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Biomedical subjects

J E Sousa

Publications and source records attributed to J E Sousa.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Coronary angioplasty of moderate lesions (50 to 60%)].

PURPOSE: To assess the efficacy of transluminal coronary angioplasty in patients with moderate (50-60%) coronary lesions. PATIENTS AND METHODS: One hundred and thirty nine patients, 108 (78%) male, mean age was 55 years, who underwent coronary angioplasty from August 1983 to January 1989. Clinical findings included stable angina in 91 (65%) and unstable angina in 48 (35%). Single vessel disease was the case for 117 (84%), whereas 22 (16%) had two vessel coronary artery disease. RESULTS: Primary success rate was 130 (94%). All patients with two vessel disease had complete revascularization. In the failure group there were 2 acute myocardial infarction (1.4%), and 4 (2.8%) emergency coronary artery by-pass surgery. There were no in-hospital deaths. Of the 130 patients with success, 119 (92%) had late follow-up (mean time 31 months). At the end of the follow-up period we found 85 (71%) asymptomatic, while 27 (23%) had recurrence of symptoms. There were 2 late cardiovascular deaths. Fifty four patients underwent late angiography and 42 (78%) had maintenance of the result while 12 (22%) had restenosis, with a mean degree more severe than pre-coronary angioplasty. CONCLUSION: Coronary angioplasty of moderate lesions has a high success rate (94%); nevertheless the rate of major complications and restenosis is very similar to that of coronary angioplasty for severe stenosis. Such findings led us to reserve the indication of coronary angioplasty for moderate lesions for patients at higher risk with clear evidence of myocardial ischemia.

Angina Pectoris↗
PubMed1990

It is valid to dilate native aortic coarctation with a balloon catheter.

We report our experience in 37 patients with aortic coarctation who underwent balloon aortoplasty. Of the 37, the lesion was native in 34 cases. Clinical re-evaluation was possible in 22 patients, with a mean follow-up period of 13 months and, of these, 21 patients were asymptomatic. Haemodynamic and angiographic studies were performed in 13 patients, with a mean period of follow-up of 12 months, showing excellent results in 11 patients. Aneurysmal formation had occurred in one and recoarctation in the other patient. Our experience has proved that balloon aortoplasty is an effective method for treating patients with aortic coarctation. Adequate selection in terms of the morphology of the coarctation and the size of the balloon catheter are crucial factors in the success of the procedure.

Adolescent↗
PubMed1990

[Infective endocarditis. Prospective Doppler-echocardiographic study].

PURPOSE: To study of the Doppler-echocardiographic aspects in patients with IE and its correlation with the prognosis and evolution. PATIENTS AND METHODS: One hundred and eight patients with clinical of IE were prospectively studied by Doppler-echocardiography (D-E) in order to determine whether the simple presence of vegetation, its size, mobility and place of attachment could identify high risk groups. Vegetations were classified according to its size (longest axis) into small (veg less than 5 mm), medium (5 mm less than veg less than 10 mm) and large (veg less than 10 mm); according to its kind into "sessible" or "mobile" and according to its appearence into "cotton like" or "calcified". RESULTS: Patients with (84.2%) and without (15.8%) vegetations didn't show any significant difference in the complications incidence (emboli, heart failure or death) and the same happened with its size. However, patients with aortic positioned vegetations showed ligher incidence of HF (Aortic 53.8 x Mitral 31.0% x Tricuspid 3.7%) need for surgery (Aortic 69.2% x Mitral 34.5% x Tricuspid 3.7%) and death (Aortic 30.7% x Mitral 13.7% x Tricuspid 7.4%). Emboli were observed in 81.4% of the patients with tricuspid valve vegetations. Eight patients showed IE on aortic prothesis. Five of them needed surgical treatment and 2 of them died. Among 12 patients with IE on mitral prothesis, 7 needed surgery and 3 died. Pericardial effusion were verified in 51 patients (47.2%), chordal rupture in 14 (12.8%) and valve abcess in 6 (5.5%). All patients with valve abcess were submitted to surgery. CONCLUSION: Doppler-echocardiography is an excellent method in the diagnosis of IE and its aspects may have, sometimes, a positive correlation with the prognosis and patient's evolution.

Adolescent↗
PubMed1990

[Acute myocardial infarction in patients under 40 years of age].

