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Biomedical subjects

J Anconina

Publications and source records attributed to J Anconina.

28 records · Page 2Linked to original sources
PubMed1992

[Relationship between right ventricular ejection fraction and pulmonary pressure in man].

This clinical study analysed the changes in right ventricular ejection fraction induced by changes in right ventricular afterload using a new thermodilution catheter linked to a rapid response computer which allowed instantaneous measurements of the right ventricular ejection fraction. The first group comprised 16 patients referred for coronary angioplasty with single vessel disease (isolated proximal stenosis of one of the two main branches of the left coronary artery) and a normal left ventricular ejection fraction (> or = 55%) and mean pulmonary artery pressure of < 25 mmHg: right ventricular ejection fraction and mean pulmonary artery pressure were measured under basal conditions and after 60 seconds' coronary occlusion with the balloon catheter in order to assess the effects of the reactional increase in afterload on the right ventricular ejection fraction. The second group comprised 11 patients with dilated primary cardiomyopathy with decreased left ventricular ejection fraction (< 50%) and mean pulmonary artery pressure > or = 25 mmHg: the right ventricular ejection fraction and mean pulmonary artery pressure were measured under basal conditions and after intravenous trinitrin (performed to evaluate the pulmonary reaction to vasodilators) in order to analyse the effects of the reduction of afterload on right ventricular ejection fraction. Negative linear correlations were observed between the right ventricular ejection fraction and mean pulmonary artery pressure under basal conditions (r = -0.72; p < 0.005) and between the right ventricular ejection fraction and mean pulmonary artery pressure after changing the conditions of afterload (r = -0.82; p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Measurement of right ventricular dP/dt. A simultaneous/comparative hemodynamic and Doppler echocardiographic study].

Right ventricular systolic function is difficult to assess by Doppler echocardiography. We studied 14 patients with tricuspid regurgitation on Doppler echocardiographic examination with the object of determining an index of right ventricular contractility based on the continuous Doppler signal of the regurgitant jet. The rate of increase in right ventricular pressure was calculated between 2 points, V1 and V2, situated on the ascending limb of the velocity profile of the tricuspid regurgitation and compared with the dP/dt max measured simultaneously at right heart catheterisation. The different values of V1 and V2 were: 0 and 1 m/s, 0 and 2 m/s, 0.5 and 1.5 m/s, 1 and 2 m/s and 0.5 and 2 m/s. An excellent correlation was observed between the catheter dP/dt max and the rate of increase in pressure measured by Doppler between 0 and 2 m/s (r = 0.93; p = 0.0001) and between 0.5 and 2 m/s (r = 0.93; p = 0.0001). The correlation was not as close between 0 and 1 m/s (r = 0.69; p = 0.048) and there was no correlation with the measurements between 0.5 and 1.5 m/s and between 1 and 2 m/s. Doppler echocardiography could therefore be used for non-invasive assessment of right ventricular systolic function in clinical practice.

Blood Pressure↗
PubMed1992

[Coronary transluminal angioplasty after 70 years of age. Multivariate analysis of parameters influencing immediate results and long-term prognosis].

Between January 1986 and July 1990, 186 patients over 70 years of age underwent 215 transluminal coronary angioplasties. The patients' characteristics were: 117 men and 69 women; mean age 75.5 +/- 4 years (70-89 years): left ventricular ejection fraction 62 +/- 12%: 40% had previous myocardial infarction; 48% had single vessel disease; 80% had severe angina (19% Class III and 61% Class IV) and 58% of dilated vessels had calcification. In all, 276 vessels (1.3 patient) were dilated: one vessel in 77%, 2 vessels in 18% and 3 or more in 5% of patients. The primary success rate defined as a reduction of the diameter of stenosis below 50% was 81% (174/215 procedures) (85%-215/253 stenosis--in dilatations and 65%-15/23 obstructions--in attempted disobliterations). There were 4 deaths (2.1%), 12 Q wave infarcts (5.5%) and 5 non Q wave infarcts (2.3%), 2 emergency bypass grafts procedures and no cerebrovascular accidents. A multivariate analysis identified two factors which reduced the primary success rate: coronary calcification (p less than 0.02) and a history of previous infarction (p less than 0.02). Three factors were associated with an increased risk of perioperative infarction: the female sex, age greater than 75 years (p less than 0.01) and previous infarction (p less than 0.03). The first 154 patients were followed up for 25 +/- 14 months (8-61 months) without any patients being lost to follow-up. In this period, 16 patients died (11 of cardiac causes), 2 had non-fatal infarction, 13 underwent secondary aortocoronary bypass surgery and 30 patients (20%) developed an angiographic restenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Comparative effects of oral molsidomine and nifedipine on methylergometrine-induced coronary artery spasm.

Twelve consecutive patients (10 men and 2 women, mean +/- standard deviation age 49 +/- 9 years) with chest pain, angiographically normal coronary arteries and coronary artery spasm documented by methylergometrine testing received a single oral dose of molsidomine (4 mg) or nifedipine (10 mg) in a randomized, double-blind, crossover fashion at a 24-hour interval. Coronary artery spasm was documented during coronary angiography in 6 patients (left anterior descending artery, 3; right coronary artery, 2; left circumflex, 1). In the remaining 6 patients, coronary artery spasm was documented by a positive methylergometrine test performed at the bedside, which provoked ST-segment elevation in the inferior (n = 3), anterior (n = 1) or lateral (n = 2) leads. Ninety minutes after administration of the study medication, methylergometrine testing was performed at the bedside, using incremental doses of up to 0.4 mg of methylergometrine. After molsidomine, 10 patients (83%) had a negative and 2 had a positive test; after nifedipine, 9 patients (75%) had a negative and 3 a positive test. Only 1 patient had a methylergometrine test that remained positive after either molsidomine or nifedipine. Therefore, molsidomine appears as effective as nifedipine in suppressing methylergometrine-induced coronary artery spasm in patients with variant angina. In addition, patients not responding to 1 of the study medications may respond to the other.

