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Biomedical subjects

G Dorros

Publications and source records attributed to G Dorros.

At least 91 records · Page 5Linked to original sources
PubMed1989

Percutaneous atherectomy of occlusive peripheral vascular disease: stenoses and/or occlusions.

Percutaneous atherectomy was performed using the Simpson Atherocath on 131 patients (87 male, 66%) with a mean age of 65 years. Clinical characteristics included evidence of significant coronary disease in 50%, hypertension in 46%, diabetes in 41%, and prior neurologic deficit in 32% of patients. The indication for atherectomy was claudication in 114 (87%) and rest pain, gangrene, or ulcer in 17 patients (13%). Atherectomy was successfully performed in 136/139 stenoses (98%) and in 56/56 occluded vessels with or without prior balloon angioplasty. No serious complications resulting in limb loss or emergency vascular surgery were encountered. Histopathology of retrieved specimens showed that 66% had atheromatous plaque, 45% had tunica media, and 30% had a form of thrombus. Material obtained from an occluded vessel was more likely to have thrombus and tunica media present than that from a stenosis (P less than 0.02 and P less than 0.05, respectively). Early angiographic follow-up (mean time, 17 weeks) showed a relatively low (17%) lesion recurrence rate. Percutaneous atherectomy can be successfully utilized in stenotic and occluded peripheral arteries with good success and no serious complications; stenoses appear to have a low recurrence rate.

Aged↗
PubMed1989

Stimulation of atrial natriuretic peptide and vasopressin during percutaneous transluminal aortic valvuloplasty.

The objective of this study was to determine the effects of transient aortic valve occlusion (balloon valvuloplasty) on vasoactive hormones in patients with heart failure. Plasma atrial natriuretic peptide, vasopressin, aldosterone, adrenocorticotropic hormone (ACTH), and plasma renin activity were measured before, immediately after, and 30 minutes and 18 to 24 hours following balloon inflation in 18 patients. Mean right atrial and pulmonary wedge pressures were 6 and 18 mm Hg before inflations, respectively, and were unchanged after balloon inflations (5 and 13 mm Hg, respectively). Systemic systolic/diastolic pressures were 139 +/- 8/65 +/- 4 mm Hg before occlusion, decreased to 47 +/- 5/34 +/- 3 mm Hg during occlusion, and returned to baseline after occlusions. Baseline atrial natriuretic peptide levels were 267 +/- 43 pg/ml and increased to 513 +/- 71 pg/ml after balloon inflations. Vasopressin levels before occlusion were 9.1 +/- 2.2 pg/ml and increased to 21.4 +/- 4.8 pg/ml after balloon inflations. Plasma renin activity was 5.4 +/- 1.4 ng/ml/hr before inflations and was not significantly changed after balloon inflations. No clinically significant changes in plasma sodium, potassium, creatinine, and osmolality were observed after the procedure. Aldosterone increased from 23 +/- 4 to 40 +/- 7 ng/dl 10 minutes after the last inflation. Plasma ACTH measured in seven patients with increased aldosterone was 28 +/- 8 pg/ml before and increased to 295 +/- 157 pg/ml 10 minutes after balloon inflations. The increases in natriuretic peptide and vasopressin were likely due to elevated intracardiac and decreased arterial pressures, respectively; they persisted in spite of no clinically significant changes in filling pressures 12 to 24 hours after the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMed1989

One-year follow-up results of the 1985-1986 National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty Registry.

In 1,801 patients in the 1985-1986 Percutaneous Transluminal Coronary Angioplasty Registry, overall 1-year mortality was 3.2%, the 1-year myocardial infarction rate was 7.2%, and the 1-year coronary artery bypass surgery rate was 13.2%. In the 78% of the cohort with all lesions successfully dilated and without major procedural complications (successful patients), the corresponding rates were 1.9%, 2.6%, and 6.4%. Nearly 20% of all deaths, 40% of all infarctions, and 25% of all bypass operations occurred in the small subset of patients (6.8%) who sustained periprocedural occlusion. Event rates were higher in patients with multivessel disease than in those with one-vessel disease. At 1 year, angina-free status was reported by approximately three fourths of all surviving patients, regardless of initial success. However, compared with successful patients, unsuccessful patients underwent intervening bypass surgery (42% vs. 6%) to achieve asymptomatic status more frequently. Comparison of the 1-year event rates in the 1985-1986 registry with those in the 1977-1981 registry indicated reductions in all major untoward events. These reductions became apparent after controlling for the more extensive disease of the 1985-1986 registry patients. In contrast, use of repeat angioplasty has increased by 50%. We conclude that the improved initial results reported in the 1985-1986 registry cohort were maintained at 1-year follow-up.

