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Biomedical subjects

H Nassar

Publications and source records attributed to H Nassar.

31 records · Page 2Linked to original sources
PubMed1995

Transradial approach for coronary angiography and angioplasty.

The transradial approach has currently been advocated as an alternative catheterization method for coronary angiography and angioplasty, due to the recent miniaturization of angioplasty equipment. The purpose of this study was to assess the practical clinical applicability of this method. From June to November 1994, 100 patients underwent coronary angiography and angioplasty with the transradial approach. Their mean age was 66.6 +/- 11.2 years, and 79 were men. In 4, radial puncture was not successful, and in 3, femoral access was necessary to complete the procedure. Coronary angioplasty was performed in 63 patients (76 lesions) with angiographic success (per lesion) of 96%. In 5 patients, a stent was successfully implanted. All patients were ambulatory on the day after the angioplasty procedure. In 98% of the patients, the introducer was taken out 1 to 4 hours after the procedure by local compression using a special custom-made device. No patient required blood transfusion. Major complications occurred in 2 patients; both had a cerebrovascular accident (1 probably not procedure-related), and both recovered. A radial pulse was palpated in 91 of the patients before discharge, and in 6 others, adequate flow could be heard with Doppler. In 2 patients, radial flow was restored within several weeks. None of the patients suffered from ischemia of the hand. Two patients had a small pseudoaneurysm successfully treated by local compression. Thus, coronary angioplasty can be performed safely using the transradial approach with relatively few vascular complications and with better patient comfort. However, the procedure is more time-consuming initially compared with the transfemoral approach due to a learning curve regarding equipment selection and catheter manipulation.

Adult↗
PubMed1995

Acute myocardial infarction--the angiographic picture: new insights into the pathogenesis of myocardial infarction.

The angiographic appearance of the coronary arteries were examined in 302 patients with stable angina pectoris and compared to 308 patients with acute myocardial infarction, who received high-dose intravenous thrombolytic therapy, in order to elucidate the underlying angiopathological picture in the two diseases. In each group coronary lesions were present in proximal segments of the arteries and were closely related to bifurcations. Lesions were more extensively distributed in the coronary tree in patients with stable angina and they had an average of 5.4 lesions per patient, compared to the acute myocardial infarction group who had only 2.4 lesions. Also, in the acute myocardial infarction patients, four-fifths of the culprit arteries were patent, 104 (34%) had a ruptured plaque, 22 (7%) had an ulcerated plaque and in 190 (62%) the lesions were eccentric. The study shows that patients with myocardial infarction who are suitable for thrombolysis have a unique coronary angiographic picture and the acute episode is caused by sudden rupture of a localized atheromatous plaque which initiates an obstructive thrombotic cascade.

Angina Pectoris↗
PubMed1995

Dissecting aortic aneurysm in systemic lupus erythematosus.

Many cardiovascular manifestations have been described in systemic lupus erythematosus (SLE). Aortic involvement, however, is very rare. We describe a 30-year-old woman with SLE who presented with extensive aortic dissection, and review the few reported cases. We discuss possible pathogenic mechanisms for aortic involvement in lupus and the appropriate diagnostic work-up.

Adult↗
PubMed1994

Creation and healing of severe coronary dissection by the use of oversized balloon for the treatment of restenosis after an initially successful angioplasty.

We describe two patients who underwent successful coronary angioplasty with a balloon that matched the normal size of the artery. Both patients returned for a second angioplasty because of restenosis. The morphology of the restenotic lesion was very similar to that of the original lesion. In the second angioplasty a larger balloon was used, and in both cases severe dissection occurred. Repeat angiography 3 months later demonstrated an open artery with clinically insignificant residual stenosis. We believe that in these two cases the initial angioplasty stretched the artery and it recoiled slowly to its original dimensions. A larger balloon size was necessary to crack atherosclerotic plaque and cause a successful long-term outcome.

Aged↗
PubMed1994

Very early thrombolysis in acute myocardial infarction--a light at the end of the tunnel.

Myocardial damage in acute myocardial infarction is a time-dependent process. Thrombolytic therapy effectively opens the coronary artery, restores coronary blood flow and prevents ongoing necrosis. We examined the effect of very early thrombolytic therapy (including prehospital administration) in a consecutive group of 510 patients with myocardial infarction on the following factors: mortality, complications and the preservation of left ventricular function. The treatment was given to 89 at home (time delay to treatment 1.2 +/- 0.6 h) and 421 in hospital (2.0 +/- 1.0 h). Twelve patients died in hospital and major hemorrhage occurred in 10. The arterial patency rate in 416 patients who underwent coronary angiography 6 days later was 82%. Infarct size measured by left ventriculography was determined by the area at risk, the delay time until the initiation of thrombolytic therapy, the total duration of ischemic pain and the degree of restoration of arterial blood flow. We conclude that early thrombolytic therapy, particularly prehospital management, is feasible and safe and reduces infarct size and mortality. A further decrease in the delay to initiation of treatment and more effective thrombolytic therapy will further decrease mortality and myocardial damage.