PURPOSE: To evaluate the short and long-term prognosis of a group of patients aged 40 and under, who developed an acute myocardial infarction. PATIENTS AND METHODS: In the last 15 years we studied a group of 73 patients aged 40 and under with a confirmed diagnosis of first acute myocardial infarction. Patients with infarctions caused by coronary embolisms or to revascularization procedures were excluded. RESULTS: Ninety percent were male and mean the age was 35. The most frequent risk factors observed were cigarette smoking in 64 (88%), hypertension in 16 (22%), hypercholesterolemia in 12 (16%) and diabetes in 3 (4%). Seven (9%) patients had no risk factors. The myocardial infarction was anterior em 50 (68%) cases and inferior in the remaining 23 (32%). Severe heart failure (Killip III and IV) was present in 3 (4%). Angiographic studies were performed in 63 (86%). Cineangiography showed critical coronary lesions (obstruction greater than 70%) in one vessel in 38 (60%) patients, multivessel disease in 18 (28%) and 7 (12%) had normal coronary vessels. In-hospital mortality was 5% (3 patients died due to severe heart failure and 1 due to cerebro-vascular accident). The 56 survivors were followed-up to 15 years, with overall survival of 74%. Fourty-nine (71%) were asymptomatic and 7 (10%) had recurrent chest pain. There were 7 (10%) late deaths and follow-up was lost in 6 (9%). Reinfarctions were observed in 5 cases (7%). Revascularization procedures were performed in 12 (17%) patients (bypass-graft surgery in 9 and coronary angioplasty in 3). CONCLUSION: Young patients with acute myocardial infarction have a low mortality rate in the early phase and a favorable outcome after the discharge of the hospital.

Adolescent↗
PubMed1990

[Visualization of coronary artery obstructions by echocardiography].

PURPOSE: The purpose of this study was to determine the sensitivity and specificity of 2D ECO in identifying proximal and medial obstruction of the coronary artery. PATIENTS AND METHOD: Sixty five patients with coronary artery disease were studied. In thirty three patients with previous coronary angiography the echocardiographer had knowledge of the topography and the degree of the coronary obstruction (group I) but in thirty two patients he didn't (group II). The mean age of group I was 54.4 years (44 to 76) and the mean age of the group II was 58 years (42 to 74). Two-dimensional echocardiography was performed at short-axis cross-sectional of aortic valve and images were frozen at end-diastole and reject settings were used to best visualize the coronary artery. RESULTS: It was possible to observe by 2D ECO the left main coronary artery in all patients. It was also possible to identify the proximal segment of the three main arteries. The detection of obstruction was overestimated by 2D ECO when it was in the left main coronary artery. In the proximal segment, in group I, the detection of obstruction in LAD, RCA and CXA was 87.5%, 66.6% and 50% and in group II, 77.7%, 100% and 50% respectively. In the medial segment, in group I, the detection of obstruction in LAD and CXA was respectively 100% and 33.3% and in group II, 60% and 75%. These results show that the sensitivity and specificity to detect obstruction was highest in the LAD. The method overestimated the presence of obstruction in the medial segment of RCA in both groups. CONCLUSION: These findings indicate that 2D ECO is a feasible noninvasive method in assessing obstruction of the main coronary arteries with good sensitivity and specificity.

Cineangiography↗
PubMed1990

[Angioplasty of the anterior descending artery with abnormal origin: use of a new low-profile catheter balloon. A case report].

It is possible to perform transluminal coronary angioplasty (TCA) in thin vessels presenting severe obstructions. One of the achievements that made such procedure possible is the development of a new generation of balloon catheters. In this case report the TCA was performed in a very thin left anterior descending artery with an anomalous origin, a quite rare situation that represents a major problem to the traditional dilator system. The catheter used was a Probe (USCI), which differs of the traditional balloons in a number of characteristics. The authors consider the procedure in detail pointing out the advantages of using of the new generations and discuss the impact that newer technological developments will have in enlarging the indications for TCA and improving the results.

Angioplasty, Balloon, Coronary↗
PubMed1989

Results of cardiopulmonary resuscitation in a cardiology hospital.

The authors analysed a series of 557 consecutive patients who suffered cardiorespiratory arrest at the Dante Pazzanese Institute of Cardiology (DPIC) during a period of 5 years in order to examine factors predicting successful resuscitation and long-term survival. Cardiopulmonary resuscitation (CPR) maneuvers were tried in 536 patients, with the following results: 284 patients (53%) died immediately, another 102 (19%) died within the first 24 h after the cardiac arrest and 150 patients (28%) survived more than 24 h. Among these, 65 (12.1%) died in the first month after cardiac arrest and other 29 (5.4%) died after that period. There were 43 late survivors (8%). Thirteen patients (2.4%) were lost to follow-up. After 9 years, the accumulative life expectancy was 8.7%. Coronary heart disease, cardiomyopathy and valvular heart disease were the most frequent underlying diseases. None of the 49 patients with cyanotic congenital heart disease survived. The heart arrest was mostly caused by heart failure (55.8%) and primary arrhythmia (17.2%) in the whole group, whereas the survivor group showed primary arrhythmia in 81.7% and heart failure in 7.3%. In those patients where the initial mechanism of cardiac arrest was ventricular fibrillation, 33.2% survived more than 1 month, while among those on ventricular asystole, only 3.4% survived more than 1 month.

Brazil↗
PubMed1989

[Use of isosorbide-5-mononitrate in acute myocardial infarction].

