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J Soler-Soler

Publications and source records attributed to J Soler-Soler.

At least 109 records · Page 6Linked to original sources
PubMed1996

[Normal values of valvular flow velocities determined by Doppler echocardiography: relations with heart rate and age].

INTRODUCTION AND OBJECTIVES: The velocity-time integral (VTI) and the mean velocity of valvular flow are widely-used variables in Doppler-echocardiography. The aim of the present work was to determine normal VTI and mean velocity values of valvular flow and their relation to age, sex, heart rate and body surface area. METHODS: One hundred and fifty-six patients (84 men, 72 women; age range: 6-86 y; mean: 37 +/- 20) without cardiovascular disease were studied by Doppler echocardiography. VTI and the mean velocity of left and right ventricular outflow tract, and mitral and tricuspid valvular flow were determined by pulsed-wave Doppler. Aortic and pulmonary valvular flow were assessed by continuous wave Doppler. RESULTS: Mean value of aortic valvular flow VTI (22 +/- 4 cm) was slightly higher than that of pulmonary valvular flow (20 +/- 4 cm). Mean VTI values of left and right ventricular outflow tract and mitral valvular flow were similar (16 +/- 3, 15 +/- 3 and 15 +/- 3 cm, respectively) with an acceptable correlation (r = 0.76-0.83). VTI of tricuspid valvular flow was clearly lower than the rest (10 +/- 3 cm; p < 0.001). Linear regression analysis showed the VTI to be inversely related to heart rate and age, and mean velocity positively related to heart rate and inversely to age. While VTI remained relatively stable up to the age of 60 and decreased sharply thereafter, mean velocity decreased progressively with age. VTI values were identical for both sexes; however, mean velocity was higher in women up to the age of 60. CONCLUSIONS: VTI is a Doppler parameter independent of body surface area, inversely related to heart rate, not sex-related and remains stable up to the age of 60. Normal mean velocity values should be defined in relation to heart rate and age. Normal values of these Doppler parameters should be borne in mind for non-invasive assessment of cardiovascular function.

Adolescent↗
PubMed1996

[Normal values of valvular annular areas. Comparison of the results of a necropsy and an echocardiographic series].

INTRODUCTION AND OBJECTIVES: Measurement of valvular annular area is necessary for valvular flow volumen quantification by Doppler echocardiography. The aim of this work was to compare normal valvular annular area values obtained in a necropsic and an echocardiographic series and to ascertain whether a relationship exists between these areas and several anthropometric variables. METHODS: Necropsic series: valvular annular area was measured in 20 hearts from deceased patients (age range: 9-79 years; mean 52 +/- 18) without cardiovascular disease. Echocardiographic series: Valvular annular area was determined in 156 patients (age range: 6-86 years; mean 37 +/- 20) without cardiovascular disease. RESULTS: Necropsic series: multiple regression analysis showed valvular annular area values to be related mainly to height (p < 0.001) but also to weight (p < 0.01). Correlations between valvular annular area and body surface were low (r = 0.64-0.75). Aortic annular area index was slightly lower than the pulmonary annular area index and half that of the mitral annular area index (2.2 +/- 0.4, 2.5 +/- 0.5 and 4.4 +/- 0.8 cm2/m2, respectively). Tricuspid annular area index was the largest (6.7 +/- 1.0 cm2/m2). ECHOCARDIOGRAPHIC SERIES: Multiple regression analysis also showed a relationship between valvular annular area and height (p < 0.00001) and weight (p < 0.004). Correlations between valvular annular real values and body surface were poor (r = 0.45-0.71). Mean values of aortic, pulmonary and mitral valvular annular area indices were similar to those obtained in the necropsic series (2.1 +/- 0.2, 2.1 +/- 0.3, 4.1 +/- 0.6 cm2/m2, respectively). However, the tricuspid annular area index was clearly lower (4.5 +/- 0.6 cm2/m2, p < 0.001). CONCLUSIONS: Valvular annular area is influenced mainly by height, but also by weight. The correlation between these values and body surface is poor. Aortic annular area is similar to the pulmonary annular area and half that of the mitral annulus. Normal values determined by echocardiography and necropsy are similar, although tricuspid annular area by apical view is smaller than that obtained in the necropsic series.

Adolescent↗
PubMed1995

Relevance of electrocardiographic findings, heart failure, and infarct site in assessing risk and timing of left ventricular free wall rupture during acute myocardial infarction.

