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Biomedical subjects

I Shapira

Publications and source records attributed to I Shapira.

At least 163 records · Page 9Linked to original sources
PubMed1987

Anomalous origin of the right coronary artery from the ascending aorta. Diagnosis by digital subtraction angiography.

The anomalous origin of a coronary artery often poses diagnostic difficulties at angiography. The right coronary artery is more rarely affected than the left. A patient is presented in whom the right coronary artery arose from the ascending aorta. The diagnosis of this rare anomaly was facilitated by the use of digital subtraction aortography and allowed selective angiography of the artery with an appropriately shaped catheter.

Angiography↗
PubMed1987

Percutaneous transluminal coronary angioplasty as a cause of isolated right ventricular infarction.

Acute myocardial infarction is a recognized major complication of percutaneous transluminal coronary angioplasty (PTCA). Isolated right ventricular infarction is rare. A 60-year-old patient underwent PTCA 24 h following clinically successful thrombolytic therapy for an acute occlusion of a dominant right coronary artery. Following successful PTCA of this artery, a right ventricular branch was noted to be occluded. This was associated with chest pain, elevated venous pressure, S-T segment elevation in ECG leads V1-3, and a transient rise in serum creatine kinase. The clinical course was uneventful and a week later the right ventricular ejection fraction had increased from 18 to 36%. The long-term effects of right ventricular infarction are benign and occlusion of a right ventricular branch during PTCA is rarely of clinical significance.

Angioplasty, Balloon↗
PubMed1987

Idiopathic ventricular fibrillation: inducibility and beneficial effects of class I antiarrhythmic agents.

Ventricular fibrillation in patients without recognizable heart disease is uncommon and electrophysiologic data on such patients is limited. Over a 7 year period, five patients (three men and two women, ranging in age from 24 to 52 years) without demonstrable heart disease underwent electrophysiologic studies with pharmacologic drug testing because of single (four patients) or multiple (one patient) documented episodes of ventricular fibrillation. The arrhythmic event was unrelated to myocardial ischemia or infarction, metabolic or electrolyte disturbances, drug toxicity, preexcitation, or prolonged QT syndromes. In all three patients receiving no antiarrhythmic drugs and in two pretreated with amiodarone, a rapid poorly tolerated ventricular tachyarrhythmia requiring cardioversion was induced by programmed ventricular stimulation with up to two extrastimuli. In all instances, addition of either oral quinidine or oral disopyramide prevented the induction of sustained ventricular arrhythmias. All five patients were placed on antiarrhythmic drug regimens found effective during electrophysiologic studies and remained asymptomatic during follow-up periods ranging from 12 to 93 (mean 52) months. We conclude that in the patients with idiopathic ventricular fibrillation in our study: programmed ventricular stimulation reliably replicated the spontaneous arrhythmia, class I antiarrhythmic agents effectively prevented induction of the arrhythmia in the laboratory, and in contrast to the severity of the presenting arrhythmia, a benign clinical course was observed during long-term therapy with class I antiarrhythmic agents.

Adult↗
PubMed1987

Cardiac rupture in patients with acute myocardial infarction.

The occurrence of myocardial rupture was evaluated in an unselected population of 1,737 patients with acute myocardial infarction (AMI). Patients with cardiac rupture after AMI were compared with age- and sex-matched control patients with fatal AMI not related to rupture and with AMI survivors discharged home. Rupture was found in 40 patients (15.7 percent of hospital deaths), or 2.3 percent of all cases of AMI. At the highest risk for rupture were women aged 60 to 69, although the age distribution did not differ significantly from that of patients dying of other causes. More patients with myocardial rupture had hypertension during hospitalization, persistent pain, and inferior wall myocardial infarction when compared with controls. The majority (95 percent) of cardiac ruptures occurred within the first six days, 40 percent within the first 24 hours after the onset of symptoms. Approximately 20 percent of ruptures were diagnosed as subacute; in only two was surgical intervention attempted unsuccessfully. The high-risk group of patients should be carefully monitored within the first six days after the onset of symptoms of AMI in an effort to prevent myocardial rupture.

Adult↗
PubMed1986

Primary angiosarcoma of the heart detected by two-dimensional echocardiography.

A 24-year-old woman with a history of syncope and recurrent hemopericardium was urgently hospitalized with signs of severe right-sided heart failure. Two-dimensional echocardiography demonstrated a largedechogenic mass that compressed the right ventricle. The patient was referred for emergency surgery. A large angiosarcoma originating in the right atrium was excised, and the patient was treated with chemotherapy. The role of echocardiography in the detection of cardiac tumors is discussed.

Adult↗
PubMed1985

Clinical significance of nonclinical ventricular tachycardia induced in amiodarone-treated patients.

The clinical significance of sustained nonclinical ventricular tachycardia (VT) induced during electrophysiologic studies was studied in 10 amiodarone-treated patients. Nine patients had previous myocardial infarction while 1 patient had right ventricular dysplasia. All patients had only a single morphologic type of VT recorded during the multiple spontaneous episodes of tachycardia. After serial pharmacological electrophysiologic testing, the patients were placed on antiarrhythmic regimens which included amiodarone in all cases. These drugs did not prevent the induction of nonclinical VT in any of the 10 patients and of sustained clinical VT in 7 patients. Nonclinical VT was sustained, requiring cardioversion (7 patients) or rapid ventricular pacing (3 patients) for termination. After a mean follow-up period of 27 +/- 10 months (range 12 to 36 months), 4 patients did not exhibit recurrent VT, 3 patients with inducible clinical VT experienced a recurrent episode of clinical VT after 16, 27 and 49 months, respectively, 2 patients had nonarrhythmia related deaths after 11 and 12 months, and 1 patient died suddenly after 17 months. These results suggest that laboratory induction of sustained nonclinical VT in amiodarone-treated patients does not imply the likelihood of their future spontaneous occurrence and, therefore, their prevention may not be required.

Adult↗
PubMed1984

Intermittent poppet dislodgment in a Braunwald-Cutter prosthesis: noninvasive diagnosis and successful surgical treatment.

A 65 year old patient had his mitral and aortic valves replaced with two Braunwald-Cutter prostheses in 1973. Seven years later, he presented with intermittent aortic insufficiency demonstrated by echocardiography, fluoroscopy and angiography. At emergency surgery, the occluders (poppets) of both prostheses were found within the left ventricular cavity. The valves were excised and replaced with Björk-Shiley prostheses and the patient recovered. Aortic occluder escape is rare and usually fatal. Mitral occluder escape of the Braunwald-Cutter prosthesis has not been described previously.

Aged↗
PubMed1984

Extensive endocardial mapping during sinus rhythm and ventricular tachycardia in a patient with arrhythmogenic right ventricular dysplasia.

A 38 year old man with arrhythmogenic right ventricular dysplasia underwent electrophysiologic study with extensive endocardial mapping of the right ventricle. During sinus rhythm, markedly reduced amplitude with or without prolonged duration was noted in multiple electrograms of the right ventricle. Delayed activation of the right ventricular outflow tract electrogram was present. Two clinical types of ventricular tachycardia with a left bundle branch block configuration and either an inferior or a superior axis were induced by ventricular stimulation. Endocardial activation sequence during the tachycardias suggested that the tachycardia with an inferior axis originated near the infundibulum, while that with a superior axis originated near the midinferior area of the right ventricle. Both areas have been previously shown to be frequently impaired in right ventricular dysplasia.

Adult↗