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Biomedical subjects

J Piessens

Publications and source records attributed to J Piessens.

At least 73 records · Page 4Linked to original sources
PubMed1988

Angina pectoris and coronary artery disease in severe aortic regurgitation.

A consecutive series of 198 patients (148 men and 50 women, mean age 51 years, range 18 to 76) with pure, isolated, severe aortic regurgitation was retrospectively studied to determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris and coronary risk factors. Significant CAD (coronary diameter stenoses greater than 50%) was found in 28 patients (14%). Typical angina was present in 18% and atypical chest pain in 16%. Angina alone had a sensitivity of 57% to detect significant CAD. The predictive accuracy of a positive history of angina was 46% and that of a negative test 93%. By using multivariate logistic regression, a risk score could be calculated that increased the sensitivity to 74% at equal specificity. Almost 40% of the total population had a risk score of less than -2.9 (only 1 patient in this group had CAD). It is concluded that coronary arteriography can safely be omitted in many patients with severe aortic regurgitation if they have no symptoms of myocardial ischemia or risk factors known to increase its incidence.

Angina Pectoris↗
PubMed1988

An unusual case of guide wire fracture during percutaneous transluminal coronary angioplasty.

We report a case of guide wire fracture during percutaneous transluminal coronary angioplasty, using one of the newer catheter systems. The broken free end of the guide wire remained within the coronary tree, and surgical removal was necessary. Entrapment and overcoiling of the guide wire can cause fracture; in our case excessive bending in a tortuous coronary tree resulted in this unusual complication. An excessive tensile load to the guide wire may result from anatomical peculiarities and can cause wire fracture.

Angioplasty, Balloon↗
PubMed1988

Intravenous streptokinase during acute myocardial infarction. A prospective open study.

To evaluate the efficacy of intravenous streptokinase in acute myocardial infarction (AMI) 108 patients received a high-dose (1.5 million units), short-term infusion (60 minutes) within 6 hours after onset of symptoms, followed by anticoagulation. Before discharge a submaximal exercise test and a coronary arteriography were performed in 100 surviving patients. Sixty-seven patients had a patent infarct-related vessel. Clinical reocclusion occurred in 21 patients. Left ventricular function was slightly, but not significantly, better in patients with patent infarct-related vessels: ejection fraction 59.5 +/- 13% versus 57.4 +/- 13%. Additional procedures were performed in 20 patients: percutaneous transluminal coronary angioplasty (PTCA) in 8 and coronary artery bypass surgery (CABG) in 12. The results indicate that streptokinase applicated during a 6 hour-time window is a potent thrombolytic agent in acute myocardial infarction with limited effect on global left ventricular function. Pre-discharge evaluation is necessary to screen patients for residual ischemia.

Adult↗
PubMed1987

Unexplained chest pain with normal coronary arteriograms. A follow-up study.

One hundred and forty-two consecutive patients with unexplained chest pain and normal coronary arteries were followed up for a mean period of 49.3 +/- 13.1 months. No cardiac deaths and one myocardial infarction occurred. Half of the patients were pain-free at follow-up. A definite relationship between persistence of pain and duration of pain history and a positive response to nitroglycerin before coronary arteriography were found. Patients with persistent pain were more frequently hospitalized for noncardiac diseases, underwent more surgical interventions and took more often noncardiac medication. Rehospitalizations for acute chest pain were infrequent. Two thirds of the patients resumed their normal activities. Younger age, disappearance of pain, type of occupation, and a shorter duration of the pain history favored return to work. Nonactive patients presented more intercurrent noncardiac, medical and surgical pathology. The findings in patients with a previous myocardial infarction were similar to those of the group with only chest pain.

Activities of Daily Living↗
PubMed1987

Complete occlusion of the main left coronary artery. A clinical study.

Between 1975 and 1985, 12 patients with complete occlusion of the main left coronary artery (MLCA) were seen. The historical, clinical, biochemical, radiological, electrocardiographic, angiographical, surgical and follow-up findings were analyzed. Eight of the 12 patients presented on admission an unstable clinical situation. A normal ECG at rest was found in only 3 patients. Exercise testing elicited definite electrocardiographic changes in 5 of 6 cases. Coronary atherosclerosis was the cause of occlusion in 11 patients; in 1 patient the underlying disease process remained unclear. Significant lesions of the right coronary artery (RCA) were found in 9 and of the left anterior descending (LAD) or circonflex (CFLX) artery in 6 patients. Global and/or regional left ventricular dysfunction at rest was present in 10 patients. Angiographically visible collateral circulation was found in all patients but its extent was variable. All patients underwent bypass surgery. There were 1 operative and 2 late deaths.

