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J Quininha

Publications and source records attributed to J Quininha.

67 records · Page 4Linked to original sources
PubMed1989

[Flow patterns of a normally functioning monocuspid aortic prosthesis evaluated using Doppler echocardiography].

STUDY OBJECTIVE: Flow analysis in normally functioning eccentric monocuspid aortic prosthetic valves, to obtain a reference data list. DESIGN: To analyse, using 2D-Doppler Echocardiography, aortic flow velocity and systolic time intervals in clinically normal patients (pts), by physical examination. SETTING: Referred pts to the Echocardiographic Laboratory at Santa Marta Hospital--HCL. PATIENTS: Sequential sample of 61 pts with aortic prosthesis (41 Bjork-Shiley and 20 Hall-Kaster) without clinical evidence of either cardiac failure or significant aortic regurgitation. Patients with bad quality record were also excluded. INTERVENTIONS: Doppler Echocardiography was used to record transaortic flow, and the following indexes were analysed: instantaneous peak velocity (pv) and gradient (pg), presence of regurgitation, systolic time intervals and both preejection period/ejection time (PEP/ET) and acceleration time/ejection time (AT/ET). RESULTS: Pv ranged from 1.1 to 4 m/sec (mean 2.4 +/- 0.2. The prosthesis size 19 and 21 showed a greater pg compared to the larger ones: 46.3 +/- 14.4 mmHg against 12.6 +/- 6.4 mmHg (p less than 0.001). Occasionally a pg over 50 mmHg was found in the prosthesis size 19 and 21. The correlation between prosthesis size and pg was also significant (r = -0.62; p less than 0.001). PEP interval was 60 +/- 10 milisec in prosthesis no. 19 and 90 +/- 13 milisec in no. 27 (p less than 0.01). AT ranged from 77 +/- 14 to 88 +/- 14 milisec (mean 82 +/- 13). ET was 294 +/- 5.4 milisec in valves size 19 and 257 +/- 34 millisec in no. 25 (p less than 0.05); there was also a significant difference between prosthesis size 19 and 27 (p less than 0.05). Mild regurgitation was detected in 32.7% of cases. CONCLUSIONS: These data may be particularly useful as reference values to the follow-up of pts these types of prosthesis. Significant differences were found in pg between different valve sizes and this should be remembered when proceeding to standard evaluation by 2D-Doppler Echocardiography. Regurgitation is frequently detected in normally functioning prosthesis, not deeper than 2 cm in the left ventricle.

Adult↗
PubMed1989

[Movement of the mitral valve in patients with ischemic cardiopathy].

STUDY OBJECTIVE: 1. Determination of the clinical value of the mitral-septal angle (MSA), a new two-dimensional echocardiographic (2DE) index, in the evaluation of left ventricular function; 2. Assessment of the relation of incomplete mitral leaflet closure (IMLC) with the presence of mitral regurgitation (MR) or elevated end-diastolic left ventricular pressure (EDLVP). DESIGN: Prospective study involving subjects without heart disease and patients with coronary artery disease. SETTING: Cardiology Department of the Hospitais Civis de Lisboa--Hospital de S. Marta. PARTICIPANTS: We studied: A - 30 normal volunteers; B - 43 patients (pt) with coronary artery disease documented by coronary angiography. METHODS: Two-Dimensional Echocardiography was performed in all subjects. MSA was measured in early diastole using the apical four-chamber view. Using the same view IMLC was assessed. Echo pulsed Doppler was used to detect the presence of MR. All patients in group B were submitted to cardiac catheterization. EDLVP was measured and left ventriculography and coronary arteriography were performed. Presence of MR was assessed and ejection fraction (EF) calculated. According to EF patients were divided: Group B1 (EF greater than 50 - 23 pt); Group B2 (EF 35-50% - 11 pt); Group B3 (EF less than 35% - 9 pt). MEASUREMENTS AND MAIN RESULTS: In group A MSA was always less than 30 degrees and IMLC was never observed. In group B pt with EF greater than 50% had MSA less than 30 degrees in all but one case. Patients with EF less than 50% had MSA superior to 30 degrees in all but two cases. MSA superior to 45 degrees was found in 2 pt with EF 35-50% and in 5 pt with EF less than 35%. IMLC was detected in 11 pt. Only 2 pt had MR and 7 had EDLVP greater than 18 mmHg - 15 pt had an elevated EDLVP in the whole group. IMLC was frequent in group B3 - 7 pt. Correlation between MSA and EF was good (r = -0.81). Sensitivity and specificity of MSA in the separation of pt with EF superior and inferior to 50% was 90% and 95%, respectively: they dropped when we tried to separate pt with EF superior and inferior to 35% (sensitivity 55%, specificity 77%). CONCLUSIONS: IMLC didn't correlate with the existence of MR or elevated EDLVP; it appears, however, to be associated with poor left ventricular function (EF less than 35%). MSA is a good echocardiographic index of left ventricular in patients with coronary artery disease. It is easily measured and it can be a good alternative to mitral E point septal separation in patients in which left sternal views are difficult or impossible.

