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Biomedical subjects

H S Wasir

Publications and source records attributed to H S Wasir.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Association of plasma lipoproteins with angiographically defined coronary artery disease.

Lipoprotein (a) and other lipoprotein variables have been correlated with angiographic severity of coronary artery disease. However, pattern of lipoprotein (a) distribution in various racial groups has been found to be different. To study this relationship in the Indian patients, plasma levels of lipoprotein (a) and other lipoprotein variables were examined in 144 consecutive patients undergoing coronary angiography. Total cholesterol and cholesterol content of various lipoproteins were assayed by chemical methods, and in 116 patients lipoprotein (a) was detected by gel electrophoresis. Lipoprotein (a) was positive in a total of 78 (67%) patients, and its positivity in the four angiographic groups with normal coronaries, single vessel, double vessel, and triple vessel disease was 69, 78, 61 and 67 percent respectively. Interestingly, lipoprotein (a) greater than 75 percentile tended to be more frequent in patients with increasing severity of coronary artery disease: 15%, 21%, 25% and 28% in the four groups, respectively. However, this was not statistically significant. Plasma levels of total cholesterol, cholesterol content of other lipoproteins and triglycerides were not significantly different in these four groups of patients. This study, therefore, shows that there is no significant correlation of lipoprotein (a) positivity with angiographic severity of coronary artery disease in our group of Indian patients, although higher values are more frequently present in patients with severe disease.

Coronary Angiography↗
PubMedDate not supplied

Our experience with Palmaz-Schatz coronary stent.

Between September 1993 and August 1994 we have implanted Palmaz-Schatz coronary stents in 44 patients. Twenty eight patients presented with stable angina and 16 with unstable angina. Stenting was carried out for denovo, focal lesions in large coronary arteries (n = 27), significant dissection during PTCA with acute threatened closure (n = 9), suboptimal results (n = 5), restenosis after PTCA (n = 2) and saphenous vein graft stenosis (n = 1). Successful delivery of the stent was achieved in 43 cases. Percent diameter stenosis was reduced from 77 +/- 11% to 10 +/- 8% and minimal luminal diameter increased from 1.08 +/- 0.28 mm to 2.92 +/- 0.39 mm. There was 1 death due to left main dissection secondary to guiding catheter trauma in a patient taken up for bail out stenting. Vascular/bleeding complications occurred in 3 patients (6.7%). There was no instance of acute or subacute stent thrombosis. Forty patients are symptom free. Eighteen patients underwent six month angiography. Restenosis (> 50% diameter reduction) was seen in 2 and a new lesion distal to stent occurred in 1 case. All have been successfully redilated. A high rate of successful delivery of the Palmaz-Schatz coronary stent can be achieved in a wide spectrum of patients with very few complications. Long term results are very gratifying and encouraging.

Angina Pectoris↗
PubMedDate not supplied

Profile of coronary risk factors in patients with manifest ischaemia and normal coronary arteries.

Risk factor profile of 142 patients with normal epicardial coronary arteries (86 males, 56 females, mean age 47 +/- 11 years) out of 1,508 consecutive patients undergoing coronary angiography was analysed. The mode of presentation in these patients was old or recent myocardial infarction (16.1%), unstable angina (12.0%), angina on effort (43.7%), atypical chest pain (8.5%), and anginal equivalent (19.7%). One or more stress test was positive in the majority (88%) of patients. Though the majority (39.5%) of patients had one risk factor, multiple (two or more) risk factors were not uncommon. Risk factor profile in patients with normal coronaries included hypertension (45.7%), dyslipidemia (33.8%), obesity (19.7%), positive family history of coronary artery disease (18.3%), cigarette smoking (16.1%), and minor risk factors (hyperuricemia, sedentary life style, Type A personality, oral contraceptive intake -15.4%). The mechanism of myocardial ischemia in patients with normal coronary arteries is not fully understood. We conclude that approximately one tenth of patients with clinically manifest coronary artery disease and one or more conventional risk factors do not have atherosclerotic changes in their epicardial coronary arteries as seen on coronary angiography.

Coronary Angiography↗
PubMedDate not supplied

A follow up study of major intimal dissections treated with perfusion balloon catheter.

Major intimal dissections during coronary angioplasty are an important cause of early morbidity and mortality. In the recent past various non-surgical modalities to manage such dissections have been developed. The choice of therapy among these needs knowledge not only of immediate success but also of long term results. Data on long term follow up of patients managed with prolonged balloon inflations using a perfusion balloon catheter is limited. We herein report our experience of twenty seven consecutive patients managed by prolonged dilatations using Stack perfusion balloon catheter. All the patients had a long dissection with luminal compromise, 6 (22%) had in addition an acute complete occlusion, and in 4 (15%) there was a thrombus. Only 6 (22%) needed an emergency CABG, with the remaining having an event free hospital stay. At follow up after 6-26 months, 7/21 (33%) had severe symptoms and 5 of them underwent coronary arteriography with four having a repeat successful dilatation. The findings of this study suggest that the perfusion balloon catheter is a useful modality for management of major dissections with a restenosis rate similar to that of primary PTCA. Randomised controlled trials are required to assess its efficacy vis a vis the newer therapeutic options like stents, lasers and atherectomy.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Collateral arteries in the presence of obstructive coronary disease.