Clinical and electrocardiographic features of 227 patients who died of an acute myocardial infarction (AMI) were compared with those of 150 survivors of a first AMI. Left ventricular (LV) free wall rupture was found in 93 patients aged > 50 years, but not in 134. The incidence of healed infarct (4 [4%] vs 50 [37%], p < 0.001), heart failure (11 [12%] vs 112 [84%], p < 0.001), and bundle branch block (11 [12%] vs 54 [40%], p < 0.001) was lower in patients with than without LV rupture. In patients with anterior AMI and early rupture (1 day), admission ST elevation was higher than in those with late LV rupture (> 1 day, 6.8 +/- 4.0 vs 4.0 +/- 2.7 mm, p < 0.01). However, lateral wall AMI had minimal ST elevation and accounted for 10% of ruptures. On day 2, the decrease in ST segment in patients with late LV rupture was less than in survivors (0.5 +/- 1.6 vs 3.2 +/- 2.9 mm, p < 0.001). Admission systolic blood pressure in patients who had early rupture was higher than in survivors (155 +/- 22 vs 137 +/- 22 mm Hg, p < 0.001) and in those with late rupture (135 +/- 23 mm Hg, p < 0.001). Late rupture was associated with infarct thinning and triggered by a physical strain in 18 of 45 patients (40%); infarct thinning, however, was present only in 4 of 48 patients (8%) with early rupture (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Diagnosis of coronary disease by means of stress gamma-tomography with 99m-technetium-isonitriles].

BACKGROUND: To assess the yield of exercise myocardial stress tomogammagraphy (SPET) with methoxy-isobutyl-isonitrile-technetium-99m (99mTc-MIBI) in the diagnosis of coronary artery disease. METHODS: Seventy-two consecutive patients, without previous myocardial infarction and with coronary angiography, were investigated. All underwent a symptom-limited exercise test with intravenous infection of 15 mCi of 99mTc-MIBI 30-60 seconds before the end of exercise. Detection of tomographic images was performed after one hour. Rest images were detected 24 hours later. Images with exercise perfusion defects which became normal at rest were considered as positive. RESULTS: Sensitivity (84%), specificity (93%), global value (87%), positive predictive value (95%), and negative predictive value (79%) of 99mTc-MIBI were significantly higher than those of conventional exercise electrocardiogram (46%, 69%, 55%, 69% and 46%, respectively). These values were lower when exercise test was insufficient (peak heart rate below 80% in the absence of angina). The sensitivity values were similar for the diagnosis of one (81%), two (76%), and three (93%) vessel disease. The application of Bayes' theorem disclosed that the highest yield of MIBI was achieved with prevalences ranging between 30% and 70%. CONCLUSION: The efficacy of 99mTc-MIBI SPET for the diagnosis of coronary artery disease was satisfactory, particularly when exercise was sufficient and with a prevalence of coronary artery disease ranging between 30% and 70%.

Coronary Disease↗
PubMed1995

Strategies for prognostic assessment of uncomplicated first myocardial infarction: 5-year follow-up study.

OBJECTIVES: Our aim was to use noninvasive studies early after infarction to assess medium-term prognosis in patients with a first uncomplicated myocardial infarction. BACKGROUND: Although the use of early postinfarction assessment to gauge short-term prognosis in myocardial infarction is well established, there have been few comprehensive evaluations of noninvasive methods for assessing medium- and long-term prognosis. METHODS: We prospectively studied 115 consecutive patients < 65 years old with a first acute uncomplicated myocardial infarction to evaluate the prognostic role of predischarge cardiac studies. These included submaximal exercise testing, thallium-201 scintigraphy, radionuclide exercise ventriculography, two-dimensional echocardiography, ambulatory electrocardiographic (Holter) monitoring and cardiac catheterization. All patients without complications were followed up > or = 5 years. RESULTS: During the follow-up period, 78 patients (68%) developed complications, which were severe in 37 (32%). Exercise thallium-201 scintigraphy yielded the highest percentage (77%) for correctly classified patients. It also had the highest predictive value for complications (97%) and severe complications (92%) when it was used in association with exercise testing and radionuclide ventriculography. The addition of cardiac catheterization did not improve on the predictive power of noninvasive studies. Four decision trees (exercise testing + echocardiography, exercise testing + radionuclide ventriculography, thallium-201 + echocardiography, thallium-201 + radionuclide ventriculography) allowed stratification of all patients in a high, intermediate or low risk category. The combination of thallium-201 scintigraphy and radionuclide ventriculography yielded the best results (90% predictive value for complications if the outcome of both tests was positive), but there were no significant differences with the other models. CONCLUSIONS: Any combination of a test detecting residual ischemia or functional capacity, or both (exercise testing or thallium-201 scintigraphy), and a test assessing ventricular function (echocardiography or radionuclide ventriculography) results in useful prognostic information in patients with an uncomplicated first acute myocardial infarction.

