Biomedical subjects
Publications and source records attributed to G Bellotti.
A 69 years old man with pulmonary embolism early after coronary bypass surgery complicated by ischemic stroke received thrombolytic therapy. Reperfusion of the pulmonary artery was achieved. Conversion of the ischemic stroke to hemorrhagic infarction was observed at the CT-Scan without neurological impairment.
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PURPOSE: To analyze adverse reactions (AR), hemodynamic and electrocardiographic changes and thallium scintigraphy (TS) results, during pharmacological stress with dipyridamole (SD), correlating these data to the presence and extension of coronary artery disease (CAD). METHODS: We studied 126 patients, 66 had no evidence of cardiovascular disease (G1) and 60 had critical occlusive CAD > or = 70% stenosis (G2). Most of them were male, mean age 56.5 +/- 10.9 years old. All patients were submitted to TS after receiving 0.56 mg/kg of dipyridamole intravenously (0.14 mg/min during 4 min) followed by 111MBq of thallium-chloride-201. Conventional ECG was recorded before and after SD; heart rate (HR) and arterial pressure (AP) were monitored during dipyridamole infusion. All signals and/or symptoms were observed. RESULTS: Cine-coronarography showed 22 patients (37%) with one vessel disease (VD) (G2a), 26 (46%) with two VD (G2b) and 12 (20%) with three VD (G2c). Of the 126 patients 63% did not present symptoms. Flushing (25%) and sick-headache (12%) were most frequent AR. Typical angina was reported by one G1 patient (1.5%) and six G2 patients (10%) (p < 0.05). HR increased 18.09 +/- 12.27% and 12.40 +/- 4.90%, systolic blood pressure varied -5.2 +/- 7.5% and -4.3 +/- 6.5% in G1 and G2, respectively. These parameters are not correlated to CAD presence and extension. ST depression and ectopic beats occurred in 5% and 11% of G1 patients, in 15% and 30% of G2 patients, respectively (p < 0.05). Typical angina was more common in G2a and G2b; ST changes in G2b and G2c; and arrhythmia in G2c (not significant). Sensitivity of TS associated to SD was 84%, comparable to stress exercise thallium test. CONCLUSION: TS associated to SD, a noninvasive, safe with low morbidity and few collateral effects method is an option to patients with limitations to physical exercise tests.
PURPOSE: To evaluate if early interventions which increase flow in the non-infarct related arteries (NRA) could improve long-term ventricular function in the non-infarct (NI) area after an acute myocardial infarction (MI). METHODS: We studied regional wall motion analyzed by the center-line method in two groups of patients with significant stenoses (> or = 70%) in the NRA after successful coronary reperfusion (chemical or mechanical thrombolysis). Group I (GI) consisted of 21 patients that were submitted to early (mean 14 days) complete surgical revascularization of both NRA and infarct related artery (IRA); the 12 group II (GII) patients underwent successful revascularization of the IRA only, with percutaneous transluminal coronary angioplasty (mean 6 days). Paired ventriculograms were obtained within 48 hours of the infarction and a mean of 17 months later. RESULTS: NI area contractility in GI patients improved from -0.35 +/- 2.16 to +0.62 +/- 1.6sd/chord (p < 0.05), whereas in GII decreased from +0.54 +/- 1.78 to -0.66 +/- 1.72 sd/chord (p < 0.05), p < 0.05 between the groups at follow-up. Mean infarct area wall motion did not differ between the two groups: from -3.04 +/- 2.43 to 2.61 +/- 2.49 sd/chord in GI (p = NS), and from -2.68 +/- 2.54 to -2.93 +/- 2.35 sd/chord in GII (p = NS). Mean global left ventricular (LV) ejection fraction did not change in GII patients (0.72 +/- 0.09 and 0.67 +/- 0.12, p = NS), but significantly increased from 0.63 +/- 0.12 to 0.72 +/- 0.11 in GI patients (p < 0.01). CONCLUSION: These data suggest that early revascularization of NRA with significant stenoses can improve not only the NI area regional contractility, but also the global LV function in the long-term follow-up of post MI patients treated with thrombolytic therapy.