Isosorbide mononitrate in a dose of 20 mg t.i.d. was used in 25 patients admitted few hours after acute myocardial infarction. The following parameters were analysed: systolic and diastolic blood pressure, heart rate, clinical features, and laboratory data. Heart rate and diastolic blood pressure remained unchanged, however systolic blood pressure was slightly reduced (p less than 0.01). There was a reduction in the angina episodes post-AMI. None of the patients included in the study had clinical deterioration or showed infarction extension. There were no changes in laboratory data. After the interruption of the drug, one patient died on the 6th day with acute mitral insufficiency. In conclusion, isosorbide mononitrate can be safely used during an uncomplicated acute myocardial infarction, without the risk of haemodynamic deterioration, and helps to prevent post-infarction angina.

Adult↗
PubMed1989

[Coronary angioplasty: efficacy of the new low profile balloon catheters].

New low profile balloon catheter have allowed the indication of percutaneous transluminal coronary angioplasty (PTCA) for more complex lesions. We report our initial experience with these systems in 50 out of 101 patients (50%) who underwent a PTCA from March 15 to May 15, 1989 in "Instituto Dante Pazzanese de Cardiologia". Mean age was 58.6 +/- 10.4 years and most of the patients were male (78%). We dilated 54 lesions. Single vessel disease was the case for 84% of the patients. As for the localization of the lesions in the coronary arteries, 56% of the lesions were in the proximal or mid segments of the coronary arteries and the mean diameter stenosis pre-PTCA was 84 +/- 10.2%. Left ventricular function was normal in 60% of the patients. Primary success rate (per patient) was 95% and the coronary stenosis was crossed in all the cases. The mean inflation number was 2.7 +/- 0.6 per patient, the mean highest pressure was 8 +/- 1.15 atm and the mean maximum time of inflation was 86.1 +/- 29.6 sec. The mean residual stenosis was 15.2 +/- 10.6%. There was only one major complication, namely an acute myocardial infarction of the lateral wall. There were no emergency CABG surgery or deaths. We conclude that the new low profile balloon catheters have broadened the indication for PTCA in more complicated lesions, showing a high rate of primary success (95%), but did not increase the number of procedural complications (2.5%).

Angioplasty, Balloon, Coronary↗
PubMed1988

Pulmonary valvoplasty--experience of 100 cases.

One-hundred patients with pulmonary valve stenosis underwent pulmonary valvoplasty, their ages ranging from 1 to 59 years. The systolic gradient across the valve ranged from 47 to 260 mm Hg (97.67 +/- 41.15) prior to the valvoplasty, and from 0 to 55 mm Hg (14.72 +/- 11.40) immediately after dilatation (P less than 0.0001). The clinical follow-up of 18.2 months of 56 patients showed a tendency for the systolic thrill to disappear, the systolic murmur became softer and there was a tendency to normalization of the electrocardiogram. A hemodynamic restudy was carried out in 54 patients and the systolic gradients across the valve ranged from 21.55 +/- 23.86. Seven patients required redilatation. In patients with hypertrophy of the infundibulum prior to valvoplasty this was observed to regress, indicating that infundibular hypertrophy is reversible.

Adolescent↗
PubMed1988

Comparison between Henley jejunal interposition and Roux-en-Y anastomosis as concerns enterogastric biliary reflux levels.

The amount of enterogastric biliary reflux was assessed in patients who previously underwent Henley operation (n = 8) or Roux-en-Y biliary diversion (n = 7) using the radiopharmaceutical 99mTechnetium-DISIDA. Two other groups were investigated: a control group consisting of patients with unoperated duodenal ulcer (n = 10) and a group of patients who underwent Billroth II gastrectomy (n = 7). The length of the interposed segment of jejunum ranged from 20 to 30 cm (median of 22.5 cm) in the Henley patients, and from 30 to 60 cm (median of 40 cm) in the Roux-en-Y group. In Henley patients, the percentage of administered 99mTechnetium-DISIDA that was recovered from the stomach (median of 0.92%) was lower (p less than 0.01) than that obtained for Billroth II patients (median of 32.28%) and did not differ (p greater than 0.10) from that of the Roux-en-Y (median of 0.36%) and duodenal ulcer groups (median of 2.53%). These results indicate that Henley operation is as effective as Roux-en-Y diversion in promoting the reduction of the amount of enterogastric biliary reflux that follows Billroth II distal gastrectomy.

Adult↗
PubMed1988

Transient platelet aggregation as a mechanism of unstable angina. Aggressive treatment with coronary angioplasty.

Decreased oxygen supply rather than increased demand may be the primary pathogenic mechanism of myocardial ischemia in patients with unstable angina. Coronary artery spasm and in vivo platelet aggregation may play an important role in the mechanism by which the magnitude of fixed obstruction secondary to coronary atherosclerosis is transiently exacerbated. In this case report, we describe a patient who developed chest pain accompanied by ischemic ECG changes during coronary arteriography, due to a transient thrombotic aggravation of a fixed, significant coronary stenosis. Percutaneous transluminal coronary angioplasty was performed with relief of the coronary stenosis and of the symptoms.

Angina Pectoris↗