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Biomedical subjects

M A Martínez-Ríos

Publications and source records attributed to M A Martínez-Ríos.

At least 19 recordsLinked to original sources
PubMed2001

Prognostic implications of right atrial ischemic dysfunction in patients with biventricular inferior infarction: transesophageal echocardiographic analysis.

In order to determine the effect of right atrial dysfunction on clinical outcome, six patients with inferior myocardial infarction with extension to right ventricle and right atrium involving only obstructions of the right coronary artery were examined with transesophageal echocardiography (TEE) at the time of the event. Five of the patients were reexamined 15 to 55 months later. Two patients underwent thrombolysis and maintained ratios of right-to-left ventricular diameters of less than 1, as well as normal convexity of the interatrial septum. One patient had spontaneous reperfusion of the right coronary artery, reduction in right ventricular diameter, and normalization of interatrial septum. Another patient underwent delayed angioplasty and manifested a diminished wall movement score (WMS) in the follow-up echocardiogram. One patient died during his first hospitalization with significant right ventricular dilatation, inverted convexity of the interatrial septum, and right atrial thrombosis. The last patient died during follow-up with right ventricular dilatation, increased WMS, right atrial akinesis, and inverted interatrial convexity. Serial TEE examination of patients with infarction of the left ventricular inferior wall is a safe technique for determining the degree of the extension of the ischemic process to the right chambers.

Adult↗
PubMed1999

Pericardium-covered stent for septal myocardial ablation in hypertrophic obstructive cardiomyopathy.

This report describes a patient with severe hypertrophic obstructive cardiomyopathy in New York Heart Association functional class III. Complete reduction of left ventricular outflow tract gradient was achieved by the selective occlusion of three target septal arteries with a pericardium-covered stent. The patient's in-hospital course was uneventful and has improved to functional class I.

Cardiomyopathy, Hypertrophic↗
PubMed1999

Transjugular liver biopsy in 52 patients with an automated Trucut-type needle.

A three-year prospective study was conducted to assess the efficacy and safety of transjugular liver biopsy with a Trucut-type needle employing an automated device. Fifty-two consecutive patients (39 women and 13 men), ages 46.3+/-14.6 years, in whom percutaneous liver biopsy was contraindicated were included in the study. An 18-gauge transjugular hepatic needle with a 20-mm throw length, a cutting cannula at the distal end, and an automated trigger device on the proximal end was used. All procedures were performed under fluoroscopic control, and the following variables were assessed: (1) number of passes, (2) size and average number of the obtained fragments, (3) number of portal triads, and (4) adequacy of the specimen for histologic diagnosis. The procedure was successful in 49/52 patients, and all samples obtained were satisfactory for histologic analysis even when cirrhosis or bridging fibrosis were present. Mean biopsy specimen length was 1.7+/-0.88 cm; mean number of passes was 2.42+/-1.01, the mean number of biopsy fragments and portal triads per attempt were 2.5+/-1.01 and 6.24+/-3.18, respectively. No major complications were observed. Transjugular hepatic biopsy with this new cutting system is an effective and safe procedure in patients with contraindication for percutaneous liver biopsy.

Adolescent↗
PubMed1998

Treatment of severe mitral stenosis with percutaneous balloon valvotomy in pregnant patients.

BACKGROUND: Pregnancy can cause life-threatening complications in women with mitral stenosis. Frequently, there is an urgent need to increase the mitral valve area mechanically. In selected cases, percutaneous mitral balloon valvotomy (PMBV) has emerged as a safe and effective alternative to surgical commissurotomy. HYPOTHESIS: The study evaluates the effects of PMBV by the Inoue technique in nine pregnant patients with severe symptomatic mitral stenosis. METHODS: The patients were in New York Heart Association (NYHA) functional class II to IV and had echocardiographic scores of < or = 8. The mean gestational age was 24.8 +/- 6.1 weeks. The patient's pelvic and abdominal regions were covered with a lead apron to protect the fetus from radiation. A stepwise dilatation technique was used. Fluoroscopy time was kept to 10 to 15 min. RESULTS: One patient developed severe mitral regurgitation requiring emergency valve replacement. The remaining eight patients showed marked immediate symptomatic and hemodynamic improvement. After dilatation, the transmitral pressure gradient decreased from 20.8 +/- 6.5 to 7.3 +/- 1.4 mmHg (p = 0.001) and the calculated mitral valve area increased from 0.9 +/- 0.1 to 1.8 +/- 0.4 (p < 0.001). All patients had uneventful term deliveries of normal babies. On follow-up they were in NYHA functional class I. CONCLUSIONS: Percutaneous mitral balloon valvotomy is a safe and effective procedure for selected pregnant patients with severe mitral stenosis. The procedure is well tolerated by the fetus. Severe mitral regurgitation requiring immediate surgery may occur occasionally. The possible harmful effects to the fetus from its exposure to radiation during PMBV are unknown.

