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Biomedical subjects

J Turina

Publications and source records attributed to J Turina.

At least 55 records · Page 3Linked to original sources
PubMed1986

Echocardiographic findings late after myectomy in hypertrophic obstructive cardiomyopathy.

Postoperative echocardiograms of 50 patients undergoing myectomy for hypertrophic obstructive cardiomyopathy between 1965 and 1982 have been evaluated. In 21 patients a comparison with preoperative echocardiograms showed that postoperatively there was a significant reduction of septal and free wall thickness, an increase of left ventricular end-diastolic as well as outflow tract dimensions and a reduction or disappearance of systolic anterior motion of the mitral leaflet. Postoperative examination at intervals greater than 3 years revealed a significant increase of left ventricular and left atrial cavity size with unchanged contractile parameters and little reduction of left ventricular hypertrophy. In 4 of 12 patients evaluated greater than 8 years after myectomy, left ventricular dilatation was observed and 3 of these 4 patients developed congestive heart failure. Development of left ventricular dilatation was independent of whether a transventricular and/or transaortic approach was used for myectomy. These data indicate that the late course after myectomy in hypertrophic obstructive cardiomyopathy may be complicated by dilatation of the left ventricular cavity.

Adolescent↗
PubMed1985

[Long-term follow-up and prognosis of dilated cardiomyopathy].

Between 1969 and 1984, 68 patients with dilated cardiomyopathy (mean age 44 years) were observed for an average period of 45 months. 46 patients (68%) died (17 sudden death, 13 congestive heart failure, 5 other causes and 11 unknown causes) during the observation period according to a cumulative 5-year survival rate of 40%. All patients underwent diagnostic cardiac catheterization. Left ventricular ejection fraction was 32%, left ventricular end-diastolic volume index 195 ml/m2, left ventricular end-diastolic pressure 17 mm Hg and cardiac index 2.7 l/min/m2. The initial hemodynamic findings in the non-survivors and the survivors were statistically not significantly different. The prognostic significance of 12 clinical and hemodynamic parameters was evaluated by multivariate regression analysis (Cox model). Only 3 hemodynamic parameters, namely left ventricular end-diastolic volume, left ventricular end-diastolic pressure and cardiac index, showed prognostic significance in regard to survival. Prognostic evaluation of medical therapy (antiarrhythmic drugs n = 14, vasodilators n = 17, anticoagulation n = 37) revealed an improved cumulative 3-year survival rate (87% versus 46%) only for vasodilators.

Adolescent↗
PubMed1985

[Therapy and course of dilated cardiomyopathy].

Dilated cardiomyopathy is a primary myocardial disease of unknown origin. The typical findings are severe systolic pump failure and dilatation of all cardiac chambers with severe cardiomegaly. Clinical symptomatology is determined by myocardial dysfunction with congestive heart failure. Cardiomegaly and arrhythmia may precede clinical symptoms of congestive heart failure by years. Medical therapy is based on classical treatment of congestive heart failure with digitalis and diuretics; recently, afterload-reducing agents, such as converting enzyme inhibitors, have become the drug of choice for patients with severe congestive heart failure. Antiarrhythmic therapy is necessary in the presence of severe arrhythmia, and anticoagulation is indicated when a low-output state or atrial fibrillation are present. Clinical course in dilated cardiomyopathy is usually poor and 5-year survival is 38% in our group.

Anti-Arrhythmia Agents↗
PubMed1985

[Severe symptomatic valve defects in elderly patients. Spontaneous prognosis and surgical results].