Adult↗
PubMed1988

[Treatment by redilatation and thrombolysis of occlusion occurring during percutaneous coronary angioplasty].

In patients who develop acute coronary occlusion during or after percutaneous coronary angioplasty, surgery is not mandatory, and other treatments may be considered, namely redilatation and/or thrombolysis. Between June, 1984 and January, 1988 we performed 500 dilatations of coronary arteries, not counting the attempts made in the acute phase of myocardial infarction. Acute coronary occlusion without angiographic image of occlusive dissection occurred in 31 patients (6.2%) and was treated by attempted redilatation and intracoronary thrombolysis. In 10 patients (group A) either the occlusion could not be removed and emergency surgery was tried (5 cases with 2 infarctions and 1 death), or the occlusion was removed but myocardial infarction took place (5 cases). In 21 patients (group B), the occlusion was removed and the outcome was favourable without myocardial infarction. Altogether, myocardial infarction or death occurred in only 8 cases, or 26% of acute occlusions. The clinical and angiographic features of the two groups before and after angioplasty were compared; two of them differentiated group A from group B: (1) unstable angina, 7/10 in group A, 4/21 in group B (p less than 0.01), and (2) degree of stenosis, 93.1% in group A, 78% in group B (p less than 0.01). When coronary occlusion occurs during or after coronary angioplasty and is poorly tolerated with fall in blood pressure, surgery must be contemplated at once, even after recanalization of the vessel and subsidence of ischaemia. In all other cases, treatment with both redilatation and thrombolysis should restore the benefits of angioplasty without myocardial infarction.

Adult↗
PubMed1985

[Echocardiographic study of left ventricular contraction by a scoring method in chronic coronary insufficiency].

The echocardiographic evaluation of left ventricular function in chronic coronary insufficiency is based on the two-dimensional ultrasound examination. Several methods of analysis can be used: volumetric analysis or comparison of the diastolic and systolic contours after separation of the images, but they are relatively difficult to perform and are associated with a certain degree of error. We present the results of a method of analysis based on scoring of the real time image without reprogramming. The left ventricle is divided into nine parts according to Heger's model and the segmental kinetics of each segment are scored according to the following system; 0: parietal aneurysm; 1: dyskinesia; 2: akinesia; 3: hypokinesia; 4: normal. The maximal score is therefore 36. This method was applied prospectively in 30 consecutive patients with chronic coronary insufficiency requiring coronary angiography. The results were compared to those of ventriculography in 30 degrees RAO and 45 degrees LAO cranio-caudal views, which were analysed quantitatively. A correct echocardiographic analysis was obtained in 29 patients. There was good concordance with the ventriculography in 20 cases. In two cases, the contractile abnormality was detected on the echocardiogram, but it was located in an adjacent area on the angiography. In five cases, a localised abnormality of one segment was only detected on angiography. The comparison of the score with the angiographic ejection fraction revealed a good concordance and a very high degree of sensitivity for the method in the identification of cases with an ejection fraction of less than 30 p. cent. This scoring method avoids a number of errors of the other volumetric methods or the methods which compare the contours and it provides clinically significant results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

New criteria for the diagnosis and treatment of atrioventricular node reentrant tachycardia.

The authors describe a new elecrocardiographic criterion to diagnose atrioventricular node reentrant tachycardia, review the electrocardiographic and electrophysiological diagnosis of this tachyarrhythmia and analyse the results of catheter ablation of fast versus slow pathway, selecting the fast pathway whenever the induction of atrioventricular node reentrant tachycardia is performed only after pharmacological maneuvers. The high specificity for atrioventricular node reentrant tachycardia of the criterion characterized by the absence of ST-segment depression found in left precordial leads from V4 to V6 suggests the need to include it in electrocardiographic algorithms for the differential diagnosis of tachycardias with a narrow QRS complex. The high primary and final success rates of catheter ablation obtained after a therapy stratification based on induction criteria, emphasize the use of the fast pathway ablation as a first option in selected cases and for the treatment of recurrences.

Catheter Ablation↗
PubMedDate not supplied

Percutaneous occlusion of patent foramen ovale in patients with paradoxical embolism.