BACKGROUND: Dynamic cardiomyoplasty is a relatively new surgical procedure proposed for treatment of severe myocardial failure. Limited clinical experience suggests that this procedure reverses congestive heart failure, improving the long-term survival. METHODS AND RESULTS: In this investigation, the late effects (16.5 +/- 4.8 months after surgery) of cardiomyoplasty on left ventricular mechanics and diastolic filling were studied in eight male patients (mean age, 45 +/- 7 years). The investigation was performed with the myostimulator on and off (24 +/- 1 hours off) using a microtip catheter to obtain the left ventricular pressures simultaneously with Doppler (inflow velocities) and M-mode and two-dimensional echocardiographic recordings. Statistical comparisons were made with Student's t test for paired data. Dynamic cardiomyoplasty increased the maximal elastance (17 +/- 1 versus 21 +/- 1 mm Hg/cm, P = .006) and decreased the systolic wall stress (253 +/- 17 versus 190 +/- 12 g/cm2, P = .029). Left ventricular end-diastolic pressure decreased (27.1 +/- 2.8 versus 17.6 +/- 1.7 mm Hg, P = .019), as did end-diastolic circumferential wall stress (69 +/- 8 versus 37 +/- 5 g/cm2, P = .002). The chamber and muscle stiffnesses decreased (120 +/- 31 versus 52 +/- 11 mm Hg/cm, P = .017; 994 +/- 185 versus 426 +/- 76 g/cm2, P = .002, respectively). The pattern of left ventricular diastolic filling changed, with a decrease of early peak flow (231 +/- 20 versus 217 +/- 21 mL/s, P = .022), of deceleration time (163 +/- 28 versus 116 +/- 26 seconds, P = .001), and of flow area during rapid filling (105 +/- 15 versus 75 +/- 12 mL, P = .004) and an increase of flow area during atrial contraction (39 +/- 4 versus 88 +/- 9 mL, P = .001). CONCLUSIONS: Our detailed evaluation of left ventricular mechanics demonstrates that cardiomyoplasty has significant multiple beneficial effects on dilated myopathic heart.
PURPOSE: To study preoperative cardiological consultations in a cardiology referral center in a general hospital. METHODS: Two hundred and fifty five patients were studied between June and December 1989; the ages ranged between 16 and 82 (mean 55) years, 120 (47%) were male and 135 (53%) female. A questionnaire was applied by the physicians during consultation. RESULTS: Main symptoms were thoracic pain in 30 (11.8%) cases, dyspnea in 57 (22.4%), palpitations in 13 (5.1%). Symptoms of cardiac disease were absent in 141 (55.3%) patients. On physical examination arterial hypertension was detected in 75 (29.4%) cases and a cardiac murmur in 21 (8.2%). Diagnosis of coronary artery disease was made in 30 (11.8%) cases--13 (5.1%) with history of previous myocardial infarction, aortic valve stenosis in 5 (1.9%), other valvular heart diseases in 14 (5.5%), cardiac arrhythmias in 11 (4.3%). Heart disease was absent in 90 (35.4%) patients. Sixty-five (25.5%) patients were on drug therapy for heart diseases. Consultations were obtained for patients that had been already admitted to the hospital in 171 (67%) cases. Cardiological follow up was recommended to 150 (58.8%) patients. Seven patients died; the cause of the death was related to the primary disease. Contraindication for surgery imposed by cardiological evaluation did not occur. CONCLUSION: In this study, patients with heart disease tolerated the surgical procedures. Preoperative cardiological evaluation added useful data for postoperative care and also for long term follow-up of the patients.
PURPOSE: To evaluate the results of direct current catheter ablation of accessory pathways by mean of a new low energy power source. METHODS: Catheter ablation was performed in 40 consecutive patients (23 male, mean age 31 +/- 11 years) with accessory atrioventricular pathways (AP) using a low energy DC power source. The electrophysiologic study and AP ablation were performed in the same procedure by endocardial approach using non-deflectable 6F bi, tri, or quadripolar electrodes. RESULTS: AP was located at left free wall (LFW) in 22 patients (55%), posteroseptal (PS) in 11 patients (27.5%), anteroseptal (AS) in 5 patients (12.5%) and right lateral (RL) in 2 patients (5.0%). A mean of 7.7 +/- 7 catodal shocks of 5-75 (20) joules (J) was delivered in 1.45 +/- 7 sessions, with a mean cumulative energy of 178 +/- 213J per patient. The mean values of number of shocks, number of sessions and cumulative energy per patient were lower in LFW AP ablation than in other positions (5 +/- 4 x 11 +/- 8 - p = 0.008; 1.1 +/- 0.3 x 1.8 +/- 0.9 - p = 0.008 and 118 +/- 150 x 260 +/- 245 - p = 0.03). The mean CK-MB rise was 18.5 +/- 7.8U/1. Three patients (7.5%) presented hemopericardium after PS AP ablation and in 1 patient (2.5%), a PS AP (paranodal pathway) ablation resulted in total atrioventricular block. During a follow-up of 9.5 +/- 4 months AP was absent in 28 (70%) patients; 18/22 (82%) with LFW AP, 6/11 (54%) with PS AP, 3/5 (60%) with AS AP and 1/2 (50%) with RL-AP, (p = 0.10). CONCLUSION: Low energy DC ablation is effective for AP ablation. The results are related with AP position.