Between 1970 and 1982 125 patients aged, 65 to 79 years with severe symptomatic valvular heart disease. Aortic valve disease (72 with aortic stenosis) was encountered in 76 cases, mitral valve disease (22 with mitral regurgitation) in 32 and combined aortic and mitral lesions in 17. Additional severe coronary artery disease (narrowing greater than 70%) was present in 25% of the patients. 80% of the patients were in NYHA class III and IV, and 42% had experienced an episode of congestive heart failure. 28 patients did not undergo surgery; 10 died before surgery and 18 were not accepted or refused the operation. After 2 years only 1 of 18 patients with aortic stenosis was alive; in mitral valve disease 5 of 6 patients were alive. Among the 97 surgical patients, aortic valve replacement was performed in 58 cases, mitral valve surgery in 26 and combined aortic and mitral valve surgery in 13. Additional aorto-coronary bypass grafting was performed in 23 patients. Early mortality was 5% and 5-year survival rate 69%. NYHA class declined from 2.9 preoperatively to 1.6 postoperatively. In the elderly patient with severe symptomatic valvular heart disease surgery can be performed with acceptable operative risk and good late results. Surgical treatment is particularly indicated in aortic stenosis, due to the poor spontaneous prognosis. Coronary artery disease is frequent in this age group but is not a contraindication for surgery, in view of the good postoperative results of additional aorto-coronary bypass grafting.

Age Factors↗
PubMed1985

[Spontaneous course of aortic valve lesions which do not have to be treated surgically].

Seventy-nine patients with aortic valve disease were studied invasively between 1966 and 1980 but were not operated upon because they were not symptomatic or the valve lesion was hemodynamically not severe enough. 65 patients were followed up for an average observation period of 7.8 years. Aortic stenosis was found in 11 patients, aortic insufficiency in 25 and combined aortic valve lesions in 29. Four patients died during the follow-up (2 sudden deaths, 2 from chronic heart failure). Eight patients underwent aortic valve replacement. Cumulative survival rate was 98% after 5 years and 92% after 10 years. Event-free rate (no deaths, no operation) was 100% in aortic stenosis, 83% in aortic insufficiency and 96% in combined valve lesions after 5 years, and 82%, 71% and 87% after 10 years. Patients with no cardiac events (group 1, n = 53) were initially less symptomatic (NYHA class 1.6 versus 2.3, p less than 0.01), had less dyspnea (36% versus 75%, p less than 0.01), less chest pain (21% versus 50%, p less than 0.05) and less frequent left ventricular hypertrophy in the ECG (25% versus 64%, p less than 0.01) than patients who died or were operated on during the follow-up (group 2, n = 12). Cardiac catheterization revealed lower left ventricular enddiastolic pressure in group 1 (12 versus 16 mm Hg, p less than 0.01) and a lower aortic regurgitant fraction (0.22 versus 0.37, p less than 0.02) than in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Improved late survival in patients with chronic aortic regurgitation by earlier operation.

Between 1970 and 1979, 156 patients with severe chronic aortic regurgitation underwent aortic valve replacement. Early mortality was 2.5%; 5 and 10 year survival rates were 85.9% and 69.2%, respectively. Early mortality decreased from 3.5% (2/56) in the period from 1970 to 1974 to 2.0% (2/100) in the period from 1975 to 1979; first-year survival rate was similar in the two periods (94.2% and 94.7%); 5 year survival rate increased from 80.1% in the period from 1970 to 1974 to 90.6% in the period from 1975 to 1979. The frequency of late death from heart failure decreased from 5/13 in the period from 1970 to 1974 to 0/9 in the period from 1975 to 1979. Preoperative NYHA class decreased from 2.7 (10 patients in class IV, none in class I) during 1970 to 1974 to 2.1 (one patient in class IV, 15 in class I) during 1975 to 1979 (p less than .001). From 1970 to 1974 preoperative cardiothoracic ratio (0.60 vs 0.57; p less than .001) and left ventricular end-diastolic pressure (33 vs 19 mm Hg; p less than .001) were higher and left ventricular ejection fraction (50% vs 54%; p less than .05) was lower than values during 1975 to 1979. The patients who died of heart failure were in a higher NYHA class before surgery, cardiothoracic ratio and left ventricular end-diastolic pressure were higher, and left ventricular ejection fraction was lower than those in patients who died suddenly. In all patients of both groups left ventricular end-diastolic volume exceeded 200 ml/m2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

[Latent cardiomyopathy - an early form of congestive cardiomyopathy].