BACKGROUND: The clinical importance of coronary collaterals in the presence of obstructive coronary artery disease is not clearly defined. METHODS: We retrospectively analysed the clinical and angiographic features of 100 patients with > or = 90% luminal diameter stenosis involving at least one major coronary artery. Coronary collaterals were graded 0 to 4 (Nitzberg's classification) and studied to determine their influence on clinical parameters. RESULTS: Thirty patients had no collaterals (group I) and 70 showed collaterals (group II). There were no significant differences between groups I and II in age and sex distribution, prevalence of risk factors of coronary artery disease (hypertension, diabetes, smoking, hypercholesterolaemia), duration of symptoms of coronary artery disease and prior myocardial infarction. Groups I and II had similar types (left anterior descending 73% v. 71%; left circumflex 50% v. 50% and right coronary 37% v. 56%) and numbers of arteries involved (one 47% v. 41%; two 47% v. 40%; three 7% v. 19%). Group II had a significantly lower prevalence of rest angina (14% v. 47%, p = 0.002). This difference was also evident when the patients were re-classified according to the extent of flow through the collaterals. Those with good collateralization (Nitzberg grades 3 and 4) had a lower prevalence of rest angina (13%) compared to those with poor collateralization (Nitzberg grades 0 to 2; 35%, p = 0.02). CONCLUSION: Coronary artery collaterals may reduce the incidence of rest angina in patients with obstructive coronary artery disease.

Angina Pectoris↗
PubMedDate not supplied

Left main coronary artery compression by dilated main pulmonary artery in atrial septal defect.

Left main coronary artery compression by dilated pulmonary artery in patients with atrial septal defect has previously been reported, but not well characterized. Accordingly, we review retrospectively data of patients with atrial septal defect in whom selective coronary angiograms were done. 41 patients (26 females), aged 47.3 +/- 7.4 years were studied. The pulmonary artery mean pressure was 22.7 +/- 8.3 mm Hg and all patients had left to right shunt ratio of 2:1 or more (mean ratio: 3.9 +/- 1.7). Two patients (4.8%) had left coronary ostial stenosis. There were no clinical or haemodynamic parameters to differentiate the patients with or without these changes. Two patients (4.8%) had coexistent atherosclerotic coronary artery disease. In conclusion, left main coronary trunk compression rarely occurs in patients with atrial septal defect. This information may be relevant in evaluating patients with atrial septal defect.

Adult↗
PubMedDate not supplied

Retrograde non-transseptal balloon mitral valvuloplasty--an initial experience.

Eleven patients with symptomatic isolated non-calcific mitral stenosis were treated with retrograde nontransseptal balloon mitral valvuloplasty. This new technique utilizes a specifically designed steerable catheter to enter the left atrium retrogradely via the left ventricle thus avoiding transseptal puncture, an essential step in other methods of balloon mitral valvuloplasty. Technical success was obtained in ten (91%) patients. Mitral valve area increased from 0.8 +/- 0.2 to 1.8 +/- 0.4 cm2 and the transmitral gradient decreased from 23.9 +/- 7.7 to 8.2 +/- 2.8 mmHg. There were no major complications such as cardiac perforation, embolic events, cardiac tamponade or severe mitral regurgitation. This early experience, the first outside Greece (centre of origin) indicates that retrograde nontransseptal balloon mitral valvuloplasty is a simple, effective and safe technique with results comparable with other techniques of mitral balloon dilatation which require transseptal catheterisation. Further experience involving multicenteric trials, is required to determine the overall efficacy of this technique for percutaneous balloon mitral valvuloplasty.

Adolescent↗
PubMedDate not supplied

Enalapril for prevention of restenosis after coronary angioplasty.

We have evaluated the effect of enalapril in the prevention of restenosis after percutaneous transluminal coronary angioplasty by a randomized trial conducted on 95 patients. The treatment group (n = 46) received enalapril 10 mg/day besides aspirin with calcium blockers, beginning 24 hours before coronary angioplasty. The conventional medical treatment group (n = 49) received only aspirin and calcium blockers. Enrollment required the presence of angina pectoris and successful dilatation of all significant coronary narrowings. All patients were followed up for at least 6 months. Restenosis was identified by symptoms and exercise testing and confirmed by angiography. The incidence of angiographic restenosis was 34% in the enalapril group and 31% in the conventional treatment group. Long term angiotensin converting enzyme inhibition with enalapril in a dose of 10 mg per day does not prevent restenosis after coronary angioplasty.

Adult↗
PubMedDate not supplied

Radiofrequency ablation of idiopathic ventricular tachycardia.

Eleven patients (9 male, 2 female) with ventricular tachycardia (VT) and structurally normal heart underwent radiofrequency (RF) ablation of VT focus. The detailed electrophysiological mapping localized the VT focus in the left ventricular (LV) apicoseptal region in 5, LV posteroseptal region in 2, right ventricular (RV) outflow tract in 2 and RV midseptal and inflow regions in one patient each. The technique of endocardial activation mapping during VT, pacemapping and the presence of His-Purkinje potential (for LV focus) were used to identify the precise site of delivery of RF energy. The procedure was successful in 9 patients. There was no complication. The mean fluoroscopic time was 45 +/- 21 (range 20-120) minutes. RF ablation is effective and may be considered as therapy of choice for patients with ventricular tachycardia and normal heart.

Adolescent↗