Adult↗
PubMed1986

Coronary artery fistulas in an adult population.

A consecutive series of 14 708 coronary arteriograms, performed between 1 April 1975 and 1 August 1983 was examined for the presence of coronary artery fistulas. The incidence was 0.13. There was 1 traumatic and 19 congenital cases. All fistulas were small and of little haemodynamic significance. No symptoms or complications could be ascribed to these fistulas. In the large majority no continuous or other murmurs suggested their presence. The large majority arose from the proximal anterior descending artery and emptied in the pulmonary artery. Surgical treatment for these fistulas is not indicated.

Adult↗
PubMed1985

Pseudoaneurysm of the left ventricle following cardiac surgery. Report of 3 cases and review of the literature.

Three cases of pseudoaneurysms of the left ventricle after aneurysmectomy are presented. Pseudoaneurysm formation was evidently caused by infection in one case. In the 2 other cases the pathogenetic mechanism remains uncertain. Both local infection or a superimposed new myocardial infarction might have been responsible for pseudoaneurysm formation. In each instance diagnosis was suggested by one or more noninvasive techniques (echocardiography, isotopic ventriculography, CT-scanning) and confirmed by cineangiocardiography. Two patients were successfully reoperated while the third died shortly after surgery. Special attention is drawn to the pathogenetic mechanisms underlying postoperative pseudoaneurysm formation. Finally, the diagnostic value of non-invasive technique is discussed.

Adult↗
PubMed1984

Platelet survival in patients with angiographically diseased and normal coronary arteries.

Platelets may contribute to the pathogenesis of atherosclerosis and to the complications of coronary artery disease. Therefore, platelet kinetics were studied in 69 patients with angiographically documented coronary artery disease and in 16 patients with a normal coronary angiogram. Platelet survival time was calculated from the decay of radioactivity after injection of 51Cr-labeled autologous platelets. None of the mathematical models used was able to discriminate between the two patients groups. No correlation existed between survival time and extent of the arterial disease. Patients with a high serum cholesterol did not exhibit an enhanced platelet consumption. Thus, these studies do not support the idea that turnover is enhanced in patients with coronary artery disease as compared to those with normal coronary arteries.

Angiography↗
PubMed1984

Coronary artery surgery in patients with myxoedema.

Thyroid replacement therapy in patients with myxoedema associated with coronary atherosclerosis often exacerbates angina or occasionally precipitates myocardial infarction. Coronary revascularization has been proposed for these patients. In an attempt to evaluate the risks of anesthesia and surgery in hypothyroidism against the possible occurrence of a coronary event during preoperative thyroid replacement therapy, we reviewed the literature and report an additional five hypothyroid patients undergoing coronary bypass grafting without operative complications. It seems recommendable not delay thyroid replacement therapy in hypothyroid patients, who need coronary artery surgery, until a few days after the intervention.

Acute Disease↗
PubMed1983

Angiographic evolution of coronary atherosclerosis in non-operated patients.

Repeat coronary arteriography was performed in 100 patients with angiographically proven coronary artery disease, because of worsening symptoms (n = 67), persistent stable angina (n = 22) or other reasons (n = 11). The mean interval between the studies was 34.6 months (range 6-99). No patient had interim coronary artery bypass surgery. Progression of coronary artery disease was demonstrated in 60 patients and was correlated in bivariate analysis with the time interval between coronary arteriograms (P less than 0.0001) and with the interim clinical evolution (P less than 0.01). The incidence of progression was similar in the coronary arteries. Moderate lesions (40-70% narrowing) had the highest progression percentages. New significant lesions in previously normal arterial segments were rare. A multivariate analysis of 18 possible predictors revealed three independent variables correlated with progression of coronary artery disease: time interval (P less than 0.0001) and change in functional class (P less than 0.02) between coronary arteriograms, as well as the presence of clinical diabetes (P less than 0.03). Other risk factors and a change of individual risk factors between coronary arteriograms were not correlated with progression of coronary artery disease. Using the results of the multivariate analysis, the evolution of coronary artery disease was correctly predicted in only 72 patients. Following the repeat coronary arteriogram, coronary artery bypass surgery was proposed to 62 patients, 26 of whom needed more distal anastomoses for optimal myocardial revascularization. Because of the important therapeutic implications and the lack of reliable predictors, an aggressive follow-up of patients with known coronary artery disease seems warranted.