Coronary Angiography↗
PubMed1991

Impact of impinging wall jet on color Doppler quantification of mitral regurgitation.

BACKGROUND: In clinical color Doppler examinations, mitral regurgitant jets are often observed to impinge on the left atrial wall immediately beyond the mitral valve. In accordance with fluid dynamics theory, we hypothesized that a jet impinging on a wall would lose momentum more rapidly, undergo spatial distortion, and thus have a different observed jet area from that of a free jet with an identical flow rate. METHODS AND RESULTS: To test this hypothesis in vivo, we studied 44 patients with mitral regurgitation--30 with centrally directed free jets and 14 with eccentrically directed impinging wall jets. Maximal color jet areas (cm2) (with and without correction for left atrial size) were correlated with mitral regurgitant volumes, flow rates, and fractions derived from pulsed Doppler mitral and aortic forward flows. The groups were compared by analysis of covariance. Mean +/- SD mitral regurgitant fraction, regurgitant volume, and mean flow rate averaged 37 +/- 17%, 3.06 +/- 2.65 l/min, and 147 +/- 118 ml/sec, respectively. The maximal jet area from color Doppler imaging correlated relatively well with the mitral regurgitant fraction in the patients with free mitral regurgitant jets (r = 0.74, p less than 0.0001) but poorly in the patients with impinging wall jets (r = 0.42, p = NS). Although the mitral regurgitant fraction was larger (p less than 0.05) in patients with wall jets (44 +/- 20%) than in those with free jets (33 +/- 15%), the maximal jet area was significantly smaller (4.78 +/- 2.87 cm2 for wall jets versus 9.17 +/- 6.45 cm2 for free jets, p less than 0.01). For the same regurgitant fraction, wall jets were only approximately 40% of the size of a corresponding free jet, a difference confirmed by analysis of covariance (p less than 0.0001). CONCLUSIONS: Patients with mitral regurgitation frequently have jets that impinge on the left atrial wall close to the mitral valve. Such impinging wall jets are less predictable and usually have much smaller color Doppler areas in conventional echocardiographic views than do free jets of similar regurgitant severity. Jet morphology should be considered in the semiquantitative interpretation of mitral regurgitation by Doppler color flow mapping. Future studies of the three-dimensional morphology of wall jets may aid in their assessment.

Adult↗
PubMed1990

[Abnormal tricuspid flow in carcinoid heart disease. A case report].

A case of the carcinoid syndrome with right heart involvement is reported. Echocardiography showed diffuse right ventricular disease with a pathological tricuspid valve. Doppler recordings of forward tricuspid blood flow showed changes suggesting abnormal right ventricular filling, the mechanisms of which are discussed.

Carcinoid Heart Disease↗
PubMed1990

[Yes, routine coronary angiography is necessary after myocardial infarction].

The author first recalls the difficulties and inaccuracies of the exercise test, even when this is combined with an isotope test in post-infarction evaluation of the myocardium. In most cases, a coronography should be performed after about ten days (because most deaths following myocardial infarction occur either within the first three weeks or within the first three months). The risks are minimal. This exploration provides a more detailed assessment of the lesions as well as detecting severe latent lesions affecting other coronary circuits. In some cases, it assists in diagnosis and may even be a guide to treatment. However, it is not easy to evaluate stenoses, and one of the big drawbacks of the method is that it is not always possible to draw all the necessary conclusions regarding the therapeutic consequences of revascularization. Coronarography is indispensable after infarction in most subjects, but it must be evaluated with caution and must be combined with an exercise test, even though the information provided by this test is only incomplete.

Coronary Angiography↗
PubMed1989

[Hemolytic anemia and cardiac heterografts. Apropos of 2 cases].

Two cases of severe haemolytic anaemia developed after heterograft valve replacement are reported. In one case haemolysis was caused by prosthetic degeneration; in the other case the heterograft was not altered, but a ventricular septal defect had created a high turbulence around the valve which was in pulmonary position. In both cases anaemia subsided after surgical correction of the abnormalities responsible for periprosthetic turbulence. Haemodialysis can only develop in patients with heterograft valve replacement if a change in blood flow rate occurs around the valve, due to its alteration or to an associated cardiac disease.

Adult↗
PubMed1989

[Difficulties in the echocardiographic diagnosis of false aneurysm of the left ventricle. Apropos of 2 cases].

The echocardiographic diagnostic criteria of left ventricular pseudo-aneurysm are well established: the demonstration of a narrow-necked communication between the left ventricular cavity and the aneurysm and endocardial discontinuity at the site of myocardial rupture. The authors report two cases in which these criteria were fulfilled, leading to an echocardiographic diagnosis of pseudo-aneurysm which was erroneous as the operative findings were those of true left ventricular aneurysms.

Diagnosis, Differential↗