Angina Pectoris↗
PubMed1989

[Complex angioplasty. (I). Single dilatation versus multiple dilatation in patients with multi-vessel coronary disease].

Coronary angioplasty was successfully performed in 658/752 multivessel disease patients. One lesion was attempted in 338 patients (45%); two or more in 414 patients (55%). Complications occurred in 39 patients (5.2%): 19 (2.5%) had a transmural infarction, 26 (3.5%) urgent surgery, and 14 (1.9%) died. Recurrence occurred in 233/658 (35%) patients with 162/171 (94.7%) having a successful second angioplasty. Clinical improvement (follow-up: 31 months) remained in 81% of successful patients. Survival was not affected by the number of dilations performed but was adversely affected by the presence of prior surgery and ventricular dysfunction. Angioplasty can be an effective treatment without the need to dilate all vessels.

Aged↗
PubMed1989

[Complex coronary angioplasty (II). Dilatation of multiple lesions in single-vessel and multi-vessel coronary disease].

Angioplasty (PTCA) was successfully performed in 404/428 patients (94%). Two lesions were attempted in 74%; three in 21%; and four or more in 6% of cases. Significant complications included: 11 (2.5%) transmural infarctions, 9 (2.1%) emergency surgeries, and 6 (1.4%) mortalities. A lesion recurrence occurred in 106/404 patients (26%) with 81/89 patients (91%) having a successful second PTCA. A second recurrence occurred in 15/81 patients (19%) with 13/15 patients having a successful third PTCA. Follow-up (mean: 28.3 months) showed an improved anginal status in 83% of patients. The probability of survival at 51 months was 93%. Multiple lesion PTCA in carefully selected patients has a good success rate, an acceptable complication rate, and a reasonable expectation of satisfactory long-term results, with or without the need for subsequent PTCA procedures.

Angioplasty, Balloon↗
PubMed1989

Percutaneous transluminal coronary angioplasty in patients over the age of 70 years.

Percutaneous transluminal coronary angioplasty was successfully performed in 207 of 242 patients over the age of 70 years. Multivessel disease was present in 71 per cent of patients; 93.0 per cent of patients had good left ventricular ejection fractions (greater than or equal to 35 per cent). Angioplasty was successful in 348 of 385 lesions dilated (90 per cent), with the desired degree of revascularization achieved in 90 per cent of patients with the dilatation of one or two lesions. The complications encountered included five Q wave infarctions (2.1 per cent), seven angioplasty-related deaths (2.9 per cent), and three emergency bypass surgeries (1.2 per cent). The cumulative probability of survival was 92 +/- 3 per cent at 63 months, and at a mean of 2.9 years 66 per cent of patients were angina-free. These data indicate that selected symptomatic coronary disease patients over the age of 70 years unsatisfactorily managed with medication have been successfully managed with coronary angioplasty. The results of coronary angioplasty compare favorably to those of coronary artery bypass surgery.

Aged↗
PubMed1989

Percutaneous transluminal coronary angioplasty in patients with severe left ventricular dysfunction.

Although bypass surgery can be utilized in the patient with impaired left ventricular function, the acute outcome (regarding morbidity and mortality) and long-term survival have significant associated problems. Percutaneous transluminal coronary angioplasty (PTCA) was implemented effectively as an accessory or alternative to coronary bypass surgery to treat obliterative coronary lesions in patients with severe ventricular dysfunction. The authors present data which indicate that PTCA should be considered in patients with left ventricular dysfunction as a primary therapeutic modality.

Aged↗
PubMed1989

[Complex coronary angioplasty. I. Single or multiple dilatations in the involvement of several vessels in patients with coronary heart disease].