Ten patients with a latent or subclinical form of congestive cardiomyopathy were selected from a group of 70 patients with congestive cardiomyopathy. Latent cardiomyopathy was diagnosed in view of the slightly decreased left ventricular myocardial function with no signs of cardiomegaly or left ventricular heart failure. Physical working capacity amounted to 89% (normal range greater than or equal to 80%) in the 10 patients. Hemodynamic evaluation showed slightly decreased systolic myocardial function with normal left ventricular volume. In 3 patients left ventricular end-diastolic pressure was significantly increased. The clinical follow-up showed a stable course in 7 patients and a slight deterioration in 2 patients, 1 patient died after 16 months. 5-year survival rate was 89% in patients with latent cardiomyopathy and 26% in the 60 patients with congestive cardiomyopathy. It is concluded that latent cardiomyopathy is a rather rare early form of congestive cardiomyopathy It is usually diagnosed by invasive evaluation because of the slightly reduced myocardial function and normal size of the left ventricle. Clinical follow-up in patients with latent cardiomyopathy is reasonably good compared to patients with congestive cardiomyopathy.

Adult↗
PubMed1980

[Correlation of preoperative hemodynamics on late postoperative outcome in chronic aortic insufficiency].

92 patients with severe chronic aortic regurgitation underwent surgery between 1973 and 1977. Patients with coronary artery disease and significant postoperative prosthesis dysfunction were excluded from the study. The overall mortality during the follow-up (1.5-7 years, average 3.5 years) was 8.7%. It was not higher in patients undergoing reoperation or additional operation for aneurysm of the aorta ascendens. The preoperative left ventricular ejection fraction, end-diastolic volume index and end-diastolic pressure, and the cardiac index and cardio-thoracic ratio in chest roentgenogram, did not reliably predict a fatal late outcome. The late postoperative outcome in patients with severely impaired left ventricular ejection fraction (less than 40%), high enddiastolic pressure (greater than 25 mm Hg), low cardiac index (less than 2.2 l/min/m2) and high cardio-thoracic ratio (greater than 0.60) was not worse than in the entire group of patients. Higher postoperative mortality was seen only in patients with a severely elevated left ventricular end-diastolic volume index (greater than 220 ml/m2).

Adult↗
PubMed1980

[How reliable is echocardiography in evaluating the severity of mitral stenosis].

40 patients with mitral stenosis were examined by M-mode and 2-dimensional echocardiography. E-F slope, mitral valve closure index and mitral valve area were compared with the invasively determined mitral valve area. E-F slope and closure index correlated with the valve area by an r of 0.65 and 0.62 respectively. The mitral valve area as calculated by 2D echocardiogram showed a correlation with the invasively determined valve area of 0.86 and was even better in patients with sinus rhythm (0.91). However, in severe mitral stenosis (less than 1 cm2) this correlation was only 0.62 by estimating 22% of patients with severe mitral stenosis as only moderate (greater than 1 cm2). It is concluded that whereas E-F slope and closure index are not of use in the quantification mitral stenosis, determination of mitral valve areas by 2D echo is reliable. However, in the severe mitral stenosis group 22% of mitral valve areas were estimated purely numerically by 2D echo as moderate (greater than 1 cm2).

Adult↗
PubMed1980

[Is echocardiography useful in assessing long term prognosis after valve replacement in patients with left ventricular volume overload?].