INTRODUCTION: A patent foramen ovale can be found in about one quarter of adults and in a small percentage it is a wide opening and may be associated with aneurysmal formation. The association between a wide patent foramen ovale and paradoxical embolism is well established. In such cases percutaneous closure is indicated, as an alternative to life-long anticoagulant therapy or surgery. Percutaneous closure is an attractive technique and is more advantageous than other methods. METHODOLOGY: We describe the first cases of percutaneous occlusion of patent foramen ovale performed in Portugal, using the Amplatzer PFO occluder, in three female patients with documented cerebrovascular accidents due to paradoxical embolism. We also analyze the rationale for using this technique in such patients and its preliminary results. RESULTS: All three patients submitted to percutaneous occlusion of patent foramen ovale had a similar history of ischemic cerebrovascular accident. Transesophageal echocardiography showed a wide-open foramen ovale ranging from 9 to 12 mm, with spontaneous right-to-left shunt in all patients, and one of them also had an aneurysmal formation. Total procedure time ranged from 30 to 55 minutes and fluoroscopic time from 9 to 12 minutes. There were no complications and during the short follow up all patients are asymptomatic and free of recurrent events. CONCLUSIONS: Percutaneous closure of patent foramen ovale is a safe and promising technique in the prevention of recurrent systemic thromboembolism in appropriately selected patients. Prospective studies comparing antithrombotic therapy or surgery with percutaneous closure should clarify its efficacy and therapeutic value.

Adult↗
PubMedDate not supplied

[Evolution of the detection of interventricular septal defect].

From 24.10.1969 to 31.12.1986, seventeen years, 1274 infants and children with proven isolated ventricular septal defect were observed and followed in Pediatric Cardiology of Santa Marta Hospital. There were 659 males and 615 females, ranging from 3 days to 12 years, born in portuguese territory and without syndromes. As early detection and referring is crucial to prevent pulmonary vascular disease with fixed pulmonary arterial resistance, the annual variation of the referring age was studied. The results improved since 1972 with a steady faster improvement during the last 7 years of the study.

Child↗
PubMedDate not supplied

[Multiple thromboembolism associated with anti-thrombin III deficiency].

Congenital deficiency of antithrombin III is considered as one serious primary hypercoagulable state. The authors present a case of deficiency of antithrombin III in a 28 years old young male, with aortic valve disease and several thromboembolic events. When discussing their diagnostical and therapeutical aspects they call the attention to the need for investigation of the situations in which thrombophilia presents with recurrent venous and arterial thrombosis.

Adult↗
PubMedDate not supplied

[Exercise 2D-Doppler echocardiography, for the evaluation of aortic valve prostheses].

STUDY OBJECTIVE: Exercise evaluation of eccentric monocuspid aortic prosthetic valves. DESIGN: Prospective study, using 2D Doppler echocardiography to analyse resting and exercise aortic flow patterns. SETTING: Laboratory of Echocardiography at Santa Marta Hospital. PATIENTS: Sequential sample of 28 patients with aortic prosthesis (19 Bjork-Shiley and 9 Hall-Kaster), without evidence of either cardiac failure, coronary artery disease, prosthesis dysfunction or stress test contraindication. INTERVENTIONS: Transaortic basal and exercise flow record, using Doppler echocardiography to analyse: instantaneous peak velocity (pv) and gradient (pg), systolic time intervals, heart rate (hr) and stress test time (stt). The patients were divided in two groups A (prosthesis valve size 19 and 21) and B (greater than 21). RESULTS: Technical success: 84%. basal pv ranged from 1.6 to 4.5 m/s in group A and 1.7 to 3 m/s in B. Rest pg was 35 +/- 1% mmHg--Group A--and 20 +/- 8 mmHg in B (p less than 0.01), increasing with stress test respectively to 62 +/- 26 (p less than 0.01) and 36 +/- 12 mmHg (p less than 0.001). 73% of group A patients had exercise pg greater than 50 mmHg. The correlation between basal and exercise pg was significant (r = 0.91 p less than 0.001). At rest the systolic time intervals revealed a significant difference between the two groups (p less than 0.05), while only the ejection time was significant with stress test (p less than 0.01). Exercise hr and stt were greater in group B-p = NS. CONCLUSIONS: These exercise Doppler echocardiography data suggest that mechanical moncuspid aortic prosthesis 19, 21 and same 23, result in left ventricular outflow obstruction mainly during exercise; these facts should be taken into account when aortic prosthesis insertion is considered. Given the good correlation between resting and exercise peak gradient, Doppler stress test is not routinely recommended in clinical practice.

Adult↗