Adult↗
PubMed1995

Cardiac index quantification by Doppler ultrasound in patients without left ventricular outflow tract abnormalities.

OBJECTIVES: We attempted to ascertain whether cardiac index can be directly estimated from Doppler mean velocity. BACKGROUND: Although diverse Doppler echocardiographic methods have been described for cardiac output quantification, they are not widely used in clinical practice. Cross-sectional area measurement has been identified as the main source of error in flow volume quantification. METHODS: A three-phase study by Doppler echocardiography was conducted in 306 patients. In phase I, the normal mean velocity ratio of the left and right ventricular outflow tracts was established in 170 normal subjects. In phase II, cardiac index, calculated as the product of aortic annular area index by mean velocity (conventional method), and mean velocity determined in the left ventricular outflow tract and ascending aorta by pulsed and continuous wave Doppler, respectively, were correlated with thermodilution cardiac index in 66 patients. In phase III, the accuracy of the regression equations obtained was prospectively assessed in an additional 70 patients. RESULTS: The normal left/right ventricular outflow tract mean velocity ratio by pulsed wave Doppler was 1.1 +/- 0.1. Cardiac index (CI) calculated by the conventional method and thermodilution (TD) showed acceptable correlation (r = 0.90, CITD = 1.20 CIPWD + 357; r = 0.86, CITD = 0.90 CICWD + 262) for pulsed (PWD) and continuous wave (CWD) Doppler, respectively, but with systematic underestimation (-28 +/- 13%, p < 0.01) by pulsed wave Doppler. Mean velocity (MV) showed excellent correlation with the thermodilution cardiac index (r = 0.97, CITD = 172 MVPWD - 172; r = 0.93, CITD = 129 MVCWD - 255). When these regression equations were prospectively applied, better agreement with the thermodilution cardiac index was obtained by pulsed wave Doppler directly from mean velocity (SD 240 ml/min per m2) than when aortic annular area was considered in the calculation (SD 428 ml/min per m2). Similar results were obtained by continuous wave Doppler (SD 433 vs. 599 ml/min per m2) but with less accuracy. CONCLUSIONS: Left ventricular outflow tract mean velocity determined by pulsed wave Doppler permits easy, accurate cardiac index quantification in the absence of left ventricular outflow abnormalities. The simplicity of this method enhances its clinical applicability in noninvasive monitoring of cardiac index.

Adolescent↗
PubMed1995

ST segment elevation at the surface of a healed transmural myocardial infarction in pigs. Conditions for passive transmission from the ischemic peri-infarction zone.