Aged↗
PubMed1992

Angiographic findings in the coronary arteries after thrombolysis in acute myocardial infarction.

The angiographic appearance of the coronary arteries was examined in 308 patients with acute myocardial infarction (AMI) who received high-dose intravenous thrombolytic therapy. Coronary angiography was performed on day 7 after admission to the hospital. Patients had an average of 2.4 discrete arterial narrowings or obstructions. The narrowings were proximal and related to bifurcations. Four fifths of the culprit arteries were patient; 104 (34%) had a ruptured plaque, 22 (7%) had an ulcerated plaque, and in 190 (62%) the lesions were eccentric. Patients differed from a comparable, previously studied, control series of 302 patients with chronic stable angina pectoris who had more extensive disease. They had 5.7 narrowings/patient, also located proximally and at bifurcations, but more widely distributed in the coronary tree. Patients with AMI who are suitable for thrombolysis have a unique coronary angiographic picture. The data confirm that AMI is caused by sudden rupture of a localized atheromatous plaque that initiates an obstructive thrombotic cascade.

Angina Pectoris↗
PubMed1992

Autodecremental pacing for the interruption of ventricular tachycardia and atrial flutter.

The efficacy and safety of autodecremental pacing (ADP) to interrupt ventricular tachycardia (VT) and atrial flutter was examined. Once tachycardia was recognized, ADP was initiated using a short train of stimuli with gradual shortening (3%) of the interstimulus interval. ADP was applied to 13 consecutive patients during 75 episodes of VT (mostly following induction by ventricular stimulation). Successful interruption of VT occurred in 88% of the episodes. In 6 episodes (8%), ADP resulted in ventricular fibrillation and in 3 episodes VT was unaffected by ADP. The only significant discriminator between the failure or success of ADP was the rate of VT. ADP was also applied to 17 consecutive patients with an atrial flutter that was resistant to conventional antiarrhythmic agents. Successful conversion of atrial flutter to sinus was seen in only 8 patients (47%). A temporary acceleration to atrial fibrillation appeared in 3 patients (18%), and in 6 patients atrial flutter was unaffected by ADP. ADP was successful in 70% (7/10) of patients with type 1 (< 300 beats/min) atrial flutter. The authors conclude that ADP is beneficial in the interruption of VT and atrial flutter in a selected group of patients, especially with a slower rate of tachyarrhythmia (atrial rate during atrial flutter < 300 beats/min and ventricular tachycardia < 180 beats/min).

Adult↗
PubMed1992

Recombinant interleukin-2 and interferon alpha immunotherapy following autologous bone marrow transplantation. A case report of cardiovascular toxicity with serial echocardiographic evaluation.

The most serious side effects of recombinant interleukin-2 (rIL-2) and recombinant interferon-alpha (rIFN alpha) immunotherapy are cardiovascular disturbances, including systemic hypotension, left-ventricular dysfunction and pulmonary edema. We present a 25-year-old female who developed reversible cardiogenic shock during intermediate dose rIL-2 and low dose rIFN alpha therapy. Rapid clinical improvement occurred after intravenous fluid and dopamine support. A serial echocardiographic evaluation, which has not been described previously in this setting, is reported.

Adult↗
PubMed1991

Cardiac tamponade following coronary arterial rupture during coronary angioplasty.

We describe a patient in whom percutaneous transluminal coronary angioplasty (PTCA) was complicated by rupture of the left anterior descending coronary artery (LAD) with pericardial tamponade. The outcome was favorable with drastic intervention which included: occlusion of the bleeding vessel with the PTCA balloon, pericardiocentesis, and ligation of the vessel without the need of aortocoronary bypass graft.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Surgical therapy for pulmonary hydatidosis.

Surgical treatment of pulmonary hydatidosis varies from one country to another. Whereas some reports describe marsupialization of the residual cavity others favor capitonnage (imbrication) to decrease complications and hospital stay. Post operative complications and hospital stay were compared in a retrospective study of 53 patients treated surgically at the American University Hospital over a period of 10 years. Forty eight cysts were treated by evacuation after chemical sterilization. Fifteen were marsupialized and 33 were imbricated. Five were excised with lung parenchyma, 5 were delivered intact and one cyst was treated by lobectomy. There was no postoperative mortality. There was no statistical difference in the hospital stay or the complication rate between the marsupialized and imbricated cases. Both imbrication and marsupialization are equally effective methods of treatment of pulmonary hydatid cysts. Anatomic resection is rarely required.

Adolescent↗