Coronary angioplasty was successfully performed in 658 of 752 multivessel disease patients. One lesion was attempted in 338 patients (45%), 2 or more in 414 patients (55%). Complications occurred in 39 patients (5.2%): 19 (2.5%) had a transmural infarction; 26 (3.5%) urgent surgery, and 14 (1.9%) died. Recurrence occurred in 233 (35%) of 658 patients with 162 (94.7%) of 171 having a successful 2nd angioplasty. Clinical improvement (followup: 31 months) remained in 81% of successful patients. Survival was not affected by the number of dilatations performed but was adversely affected by the presence of prior aorto-coronary bypass, surgery and ventricular dysfunction. Angioplasty can be an effective treatment without the need to dilate all vessels.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Complex coronary angioplasty. II. Dilatation of the multiple lesions in stenosis of one or several coronary vessels].

Angioplasty (PTCA) was successfully performed in 404 (94%) of 428 patients. Two lesions were attempted in 74%, 3 in 21% and 4 or more in 6% of cases. Significant complications included: 11 (2.5%) transmural infarctions, 9 (2.1%) emergency surgeries, and 6 (1.4%) mortalities. A lesion recurrence occurred in 106 (26%) of 404 patients with 81 (91%) of 89 patients having a successful 2nd PTCA. A 2nd recurrence occurred in 15 (19%) of 81 patients with 13 of 15 patients having a successful 3rd PTCA. Followup (mean: 28.3 months) showed an improved anginal status in 83% of patients. The probability of survival at 51 months was 93%. Multiple lesion PTCA in carefully selected patients has a good success rate and an acceptable complication rate.

Angioplasty, Balloon, Coronary↗
PubMed1989

Complex angioplasty: single versus multiple dilatations in multivessel coronary disease patients.

Percutaneous transluminal coronary angioplasty (PTCA) has become an accepted therapy in the management of selected patients with obstructive coronary disease, including selected patients with multivessel disease. This article reports the authors' experience with PTCA in patients who underwent single or multiple dilatation angioplasty, their outcome, and follow-up. It also provides an additional perspective to the multivessel coronary disease patient.

Adult↗
PubMed1989

Coronary angioplasty in patients with prior coronary artery bypass surgery: all prior coronary artery bypass surgery patients and patients more than 5 years after coronary bypass surgery.

Percutaneous transluminal coronary angioplasty (PTCA) has been used successfully in patients who have had prior bypass surgery (CABG) as a means of revascularizing the myocardium and avoiding repeat myocardial revascularization. However, angioplasty has been considered inappropriate as a means of dilating old saphenous vein grafts. The first section of this article details the authors' experience with PTCA of prior CABG patients, and the second section discusses the results of PTCA in the subset of patients 5 or more years after their last coronary bypass surgery. These data may make individuals rethink the appropriateness of PTCA in old saphenous vein grafts.

Aged↗
PubMed1988

Percutaneous transluminal coronary angioplasty in patients with two or more previous coronary artery bypass grafting operations.

Between 1979 and 1986, 65 of 76 patients (86%) (82% men, with a mean age of 58 +/- 8 years) with greater than or equal to 2 previous coronary artery bypass grafting (CABG) operations and symptomatic myocardial ischemia underwent successful percutaneous transluminal coronary angioplasty (PTCA). Sixty-two patients had 2 prior CABG operations, 10 had 3 and 4 had 4. Clinical characteristics included prior myocardial infarctions in 49 (65%), severe angina (class III or IV) in 47 (62%) and left ventricular ejection fraction less than or equal to 35% in 13 (17%). There were 139 lesions dilated: 1 lesion in 39 (51%), 2 in 22 (29%) and greater than or equal to 3 in 15 (20%) patients. Arterial lesions were successfully dilated in 71 of 81 cases (88%), vein grafts in 44 of 53 (83%) and mammary artery grafts in 3 of 5 (60%). In 12 patients, PTCA was used to dilate significant lesions less than 15 days after CABG in vessels which were unable to be bypassed. Significant complications were encountered in 4 patients (5%). These included 3 of 53 vein graft dilatations with embolization (6%), with 1 resulting in infarction and death, and 1 patient dying after emergency CABG. At hospital discharge, 65 patients were clinically improved. An apparent symptom-related lesion recurrence occurred in 23 of 65 patients (35%), with 5 patients dying of cardiac causes, 4 having CABG without previous angiography and 12 of 14 patients undergoing repeat successful PTCA (mean time and standard deviation 9 +/- 6 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1988

Percutaneous mitral valvuloplasty: retrograde, transarterial double-balloon technique utilizing the transseptal approach.