BACKGROUND: Ischemia of the myocardium surviving an infarction induces ST segment elevation in infarct-related ECG leads. In cases with no viable tissues, ischemia adjacent to the infarction could induce a similar ECG pattern if there is ST segment potential transmission through the necrotic scar. We analyzed whether acute ischemia adjacent to a healed infarction with no viable tissue may induce ST segment elevation on the surface of the necrotic scar. METHODS AND RESULTS: Epicardial ST segment changes elicited during 30 minutes of acute reocclusion of the left anterior descending (LAD) coronary artery 2 cm above the first diagonal branch were analyzed by 32-channel mapping in 18 chloralose-anesthetized open-chest pigs with 1-month-old anterior infarctions induced by permanent ligature below the first diagonal branch (group 1). The effect of a previous infarction on the magnitude of ischemic ST segment changes was assessed by similar mapping in 21 control pigs submitted to a LAD ligature 2 cm above the first diagonal branch (group 2, n = 11) or just below this branch (group 3, n = 10). Myocardial perfusion after coronary ligature was estimated in 7 pigs with chronic infarction and in 3 control pigs by mapping of myocardial technetium-99m-methoxyisobutyl isonitrile (99mTc-MIBI) activity in transmural samples underlying each epicardial electrode. The width of cell layers surviving the infarction was measured and their viability after 60 minutes of coronary reocclusion was assessed by intracellular glycogen staining. Reocclusion of the LAD induced parallel ST segment elevation at the periinfarction zone and at the necrotic scar, although in the latter region the changes were less marked (maximal ST segment, 8.4 +/- 3.0 mV versus 2.7 +/- 1.8 mV, ANOVA, P < .001). ST segment elevation inside the scar was greater at the margins (3.9 +/- 1.8 mV) than at sites 20 mm toward the center (2.8 +/- 1.7 mV, P = .003). The necrotic area was virtually devoid of surviving cells except for a 0.22 +/- 0.04-mm-wide subendocardial band that continued to show a positive intracellular glycogen reaction after the second LAD ligature. Acute ischemia adjacent to the infarction (group 1) induced lower ST segment elevation than acute ischemia at a comparable cardiac region in noninfarcted pigs (group 2) (ANOVA, P = .02), despite the fact that these areas developed similar underperfusion after coronary occlusion (percent MIBI activity of that in normal myocardium, 7 +/- 8 versus 7 +/- 6, P = NS). ST segment changes in group 2 pigs were comparable to those induced in group 3 pigs with a 2-cm-lower coronary occlusion. CONCLUSIONS: Acute ischemia adjacent to a chronic infarction induces ST segment elevation at the surface of the scar despite the virtual absence of viable tissue within the infarction. Data suggest a passive ST segment potential transmission through the infarction. Moreover, ischemia adjacent to a chronic infarction induces lower ST segment elevation than ischemia not adjacent to a necrosis. The mechanisms accounting for these regional differences are probably independent of collateral myocardial perfusion and ischemia extension.

Animals↗
PubMed1995

Contraction band necrosis at the lateral borders of the area at risk in reperfused infarcts. Observations in a pig model of in situ coronary occlusion.

The aim of this study was to test the hypothesis that increased mechanical stress at the lateral borders of the area at risk may render this area more susceptible to ischaemia/reperfusion injury in the absence of collateral flow. The spatial distribution of myocardial necrosis within the territory of a transiently occluded left anterior descending coronary artery was investigated in 31 porcine hearts submitted to 48 min of coronary occlusion and 6 h of reperfusion. Immediately before excising the heart, the left anterior descending coronary artery was re-occluded and 10% fluorescein was injected in the left atrium. The area at risk was imaged by ultraviolet illumination of the myocardial slices, and the area of necrosis by incubation in triphenyltetrazolium chloride. The area at risk was divided in four sectors and an index of eccentricity was calculated as the percent of the area of necrosis located in the two lateral sectors of the area at risk. The area of contraction band necrosis was measured in whole heart histological sections. Infarcts were generally small, and were composed almost exclusively of contraction band necrosis. There was a good correlation between the extent of the area of contraction band necrosis and infarct size (r = 0.831, P < 0.0005). The area of necrosis had a patchy appearance and was predominantly distributed along the lateral borders of the area at risk. This eccentric distribution was more prominent in smaller infarcts, and the eccentricity index was inversely correlated with infarct size (r = -0.471, P = 0.007), suggesting that contraction band necrosis occurs first at the interface between control and reperfused myocardium in this model. These results are in agreement with a prominent role of mechanical factors in the genesis of myocardial necrosis during transient coronary occlusion.

Animals↗
PubMed1995

Clinical outcome of severe asymptomatic chronic aortic regurgitation: a long-term prospective follow-up study.

One hundred one patients with asymptomatic chronic severe aortic regurgitation and normal ejection fraction were monitored for up to 10 years (mean 55.4 +/- 33.5 months). Predefined surgical indications were the development of cardiac symptoms or the documentation of impaired basal left ventricular function. During the follow-up period there were no cardiac deaths; 14 patients needed surgery, 8 because of development of symptoms and 6 because of left ventricular impairment. The risk of surgery was 12% at 5 years and 24% at 10 years. Baseline end-systolic diameter > 50 mm and radionuclide ejection fraction < 60% were independent predictors or either cardiac symptoms or left ventricular dysfunction. In patients needing surgery, a pattern of progressive left ventricular dilatation was demonstrated. There were no deaths during surgery, and echocardiographic and radionuclide parameters normalized in the first year of follow-up. Our data confirm that the prognosis of severe aortic regurgitation in patients with no symptoms is good and that the occurrence of asymptomatic left ventricular dysfunction is an uncommon event. Surgery can be safely postponed until the appearance of cardiac symptoms or the documentation of left ventricular dysfunction at rest.