Adult↗
PubMedDate not supplied

[Correlation between exercise test and coronariography].

In order to evaluate the sensibility and specificity of the maximal treadmill exercise-stress test, a correlation was made, in fifty patients, of the resus of the test and the findings at selective coronary arteriography. None of the patients had received cardioactive drugs previous to the study. Among twenty-nine patients with proven coronary disease, three had false negative exercise tests. The remaining twenty-six cases had positive tests. The sensitivity of the method (reliability in identifying the presence of disease) was 89.7%. Twelve of twenty-one subjects with normal coronary arteries had negative exercise tests. In eight patients without coronary artery lesions, the exercise test was positive (false positive tests). An additional patient had an equivocal response and is included among the false positive responses. These nine-patients form a special group since they had severe heart disease, even though it was not due to atherosclerosis of the major coronary vessels. The specificity of the test (reliability in identifying the absence of disease) was 57.1%. However, in the absence of other heart disease, none of the subjects with normal coronary arteries had a false positive response. An analysis is made of the possible causes of these false negative and false positive responses. It was also shown in this study that the patients with coronary artery disease and positive treadmill tests had a definite functional aerobic impairment as well as a significant reduction in such indices of myocardial oxygen consumption as the heart rate and the double product (pressure-pulse), when compared to the subjects with normal coronary vessels and negative tests. In the group of patients with false positive responses, these parameters were not significantly different from the normals. The exercise-stress test protocol used in this study appears to have an adequate sensibility and an acceptable specificity.

Adult↗
PubMedDate not supplied

[The benefit of a coronary stent in the reduction of major cardiac complications in acute coronary syndromes].

To assess the incidence of in-hospital major adverse cardiac events (MACE), we analyzed 694 procedures in 613 consecutive patients during one year period. Patient population included 550 (79.2%) patients with unstable angina, 43 (6.2%) with stable angina and 101 (14.5%) with acute myocardial infarction. Elective percutaneous transluminal coronary angioplasty (PTCA) was performed in 593 (85.4%) patients, rescue PTCA in 7 (1%), and primary PTCA in 94 (13.5%). Angiographic lesion morphology was as follows: type A 30%; type B 58%; type C 12%. We compared patient population who received stent with PTCA-balloon only. Technical success was 95% and clinical success was achieved in 80% of the cases. Overall mortality was 1% in the stent group and 3% in the conventional PTCA. The incidence of MACE was 4% and 15.1% in the stent and angioplasty balloon groups respectively. We found a dramatic impact on reduction of the incidence of acute complications in the groups with stenting for unstable angina (p = 0.0001) and acute myocardial infarction (p = 0.0001). The major clinical advantage of stenting over balloon angioplasty was a lower need for repeated procedures.

Acute Disease↗
PubMedDate not supplied

[Antiarrhythmic effects of verapamil].

The effect of verapamil were studied on 50 episodes of supraventricular and ventricular tachycardia in 44 patients. An i.v. dose of 0.10 to 0.15 mg/kg. was used. In 5 cases His bundle electrograms were obtained while maximal dp/dt was determined in 7 others. Sinus rhythm was obtained in 21 (81%) of 26 cases of PSVT. In all cases of rapid atrial fibrillation (n-11), an important decrease in the ventricular response was elicited. Of 7 cases of atrial flutter, verapamil induced sinus rhythm in 3 and a significant decrease in the ventricular rate in 3 others. In 2 out of 6 cases ventricular tachycardia reverted to sinus rhythm. The latency time between the injection and the manifestation of the effect ranged from 2 to 4 minutes. A slight and short-lasting depression of dp/dt was observed in all cases studied. Verapamil produced an increase in the A-H interval in 4 of the 5 cases studied with His bundle recordings. Verapamil was found to be a useful drug to suppress PSVT, to decrease the ventricular response in flutter or atrial fibrillation and to convert some ventricular tachycardias to sinus rhythm. Verapamil should be used with caution in previously digitalized patients and is contraindicated when there is S-A node dysfunction as in the tachycardia-bradycardia syndrome.

Adult↗
PubMedDate not supplied

[Clinical electrocardiographic and coronary angiographic findings in 200 cases of ischemic cardiopathies].

A correlative analysis of clinical, electro and angiographic data was carried on, in a series of 200 cases of ischemic heart disease. The possible pathophysiological mechanisms of coronary insufficiency in cases with normal arteriograms, are briefly discussed. Based upon the statiscal results, it can be concluded that there is a close relationship between angiographic findings, and the clinical and electrocardiographic data suggestive of coronary insufficiency.