PURPOSE: To analyze macro and microscopic features of atherosclerotic plaques located in bifurcation of coronary arteries, defining their spatial disposition in those sites. METHODS: We studied 38 bifurcations of coronary arteries of patients whose cause of death was related to coronary artery disease. Histologic sections of 0.5mm were sequentially made from the main artery to the secondary branches. They were stained with hematoxilin-eosin technique. Histological analysis evaluated: a) morphologic composition of the plaques, b) degree of obstruction and c) plaque's disposition. RESULTS: a) Plaque's composition: fibrolipid plaques constituted 80% of the cases and mingled focal atrophy of the media at the base of the plaque in 61% with spots of total destruction and rupture of the elastic layers in 30%; b) degree of obstruction: ranged from 20% to 95%, with average 60 +/- 28%; c) disposition of plaques: we verified morphologic variation along the plaque, most of them (71%) being eccentric at bifurcation and not reaching the beginning of flow divider walls. CONCLUSION: Atherosclerotic plaques located in bifurcation of coronary arteries of adults are often fibrolipid plaques, eccentric, and their spatial disposition on those sites spare the beginning of the inner walls, reaching the outer walls.
PURPOSE: To compare immediate and long term results balloon mitral valvuloplasty (BMV) using double balloon or bifoil balloon. METHODS: One hundred and thirteen consecutive cases of BMV used aleatory double balloon (group DB--55 cases) or bifoil balloon (group BF--16 cases). Patients were similar regarding to age, sex, valvopaty etiology, functional class and echocardiographic score. Seventy one (63%) patients achieved 12 months follow-up. RESULTS: In group DB there were 2 (4%) insuccess, 2 (4%) cardiac tamponade and 2 (4%) deaths, 91% patients had immediate criteria of success. Mitral valve area (MVA) increased from 0.8 to 1.69cm2 and mitral gradient (G) by echodopplercardiographic (ECHO) decreased from 17.9 to 4.8mmHg. Three (5%) patients developed severe mitral regurgitation (MR) and needed surgical intervention. At follow-up 2 (4%) developed mitral restenosis. MVA estimated by ECHO study after one year follow-up was inferior to 1.15cm2 in 15 (32%) cases, between 1.5 and 2.0cm2 in 17 (37%) and superior to 2.0cm2 in 14 (31%). In group BF there were 2 (12.5%) insuccess, 4 (25%) developed severe MR occurring 1 death immediate post-operative mitral valve replacement. Among 14 (87%) success cases, MVA increased from 0.8 to 1.89cm2 and G decreased from 18 to 6.4mmHg. Lately 2 (12.5%) needed surgical intervention because significative MR. At 12th month follow-up the ECHO study showed that in one (10%) case MVA was < 1.5cm2, and in 3 (27%) cases was between 1.5 and 2.0cm2. CONCLUSION: There were similar good results in both groups, however group DB had more restenosis, cardiac tamponade and vascular complications and group BF had more severe MR.
PURPOSE: To verify if the ventricular function and the incidence of arrhythmias in patients of both sexes could be predominant in male patients with Chagas' disease. METHODS: Six hundred and thirty one patients were studied, 329 female and 302 male, with age of 10 to 64 years old (mean 40). All patients were submitted to M mode echocardiographic study to analyse the ejection fraction (EF). To verify the importance of the ventricular dysfunction in male and female patients, they were divided according to the EF in three groups: A) normal EF, B) EF between 0.64 and 0.45 and C) EF less than 0.44. The incidence of ventricular tachycardia was analyzed at the stress test or 24h Holter studies. RESULTS: The number of patients with depressed EF was more frequent on male patients (p < 0.0001). The incidence of ventricular tachycardia was similar in both sexes, however it was more frequent in patients with ventricular dysfunction. CONCLUSION: Our results show that there are greater myocardial dysfunction on male patients, what could explain the worse prognosis observed on patients of this sex.