Adult↗
PubMed1995

Limitations of head-up tilt test for evaluating the efficacy of therapeutic interventions in patients with vasovagal syncope: results of a controlled study of etilefrine versus placebo.

OBJECTIVES: This study assessed the efficacy of oral etilefrine (10 mg three times a day) in preventing a positive response to head-up tilt testing. BACKGROUND: Previous reports have suggested that oral etilefrine can be effective either in preventing a positive response to head-up tilt testing or in reducing syncopal recurrences in patients with vasovagal syncope. Up to now most studies assessing drug therapy in these patients have been uncontrolled. METHODS: This was a randomized double-blind crossover study of etilefrine versus placebo in 30 consecutive patients with syncope and a baseline positive head-up tilt test. After the first test, patients had no treatment for 3 days and were randomized to receive etilefrine or placebo for 4 additional days. They underwent tilt testing under treatment and again after 3 days of washout; they then received the alternative treatment for 4 days, and a third test was performed. RESULTS: Head-up tilt test results were negative in 13 (43%) patients with etilefrine and 15 (50%) with placebo (p = NS). Therefore, the statistical power of the study was only 10%. The rate of positive responses decreased with repeated testing irrespective of the assigned treatment: A positive response was obtained during the second head-up tilt test in 20 patients (10 with placebo, 10 with etilefrine) but in only 12 during the third (7 with etilefrine, 5 with placebo) (p < 0.05). CONCLUSIONS: Oral etilefrine (10 mg three times a day) was not superior to placebo in preventing a positive response to head-up tilt testing. Despite a low statistical power, the high rate of negative response with placebo (50%) suggests that controlled trials are needed to assess the real efficacy of any treatment in patients with vasovagal syncope.

Administration, Oral↗
PubMed1995

Is the clinical spectrum and prognosis of native valve infective endocarditis in non-addicts changing?

One hundred and ninety-four episodes of endocarditis on native valves in non-addict patients were diagnosed from 1975 to 1992 and were divided into groups A (78 patients, 1975-1983) and B (116 patients 1984-1992). Both groups had the same gender distribution, similar valvular involvement and microbiological characteristics. In group B patients, median age was older (46 vs 54 years, P = 0.0002), the number of patients without previous heart disease was higher (46% vs 22%, P = 0.02) and the median time of symptoms before diagnosis was shorter (30 vs 50 days, P = 0.038). Both groups had similar incidence of heart failure (32% vs 36%), surgical treatment (30% vs 33%) and embolic episodes (26% vs 34%). Surgical mortality decreased from 43% to 18% (P = 0.03). Overall mortality decreased non-significantly from 19% in group A to 12% in group B. Predictors of death in group A were heart failure (odds ratio 9.6, 95% confidence interval 3-36) and surgical treatment (odds ratio 5, 95% confidence interval 1.3-19). Predictors of death in group B were age (odds ratio 4.98, 95% confidence interval 1.4-19), female sex (odds ratio 5.3, 95% confidence interval 1.3-20), staphylococcal infection (odds ratio 4.9, 95% confidence interval 1.1-22) and heart failure (odds ratio 5.2, 95% confidence interval 1.3-20). Although in recent years infective endocarditis occurs in older patients and is more common in patients with previously unknown heart disease a substantial change in major clinical and prognostic variables is not apparent in our population. Overall in-hospital mortality has decreased from 19% to 12% mainly due to better surgical results.

Adolescent↗
PubMed1995

Effect of osmotic stress on sarcolemmal integrity of isolated cardiomyocytes following transient metabolic inhibition.