Adult↗
PubMed1982

Evaluation of bedside myocardial scintigraphy with 201Tl in acute myocardial infarction.

Bedside myocardial scintigraphy was performed on 149 patients admitted to the Coronary Care Unit (CCU), after IV injection of 74 MBq 201Tl, using a mobile gamma camera (Dynamo). The study was displayed on Polaroïd pictures, without any image treatment, and read by two independent readers. Clinical history, findings, and final diagnosis were assessed by an independent clinician. The following conclusions were reached: 1) The sensitivity of the study for the detection of a recent myocardial infarction (MI) was 0.84 with a specificity of 0.87. 2) There was a good correlation between scintigraphic and ECG localization. 3) No firm correlation was found between scintigraphic and enzymatic estimates of infarct size. 4) Abnormal visualization of the right ventricle was probably associated with more extensive infarction.

Aged↗
PubMed1982

Comparative effects of alinidine and propranolol in ischaemic heart disease.

The effects of single oral doses of alinidine 40 mg, propranolol 40 mg or placebo during a maximal exercise test on a bicycle ergometer in patients with angina pectoris were studied in a randomised, double blind study. 2 and 5 h after drug intake a small fall in resting heart rate and systolic blood pressure was observed both after alinidine and propranolol. At a fixed work load both drugs decreased heart rate, systolic blood pressure, double product and the extent of ST segment depression. Total work performed and time to appearance of angina pectoris were increased 2 h alinidine and propranolol. The same effects were still apparent 5 h after propranolol but not after alinidine. At peak exercise neither drug had any effect on the extent of ischaemic ST segment depression.

Blood Pressure↗
PubMed1981

Ultrastructural correlates of left ventricular contraction abnormalities in patients with chronic ischemic heart disease: determinants of reversible segmental asynergy postrevascularization surgery.

The relationships between structural alterations and left ventricular (LV) contraction abnormalities were studied in patients with coronary artery disease (CAD). Transmural biopsies of the LV anterior free wall were taken during aortocoronary bypass surgery (CABG) in 62 patients. When preoperative anterior wall motion (AWM) was reduced, significant myocardial cell degeneration was found in patients with as well as without previous anterior infarction (MI). The amount of myocardial fibrosis was increased only in patients with ECG evidence of previous anterior MI (p less than 0.001). In a second series of 139 CAD patients, cineventriculograms performed before and 8 months after CABG were examined. In patients with patent grafts to the LV anterior wall not previously infarcted, reduced AWM became normal. In patients with previous anterior MI the outcome of AWM was unpredictable (usually unimproved). Thus the histologic correlate of reduced AWM in segments not previously infarcted was progressive loss of contractile material in otherwise viable myocardial cells. Some reversibility was suggested by restoration of resting function after CABG. Unpredictable results in segments associated with pathologic Q waves appear related to the fibrous component of these previously infarcted areas.

Adult↗
PubMed1981

Coronary arterial lesions in young men who survived a first myocardial infarction: clinical and electrocardiographic predictors of multivessel disease.

An analysis was made of clinical and electrocardiographic prognostic determinants of multiple vessel disease in 100 men, aged under 45 years, who survived a myocardial infarction. All patients underwent selective coronary arteriography within 1 year after sustaining a myocardial infarction. Multivessel disease was present in 64 patients; 33 patients had single vessel disease and 3 had either normal coronary arteries or minimal lesions. Exercise stress testing, electrocardiographic location of the infarction, total serum cholesterol and clinical features including body build, arterial blood pressure, smoking habits, family history of coronary artery disease and the presence of angina pectoris either before or after the acute event proved to be poor predictors of multiple vessel disease. Only 74 percent of the patients were correctly classified by a discriminant function analysis. Thus, for prognostic reasons, coronary arteriography seems warranted in young patients after acute myocardial infarction, even in the absence of residual angina or multiple risk factors.

Adult↗