarction, showed preserved ventricular function. CONCLUSION: Holter system and electrocardiographic exercises test revealed complex dysrhythmia in the tree phases of the study, independently of the induced response; C--Holter system and electrocardiographic exercise test studies revealed no relation. between sudden death and the kind of ventricular induced response or complex arrhythmia. Ventricular arrhythmia induced with S2, S3 and S4 protocol in patients with preserved ventricular function seems to indicate results without predictive value for cardiac sudden death.

Aged↗
PubMed1990

[Infective endocarditis: analysis of 300 episodes].

PURPOSE: Study of clinical features and etiologic agents, treatment and mortality of patients with infective endocarditis (IE). PATIENTS AND METHODS: 300 episodes of IE occurring in 288 patients, ages ranged between 0.2 and 78 (mean 30.76) years; 185 (62%) episodes occurred in males. RESULTS: a) etiologic agents: viridans group streptococci in 93 (31%) episodes, enterococci en 21 (7%), group D-non enterococci in 19 (6%) (13 S. bovis), other streptococci in 14 (5%), Staphylococcus aureus in 59 (20%), Staphylococcus epidermidis in 14 (5%), gram-negative bacteria in 16 (5%), gram-positive bacteria other than streptococci and staphylococci in 8 (3%), fungi in 4 (1%). The etiologic agents were not identified in 52 (17%) episodes; b) underlying cardiac diseases: valvular heart disease in 119 (40%) episodes, congenital heart disease in 37 (12%), prosthetic heart valves in 69 (23%), other heart diseases in 6 (2%). There was no evidence of previous heart disease in 69 (23%); c) treatment: surgical treatment was undertaken in 102 (34%) episodes. The frequency of surgical treatment in relation to the etiologic agents ranged between 1% (non-group D streptococci) and 62% (negative blood cultures). The frequency of operation in relation to underlying heart disease ranged between 17% (other heart diseases), 19% (congenital heart disease) and 54% (prosthetic heart valve); d) mortality: 78 (26%) patients died, 56 (28%) of the 198 submitted to medical treatment and 22 (21%) of the 102 submitted also to surgical treatment. The mortality in the different groups of etiologic agents ranged between 5% (non-group D streptococci) and 62% (gram-positive bacteria other than streptococci and staphylococci); in relation to the underlying heart disease, the mortality was 16% in patients with other heart disease, 19% in valvular heart disease patients, 21% in patients with congenital heart disease, 23% in patients without known heart disease and 43% in patients with prosthetic heart valves. CONCLUSION: The mortality associated with IE remains still high in spite of modern treatment; the mortality is different in relation to the different etiologic agents and in relation to the cardiac status before the IE.

Adolescent↗
PubMed1990

[Late potentials in patients with myocardial infarction subjected to coronary thrombolysis].

PURPOSE: Analyse the behavior of the late potentials (LP) in patients submitted to thrombolysis with success. MATERIAL AND METHODS: Thirty-five patients with acute myocardial infarction, 32 (91.4%) male with ages varying from 33 to 68 (mean 52.6). Thrombolysis was obtained during cinecoronarography with intravenous infusion "in bolus" of doses of 50 mg, 60 mg and 70 mg of rt-PA, with a new bolus of 30 mg at 60 minutes after the procedure. A new angiographic study was performed 12-48 hours late. The high resolution ECG was taken with the ART system model 1200 EPX, before, after and 72 hours later. The presence of electrical activity in the last 40 ms of the QRS complex with less than 20 mu volts in amplitude and more than 35 ms in duration characterized the LP. RESULTS: LP was observed in 16 (46%) patients during the phase of arterial occlusion. LP was recorded only in 23% after recanalization and in 26% when the infarcted related artery (IRA) remain opened. The reduction in the LP was 43.5%. Only one patient with LP had threatening arrhythmia. CONCLUSION: In patients with demonstrated thrombotic occlusion of the IRA, the recanalization diminished the incidence of LP in 43.5% of the patients. Further studies are necessary to achieve the exact clinical importance of these findings.

Action Potentials↗
PubMed1990

[Endocarditis caused by Streptococcus bovis and colorectal neoplasms].

PURPOSE: To evaluate the association of Streptococcus bovis endocarditis with large bowel neoplasms. PATIENTS AND METHOD: Twenty episodes (19 patients) of Streptococcus bovis endocarditis (5.05%) selected from 396 episodes of endocarditis followed up from 1978 to 1990. The mean age was 57.68 years, 16 (84.21%) were males. Previous heart disease was not known in nine (45%). Previous manipulation that might induce bacteremia was identified in three patients. Symptoms related to neoplasia of the digestive system were not informed. The mean time of follow up (17 cases) was 33.76 months, standard deviation 27.37 months. Sixteen patients were submitted to colonic evaluation (barium enema in 11, colonoscopy in 5 patients, and both were performed in 5 patients). RESULTS: Bowel neoplasias were diagnosed in 12 (75%) of 16 patients submitted to colonic evaluation, one colonic adenocarcinoma in one (8.33%), patient, histologic benign polyps in eight (66.6%). Two patients are waiting for colonoscopic resection. In one patient the polyp was lost after colonoscopic resection. CONCLUSION: The high incidence of large bowel neoplasia in patients with Streptococcus bovis endocarditis indicates that evaluation of the large bowel must be performed on in patients with S. bovis endocarditis in order to diagnose neoplasias, even in the absence of symptoms of bowel disease.

Adenocarcinoma↗