Echocardiographic recordings in 87 patients with chronic volume overload of the left ventricle (32 pure aortic incompetence, 18 mixed aortic lesions with predominating regurgitation, 17 mitral incompetence and 20 combined aortic and mitral incompetence) who underwent valve replacement between 1975 and 1976 were reassessed to determine the prognostic interest of echocardiography in the long-term postoperative period. The follow-up was a least 2.5 years (average 2.8 years). Patients with coronary artery disease or paravalvular leaks were excluded from the study. The evaluation of the echocardiogrammes comprised the measurement of the end diastolic left ventricular internal dimension (Dd) and the end systolic dimension (Ds) and the calculation of the percentage systolic shortening of the internal dimension (p. 100 Sh) and of the ratio, radius/thickness in end diastole (Dd/2th). A poor surgical result was defined by a postoperative work capacity of less than 60 p. 100 normal or by postoperative death (7 deaths, one of which was in the perioperative period). 21 patients had poor results (group I) and 66 patients, good results (group II). None of the individual echocardiographic parameters differed significantly in groups I and II. In a sub-group of 50 patients, with isolated aortic incompetence, the preoperative echocardiographic data could not distinguish between patients with good and poor postoperative courses. On the other hand, the 4 patients with chronic aortic incompetence who died before operation were characterised by a Dd > 80 mm and Ds > 60 mm, although p. 100 sh was only < 25 p. 100 in one of these 4 cases. In conclusion, M mode echocardiography in patients with chronic volume overload of the left ventricle did not appear to have any value in the prediction of the long-term postoperative result. In patients with chronic aortic incompetence, greatly increased left ventricular internal dimensions indicate a compromised natural prognosis and are an urgent indication for surgical intervention.

Adolescent↗
PubMed1979

[The value of echocardiography in the diagnosis of cardiac diseases].

Single beam echocardiography is now an established diagnostic tool in non-invasive cardiology. The principle indications are valvular diseases, pericardial effusion, aneurysm of the ascending aorta, and congenital heart disease. In the absence of regional contraction disorders, left ventricular function can be assessed by the extent of systolic shortening of the left ventricular diameter. More recently, two-dimensional echocardiography has made a very significant contribution to anatomical and functional evaluation of the heart and the great vessels, since the cardiac structures can be visualized in various cross-sections. This technique is especially helpful for the assessment of left ventricular regional contraction disturbances, the diagnosis of dysfunction of artificial valves and bioprotheses, the detection of dissecting aneurysm, and the estimation of mitral valve area in mitral stenosis. Since various left ventricular axes can be determined, the quantitation of left heart volumes appears to be within the capability of the two-dimensional technique.

Aortic Aneurysm↗
PubMed1978

[The influence of meproscillarin on human left ventricular function (author's transl)].

Left ventricular (LV) function was assessed by echocardiography in 11 cardiac patients before and after treatment with 14-hydroxy-3beta-[(4-O-methyl-alpha-L-rhamnopyranosyl)-oxy]-14beta-bufa-4,20,22-trienolide (meproscillarin, Clift). This drug was given during 7 days in a dose of 4 X 0.25 mg/d. During a placebo period of 7 days the LV function parameters percent systolic shortening of the transverse LV diameter and mean velocity of circumferential fiber shortening did not change significantly but increased significantly (P less than 0.001) after meproscillarine. Heart rate and end-diastolic LV diameter remained unchanged throughout the study. It is concluded that peroral meproscillarin induced a true increase of LV inotropic state.

Adult↗
PubMed1977

[Course and prognosis of primary pulmonary hypertension].

Between 1967 and 1970 primary pulmonary arterial hypertension was diagnosed in 52 patients. Menocil had been taken by 36 patients. Overall survival rate after 9 years was 0.58. Mortality was particularly high within 2 years after the diagnosis was established (22%). Survival rate was low in the group with pulmonary vascular resistance exceeding 1000 dynes-sec-cm-5 (0.42 after 9 years). Initially slight pulmonary hypertension generally had a good prognosis but even severe pulmonary hypertension can regress or even disappear. With respect to survival rate, there were no significant differences between patients with and without Menocil intake.

Adult↗