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PURPOSE: To evaluate percutaneous mitral balloon valvuloplasty (PMBV) in surgical high risk patients. METHODS: Twenty (12%) patients out of 172 submitted to a PMBV were considered high surgical risk cases; 17 (85%) were women and mean age was 43 (18-69). Thirteen (65%) were in acute pulmonary edema (3 were pregnant, 2 had previous cerebrovascular event, 1 had pulmonary thromboembolism and other had chronic renal failure), and 7 (35%) were in functional class (CF) III (2 had coronary artery disease, 2 severe obesity, 1 pulmonary neoplasia, 1 cardiac cachexia and one with previous cerebrovascular event). All patients underwent PMBV through transseptal technique. Double balloon was used in 10 (50%) patients; Inoue balloon in 5 (25%), mono-foil in 3 (15%) and bi-foil in 2 (10%). RESULTS: Seventeen (85%) obtained success and 2 (10%) had clinical improvement. The hemodynamic results pre versus post-PMBV showed: left atrium pressure (LAP) mmHg 28.2 +/- 10.0 x 15.2 +/- 9.2 (n = 20) (p < 0.001), mitral medium gradient (G) mmHg 21.2 +/- 10.7 x 10.7 +/- 6.7 (n = 18) (p < 0.001), mitral valve area (MVA) cm2 0.73 +/- 0.3 x 1.73 +/- 0.6 (n = 11) (p < 0.001), pulmonary artery pressure mmHg 52.0 +/- 18.2 x 40.1 +/- 14.7 (n = 18) (p < 0.001) and cardiac index L/min/m2 2.1 +/- 0.4 x 2.5 +/- 0.6 (n = 14) (p < 0.001). Comparative echocardiography results pre, post and 6 months after PMBV showed: MVA 1.06 +/- 0.39 x 1.92 +/- 0.51 x 1.65 +/- 0.5 and G 13.8 +/- 4.7 x 7.3 +/- 3.6 x 7.3 +/- 4.4. There were two immediate deaths (pulmonary thromboembolism and multiple organs failure) and other after hospital discharge. The complications were: 2 (10%) patients with neurological complications, 1 (5%) atrial septal defect and other right atrium perforation (5%). CONCLUSION: PMBV offers an alternative to surgical treatment in high risk surgical patients and the results are maintained in the 6 month follow-up.
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This study evaluates the association between the presence of diagonal earlobe creases (ELC) and coronary artery disease (CAD). One thousand four hundred twenty-four patients (760 men and 664 women, aged 30 to 80 years) were examined for the presence of ELC and classified into 2 groups: group I control--1,086 consecutive patients who denied symptoms of myocardial ischemia and were admitted to a general hospital for other reasons; group II CAD--338 patients with documented CAD (presence of > or = 70% coronary diameter stenosis at angiography). ELC was present in 304 patients (28%) in group I and 220 (65%) in group II (p < 0.0001). The patients were stratified in age groups to isolate the influence of age because the prevalence of ELC and CAD increased with advancing age (p < 0.0001 for both). This association remained statistically significant in all decades, except for patients aged > 70 years. To further remove the confounding effect of different age and sex distributions between the groups, a direct adjustment of the ELC prevalence was performed. When adjusted for age and sex, the prevalence of creases was still 58% higher in patients with CAD than in control subjects (p < 0.001). The presence of ELC was also related to the extent of CAD as measured by the number of major arteries narrowed (p = 0.015). The observed sensitivity of the sign for the diagnosis of CAD was 65%, the specificity 72%, the positive predictive value 42% and the negative predictive value 87%.