Between February 1985 and May 1987, 72 patients with mitral stenosis (MS) underwent percutaneous transluminal mitral valvuloplasty (PTMV). The retrograde transarterial double-balloon technique was used on 54/72 patients (75%); 16 males, 38 females; mean age: 39 +/- 11 years. Transseptal catheterization was used to place two 0.035", 350-cm exchange wires into the ascending aorta in order to be snared, retrieved, and exteriorized, each through a femoral artery. Over these wires, the balloon dilation catheters were advanced through the femoral artery, retrogradely, across the mitral valve, for PTMV. The transmitral mean gradient fell [18 +/- 4 to 9 +/- 5 mmHg (P less than 0.001)]; the cardiac output increased [5.1 +/- 0.8 6.1 +/- 0.8 L/min (P less than 0.001)]; the hemodynamically calculated valve area increased [1.2 +/- 0.2 to 2.3 +/- 0.6 cm2 (P less than 0.001)]; and the short axis two-dimensional echocardiographic valve area increased [1.1 +/- 0.3 to 2.2 +/- 0.7 (P less than 0.001)]. PTMV was unsuccessful in two patients (4%), due to the inability to maintain the inflated balloons in the mitral position. Significant complications were encountered in two patients: two strokes (3.7%) and one mortality from the stroke (1.4%). Significant mitral regurgitation occurred in two patients (3.7%); no post-PTMV hemodynamically significant atrial septal defects were detected. Follow-up (mean time: 11 +/- 6 months) of 43 patients showed a persistent improvement in echocardiographic findings in 27 (63%) and hemodynamically measured mitral valve area in the 16 patients in which cardiac catheterization was repeated. The retrograde, transarterial double-balloon technique can successfully accomplish PTMV with good results and an acceptable low morbidity and mortality.

Adult↗
PubMed1988

Probe, a balloon wire: initial experience.

Coronary angioplasty is unsuccessful in less than 3-5% of cases because the balloon catheter fails to follow a guidewire that has traversed a lesion. Between June 1986 and August 1987, 31 lesions were unable to be crossed with at least two standard angioplasty catheters. Finally, a 2.0-mm-diameter Hartzler LPS (ACS) was utilized and successfully crossed and dilated 16 out of 31 lesions (52%). In the remaining 15 lesions, the Probe (USCI) 2.0 mm diameter x 1.5 cm long balloon wire was able to cross the lesions in 13 (82%) and successfully dilated 12. In one case, lesion rigidity prevented the balloon from expanding at 14 atm. A right coronary artery lesion was attempted in 11 cases, and a left anterior descending and circumflex artery lesion in two patients each. No complications were encountered. In seven out of 12 successful Probe cases, a larger balloon catheter was used to further dilate the artery. This new balloon wire has increased our success rate in severe stenoses and in tortuous vessels with severe distal lesions, in which presently available angioplasty equipment has failed.

Angioplasty, Balloon↗
PubMed1988

Percutaneous transluminal coronary angioplasty in multivessel coronary disease patients: short- and long-term follow-up in single and multiple dilatations.