OBJECTIVE: Exposure to hypotonic medium induces sarcolemmal rupture in metabolically inhibited cardiomyocytes. This study investigated the effect of osmotic stress applied during reoxygenation and the possible cooperation between cell swelling and hypercontracture to produce sarcolemmal disruption. METHODS: Freshly isolated adult rat myocytes were submitted to 60 min of metabolic inhibition (NaCN 2 mM). Reoxygenation was simulated by changing to one of 3 inhibitor free buffers: (1) normo-osmotic (312 mOsm); (2) hypo-osmotic (80 mOsm); (3) low Na+ normo-osmotic (312 mOsm). The contribution of hypercontracture-induced reoxygenation on sarcolemmal rupture was investigated in myocytes submitted to hypo-osmotic reoxygenation in presence of 2,3-butanedione monoxime 30 mM, a blocker of contractility. Recovery from mechanical fragility was studied by exposing cells to hypotonic buffer 20 or 40 min after restoration of metabolic activity, in either presence or absence of 2,3-butanedione monoxime. Two control groups without metabolic inhibition were used. One was exposed to osmotic stress after 60 min incubation in control conditions, the other was induced to hypercontract by exposure to hypo-osmotic, high-calcium buffer. Cell viability was assessed by the Trypan blue test. RESULTS: Before any intervention 81.9(1.2)% of cells were rod-shaped. After 60 min of metabolic inhibition most cells developed rigor contracture and only 16.4(1.8)% remained rod-shaped. Restoration of metabolic activity induced hypercontracture of most cells with rigor independently of buffer osmolality. Cell viability, however, significantly differed among groups: only 25.9(4.4)% of cells reoxygenated with hypo-osmotic buffer were viable vs. 74.1(7.6)% in the normo-osmotic reoxygenation group, and 82.9(2.9)% in the control group. Addition of 2,3-butanedione monoxime 30 mM during hypo-osmotic reoxygenation prevented hypercontracture and preserved cell viability. Delaying osmotic stress 20 or 40 min after the onset of reoxygenation did not improve viability [19.3(3.9) and 34.9(1.3)%, respectively]. Contractile blockade with 2,3-butanedione monoxime during the first 20 or 40 min of reoxygenation was associated with a reduction in the number of hypercontracted cells after the removal of the inhibitor but did not increase the proportion of hypercontracted viable cells (25% and 27%, respectively). CONCLUSIONS: (1) Osmotic stress following transient metabolic inhibition produces sarcolemmal disruption, and this effect is not related to the low Na+ concentration present in the hypo-osmotic buffer; (2) reoxygenation-induced hypercontracture cooperates with cell swelling to produce sarcolemmal disruption; and (3) osmotic fragility persists for at least 40 min after restoration of metabolic activity.

Animals↗
PubMed1995

[Effects of reoxygenation-induced osmotic edema on cell viability. Study using isolated myocytes].

OBJECTIVE: To investigate the hypothesis that reperfusion edema may kill myocytes. METHODS: Adult Sprague-Dawley rat hearts were perfused with a calcium free dissociation buffer containing collagenase 0.03% in a Langedorff system. Intact cells were selected and myocytes were cultured in adherent pretreated dishes. After 3 hours, 80% of cells were rod-shaped. Anoxia was simulated by means of metabolic inhibition by adding NaCN 2 mM to the control media, and reoxygenation by substituting this media with one of the following media non containing NaCN: 1) normo-osmotic (312 mOsm); 2) hypoosmotic (80 mOsm); 3) normo-osmotic with low Na+ (312 mOsm). A group of cells was kept with control media without metabolic inhibition and then submitted to simulated reoxygenation with hypoosmotic media (control group). The number of rod, square and round-shaped cells was monitored, and cell viability was assessed after 5 min of reoxygenation by the Trypan blue test. RESULTS: After 60 min of metabolic inhibition there were no differences in the % of cells without hypercontracture among groups reoxygenated with normo-osmotic, hypoosmotic, low Na+ normo-osmotic and control media (84 +/- 16, 74 +/- 10, 76 +/- 14 and 90 +/- 6% respectively (p = NS). After 5 min of reoxygenation, these values decreased (p < 0.001) to 19 +/- 6, 11 +/- 9 and 13 +/- 3% (p = NS), respectively, in groups with normo-osmotic, hypoosmotic, and low Na+ normo-osmotic reoxygenation, but were not modified in the control group (78 +/- 4). The % of viable cells (Trypan negative) preserved after 5 min of reoxygenation was 67 +/- 29% in the group with normo-osmotic reoxygenation, 31 +/- 23% in the group with hypoosmotic reoxygenation, and 85 +/- 12% in the group with low Na+ normo-osmotic reoxygenation (p < 0.001). Exposing cells without metabolic inhibition to hypoosmotic media resulted in no significative reduction of cell viability. CONCLUSION: Hypoosmotic reoxygenation following prolonged metabolic inhibition may kill viable myocytes. This effect is not due to the low Na+ concentration in the hypoosmotic medium.

Animals↗
PubMed1994

[Neurologic complications of infective endocarditis].