To assess the role of arterial hypertension in left ventricle (LV) hypertrophy among hemodialysis patients, echocardiographic evaluation was performed in 10 hypertensive and 13 normotensive hemodialysis subjects matched for age, sex, race, duration of dialysis treatment and degree of interdialytic volume expansion. We excluded from the latter group patients with previous hypertension since hypertensive heart disease may persist after adequate blood pressure control. We also studied 17 normal controls and 10 non-uremic patients with essential hypertension. Comparisons between the two uremic groups showed that the hypertensive patients had a higher mass index (222 +/- 74 x 108 +/- 26, p = 0.0001) and posterior wall thickness (12 +/- 2 x 9 +/- 2, p = 0.0001) and a reduced LV radius/wall thickness ratio (4.4 +/- 0.7 x 5.8 +/- 1, p = 0.0001). There were no significant echocardiographic differences between normal controls and normotensive uremics. In contrast, compared to controls, hypertensive uremic patients showed an increased LV mass index (222 +/- 74 x 83 +/- 21, p = 0.0001) and posterior wall thickness (12 +/- 2 x 7 +/- 1, p = 0.0001) and a reduced LV radius/wall thickness ratio (4.4 +/- 0.7 x 6.5 +/- 1.1, p = 0.001), characterizing concentric hypertrophy. They also had ventricular dilation with larger LV dimensions than in controls (53 +/- 5 x 47 +/- 4, p = 0.004). In patients with essential hypertension, the mass index (135 +/- 22), wall thickness (11 +/- 1) and LV radius/wall thickness ratio (4.3 +/- 0.7) significantly differed (p = 0.0001) from those in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Malignant hypertension is a unique and natural model for the study of abnormalities of left ventricular function due to arterial hypertension, because the development and regression of these abnormalities can be observed in a short period. Studies of ventricular function by radionuclide ventriculography, either before or after therapy, have not been previously reported in malignant hypertensive patients. We used this methodology to study left ventricular function in 17 malignant/accelerated hypertensive patients at the time of admission to the hospital and 3, 6, and 9 months after discharge. Seventy percent of patients (12 of 17) had symptoms of congestive heart failure at admission. We compared these data with those obtained in 12 normotensive subjects and 13 mild-to-moderate untreated hypertensive patients. Blood pressure of malignant hypertensive patients was 213 +/- 26/140 +/- 17 mm Hg at admission and 165 +/- 23/101 +/- 15 after 9 months of therapy. Radionuclide ventriculography at admission showed that peak filling rates of malignant hypertensive patients (2.13 +/- 0.21 end-diastolic volume [counts] [EDV]/sec) were significantly lower than those in normotensive subjects (2.40 +/- 0.41) and in mild-to-moderate hypertensive patients (2.46 +/- 0.21). In contrast, peak ejection rates were significantly higher in malignant hypertensive patients (3.44 +/- 0.38 EDV/sec) than in the two control groups (3.01 +/- 0.32 and 3.10 +/- 0.43, respectively). Ejection fractions were similar in the three groups of patients. After 9 months of therapy, peak filling rates of malignant hypertensive patients increased to 2.38 +/- 0.35 EDV/sec, whereas peak ejection rates decreased to 2.89 +/- 0.43 EDV/sec, both not significantly different from data in controls.(ABSTRACT TRUNCATED AT 250 WORDS)
Data from a previous study concerning the distribution of human leukocyte antigen (HLA) haplotypes in siblings with essential hypertension suggested that at least one of the genes responsible for the genetic susceptibility to this disease is located in or near the HLA complex. The objective of the present study was to investigate if a given HLA-A, B, or DR gene could represent a marker for susceptibility to essential hypertension at the population level. Thus, the frequencies of HLA antigens were determined in Caucasian patients with essential hypertension (HLA-A and B antigens were determined in 89 cases, 85 of which were also typed for HLA-DR antigens). The results showed an increased frequency (p = 0.00064) of HLA-DR4, which was present in 34% of the patients and in 16% of local ethnically matched control subjects. We conclude that HLA-DR4 may represent a marker for susceptibility to essential hypertension in the Brazilian Caucasian population.
The aim of this study was to correlate the occurrence of ventricular dysrhythmias induced by programmed ventricular stimulation and sudden cardiac death (SCD) after a first episode of acute myocardial infarction (AMI). Twenty-seven consecutive male patients aged fifty-four +/- six (forty-seven to seventy) years were studied prospectively. Thirty days after AMI, patients were submitted to coronary arteriography and programmed ventricular stimulation with the S2-S3-S4 protocol. Noninvasive assessments, including Holter monitoring, ECG stress test, and radionuclide ejection fraction, were also repeated six and twelve months after AMI. Ventricular dysrhythmias were induced in all patients. According to such response, patients were divided into three groups: (1) repetitive ventricular response (n = 9); (2) nonsustained ventricular tachycardia (n = 8); and (3) sustained ventricular tachycardia (n = 10). All patients consistently developed complex ventricular dysrhythmias at Holter monitoring and ECG stress test. One patient from group 2 suffered SCD and another presented a syncope. Similarly, in group 3, 2 patients suffered SCD, 1 during a documented episode of recurrent AMI. Except for 1 patient, radionuclide ejection fraction remained unchanged throughout the study in all cases. SCD was also unrelated to the presence and type of dysrhythmias at noninvasive evaluation. Therefore, the type of ventricular dysrhythmia induced by the S2-S3-S4 protocol has no correlation with late SCD in patients with a first AMI and preserved ejection fraction.