Transluminal coronary angioplasty was successfully performed in 658 of 752 patients with multivessel disease. An angiographic success was achieved in 1198 of 1358 lesions (88%). One lesion was attempted in 338 patients (45%); 2 in 273 (37%); 3, in 101 (13%); and, 4 or more in 40 cases (5.3%). Significant complications occurred in 39 patients (5.2%): 19 (2.5%) had a transmural infarction; 26 (3.5%) required urgent myocardial revascularization; and 14 (1.9%) died. An apparent lesion recurrence occurred in 233 of 658 (35%) patients with 162 of 171 (95%) having a successful second coronary angioplasty. A second apparent lesion recurrence occurred in 37 of 162 patients (23%) with 24 of 28 (86%) having a successful third coronary angioplasty. Clinical improvement (mean follow-up: 31 +/- 17 months) persisted in 81% of successful patients. The cumulative probability of survival was 91.5% at 72 months. Survival was adversely affected, at 63 months, by the presence of prior bypass surgery (no prior bypass surgery, 94% vs. prior bypass surgery, 86%; p less than 0.05): at 24 months by a low left ventricular ejection fraction (less than or equal to 35%, 82% vs. left ventricular ejection fraction greater than 35%, 95%; p less than 0.01) and, at 57 months, in the multiple dilatation group with prior bypass surgery (no bypass surgery 96% vs. prior bypass surgery 84%; p less than 0.05). Multiple dilatation had a beneficial effect upon survival, at 27 months, in patients with a left ventricular ejection fraction less than or equal to 35% [single dilatation, 74% vs. multiple dilatation, 93%; p less than 0.001], and in patients greater than or equal to 70 years, at 39 months (79% vs. multiple dilatation, 92%; p less than 0.01). These data suggest that coronary angioplasty can be an effective treatment in patients with multivessel coronary disease without the need to dilate all diseased vessels, with good success, acceptable complication rates, and a reasonable expectation of satisfactory long-term clinical improvement.

Actuarial Analysis↗
PubMed1988

Comparison of complications during percutaneous transluminal coronary angioplasty from 1977 to 1981 and from 1985 to 1986: the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.

Because the effects of changing technology in percutaneous transluminal coronary angioplasty, increased operator experience and use of the procedure in patients with extensive disease are unknown in regard to complication patterns, the initial 1977-1981 cohort and the recent 1985-1986 cohort of the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry were analyzed with respect to complications. Compared with the initial cohort of 1,155 patients, the 1,801 new cohort patients were older and had an increased prevalence of multivessel coronary artery disease, depressed left ventricular function and prior infarction. Overall complication rates in the recent cohort were either unchanged or decreased from the rates in the initial cohort despite a higher risk patient population. The most significant decreases were in the incidence of coronary spasm (p less than 0.001) and the need for emergency coronary bypass surgery (p less than 0.01). Overall in-hospital mortality was low but was dependent on the extent of vessel disease--0.2% for single vessel disease, 0.9% for double vessel disease and 2.2% for triple vessel disease (p less than 0.001 for linear trend). Acute coronary complications of branch occlusion, dissection or abrupt closure were associated with increased rates of death, nonfatal infarction or need for emergency surgery. Factors showing a multivariate association with increased mortality included a history of congestive heart failure (p less than 0.001), age greater than or equal to 65 years (p less than 0.01), triple vessel or left main coronary artery disease (p less than 0.05), female gender (p less than 0.05) and new onset angina.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1988

Coronary artery bypass grafting for the third time or more. Results of 150 consecutive cases.

Through December 1986, coronary artery bypass surgery was performed on 150 patients who had undergone at least two previous myocardial revascularization surgeries. One hundred thirty-seven patients had two, 12 patients had three, and one patient had four previous operations. There were 117 men (78.0%); the mean age was 55.5 years (range, 28-76 years); 137 patients (91.3%) had triple-vessel disease, and 36 (24.0%) had a left ventricular ejection fraction less than 0.40. One hundred forty-nine patients (99.3%) had angina preoperatively, with 142 (94.7%) having Class III and IV angina. Direct myocardial revascularization was performed in all patients, with a mean of 3.3 grafts per patient (range, 1-6). In addition, coronary artery endarterectomy was performed in 70 cases (46.7%): right coronary artery endarterectomy in 15 (10.0%), left coronary artery endarterectomy in 39 (26.0%), and multiple coronary artery endarterectomies in 16 (10.7%). There were 18 in-hospital deaths (12.0%). Statistically significant risk factors for increased early mortality (p less than 0.01) included age over 65 years and left ventricular ejection fraction less than 0.40. Diffuse coronary artery disease requiring multiple coronary artery endarterectomies almost achieved statistical significance as a risk factor (p = 0.06). Complications in the surviving 132 patients included seven nonfatal perioperative myocardial infarctions (5.3%). Follow-up data for a period of 8-172 months (mean, 43.1 months) is available for 100 of 103 patients (97.1%). Five-year actuarial survival was 76.4% for the entire series and 87.3% for hospital survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