Biomedical subjects

L Bernardes

Publications and source records attributed to L Bernardes.

21 records · Page 2Linked 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↗

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↗