BACKGROUND: Neurologic involvement is a frequent cause of morbidity and mortality in patients with endocarditis. The aim of this study was to evaluate the most relevant clinical, epidemiologic and evolutive characteristics of patients presenting neurologic complications during the evolution of endocarditis. METHODS: Fifty adult non intravenous drug addict patients who had neurologic complications during endocarditis were prospectively evaluated. The presence of cerebral ischemia, hemorrhage, or infectious complications were studied by established criteria. RESULTS: Neurologic complications were detected in 50 of the 282 patients (18%) with endocarditis diagnosed over 17 years in one institution. The most common complications were seen in patients with mitral endocarditis of either native valves (28%) or prosthetic valves (30%). The prevalence was identical in the endocarditis of either type of valve (18%). The most frequent complication was cerebral ischemia (29 episodes) and central nervous system infection (8 episodes). Fifty-nine percent of the complications presented prior to the diagnosis of endocarditis with half of the remaining 41% occurring during the first 2 weeks of antibiotic treatment. Endocarditis by Staphylococcus aureus was associated with neurologic complications in 40% of the cases. Global mortality was 48%, being related with prosthetic endocarditis, the existence of cerebral hemorrhage or central nervous system infection, etiology by S. aureus and the presence of anticoagulant treatment. CONCLUSIONS: Neurologic complications are frequent during the evolution of infectious endocarditis, both or an initial feature and during its evolution. The presence of complications considerably impairs the prognosis of this disease.

Adolescent↗
PubMed1994

Right subclavian artery aneurysm and coarctation of the aorta.

A patient, diagnosed with coarctation of the aorta at the age of 59, was found to have a pulmonary mass in his right upper lobe. A chest scan and digital intravenous arteriography revealed a right artery subclavian aneurysm. Such an unusual association is described.

Aneurysm↗
PubMed1994

Low incidence of ventricular arrhythmias induced by ischaemia at the borders of a chronic infarct in a model with local postinfarction denervation.

OBJECTIVE: The aim was to assess the arrhythmogenic potential of acute ischaemia superimposed at the borders of a chronic myocardial infarct and to analyse the effects of myocardial necrosis on local autonomic innervation in pigs. METHODS: Ventricular arrhythmias were measured in alpha chloralose (100 mg.kg-1) anaesthetised open chest pigs during 60 min occlusion of the left anterior descending coronary artery 2 cm above the first diagonal branch (group I, n = 11) or just below this branch (group II, n = 12). These arrhythmias were compared with those induced in pigs with a one month old anteroseptal infarction (coronary ligature as in group II) submitted to a second occlusion 2 cm above the first (group III, n = 12). The area at risk after high or low ligature was measured in 12 control pigs using fluorescein. Sympathetic and parasympathetic innervation of the anteroseptal myocardium was studied in three pigs with a chronic anteroseptal infarction and in six pigs without infarction using adrenergic histofluorescence and acetylcholinesterase reaction. RESULTS: Compared with ischaemia alone, ischaemia at the borders of a chronic infarct induced a lower incidence of ventricular fibrillation (1/12 pigs v 11/11 in group I, p < 0.001, or 6/12 in group II, p < 0.05) and a tendency towards a lower occurrence of ventricular tachycardia (2/12 pigs v 8/11 in group I, p = 0.01, and 4/12 in group II) and fewer ventricular premature beats (mean number: 105 in group I v 30 in group III, p < 0.05). The mass of the ischaemic regions after low or high occlusion was 13.3(SD 3.0) g and 23.2(5.8) g, respectively. Adrenergic and cholinergic denervation was observed inside the necrotic area, along the subendocardium surviving the necrosis, and in a band of normal bordering myocardium [width: 3.2(2.0) mm for adrenergic and 2.1(1.2) mm for cholinergic denervation]. CONCLUSIONS: Acute ischaemia at the borders of a chronic anteroseptal infarct has a low arrhythmogenic potential in pigs. In this model the peri-infarction zone shows a band of sympathetic and parasympathetic denervation secondary to the necrosis.

Animals↗
PubMed1994

Recurring free-floating thrombus in the left atrium in a patient with mitral prosthesis.

A case of recurrent left atrial free-floating thrombus in a patient with mitral prosthesis and multiple emboli is described. Transthoracic echocardiography failed to show the first ball thrombus, whereas transesophageal echocardiography proved highly useful both in diagnosis and in indicating the left atrial appendage as the source of the thrombi.

Echocardiography, Transesophageal↗