Adult↗
PubMedDate not supplied

[Hemodynamic consequences of ventriculography in ischemic cardiopathy].

A series of 13 cases of ischemic heart disease, proved by coronary angiography, were submitted to ventriculography in order to study the hemodynamic consequences of the injection of the contrast material. The parameters used to evaluate the ventricular function were the end diastolic pressure, the dp/dt, the VEC and the V. max. A close relationship was observed between the hemodynamic changes secondary to the ventriculography and the degree of coronary involvement. The behaviour of the end diastolic pressure postventriculography can be considered a reliable parameter for evaluating the ventricular functional capacity. Contrariwise, the minimal changes of thee V. max. makes it of doubtful valve.

Angiocardiography↗
PubMedDate not supplied

[Mitral valve replacement in children and in adolescents. Surgical indication and long-term results in 86 cases].

1. The authors present 86 children and adolescents with rheumatic heart disease of the Pediatric Cardiology Service of the Instituto Nacional de Cardiologia who received valve replacements in the period between September, 1964 and April, 1973, a series which is more numerous and of longer follow-up than any published up to the present 2. In order to obtain comparable results, patients with mitral heart disease of other origen and aortic replacement as well as those subjected to double or triple exchange, were omitted from the study. 3. The symptomatology, the presence of compensated heart failure, the progression of cardiomegaly, the radiologic and electrocardiographic changes, the presence of atrial fibrillation, the mean venocapilary, pulmonary arter, and left right ventricle telediastolic pressures, the pulmonary resistence figures and the results of cineangiocardiography were the fundamental elements used to establish the surgical indication. 4. None were operated with clinic or laboratory data suggesting rheumatic activability. The shortest period between the last bout of rheumatic fever and surgery was 10 months. 5. The clinic improvement was remarkable. Half of the cases receiving digitalis and diuretics were released without this prescription and only 10% continue to take digitalis. With the exception of five patients, the physical capacity is normal and most play sports. The postoperatory radiologic and electrocardiographic changes were remarkable, most were obtained a few months after surgery. With the exception of one case, atrial fibrillation disappeared (in 58% before six months in a group of 31 patients). 6. The later complications attributed to the valve replacement as well as the 15 deaths in the total lot were analyzed. It was pointed out that the hospital death rate was 12.6% and the later was 5.3%, extraordinarily low figures if it is taken into account that the material corresponds to nine years of work and the problems inherent to the initial period are included. It gains still greater importance if compared to the series published up to the date. The global mortality rate of 17.9% is small in relation to the only comparable publication, -30 and if only the results of the last three years are compiled (61 cases equals 70 of the series), the global death rate was 9.8%. 7. It was noted that the results are due to the system adopted for establishing the surgical indication, to the good state of the myocardial fiber...

Adolescent↗
PubMedDate not supplied

[Aneurysm of the left ventricle associated with inactive rheumatic heart disease. Report of a case].

A case of aneurism of the left ventricle, confirmed by ventriculogram, associated to an inactive rheumatic cardiopathy with a pure mitral stenosis is presented. Since none of the usual causes that have been reported were found to explain the aneurism of the left ventricle; the possibility of the aneurism resulting from residual myocardiac fibrosis produced by the rheumatic myocarditis is suggested.

Adult↗
PubMedDate not supplied

[Familial occurrence of Wolff-Parkinson-White syndrome. Report of a family group and review of the literature].

A family group of nine members was studied, two of which had W-P-W syndrome; the father type A; and the son type B. These two patients were studied from the clinical electrocardiographic and vectocardiographic point of view; and they were subject to hisian electrogram recordings. The atrial-ventricular conduction under basal conditions and during atrial stimulation is analyzed. In the first case, potential H is registered after the beginning of delta wave of the ventricular complexes in lead II. In th second case, atrial-ventricular conduction can only occur through the abnormal via (no H potential and register of delta wave in the periferial simultaneous lead), or only through the normal via (evidence of potential H with a normal H-V interval and no delta wave in the periferial line of control). The bibliography of the observation that in most family groups described up until now, there is a good correlation concerning sex. This gives the impression to be a genetic disorder linked to sex.

Adult↗
PubMedDate not supplied

[Value of the electrocardiogram to predict the pattern of left ventricular contraction in ischemic cardiopathy].

A correlative electrocardiographic and ventriculographic study was performed in a series of 100 patients with clinical and electrocardiographic diagnosis of ischemic heart disease. The analysis was focused on the possibility of predicting ventricular contraction pattern (VCP) disturbances, through electrocardiographic signs of coronary insufficiency. Two main groups were separated on the basis of the presence of necrosis. There were 66 cases with necrosis, and 34 without it. The type of VCP was calssified in accordance with the criterion of Herman et al. in: asyneresis, akinesis and dyskininesis. The degree of coronary narrowing was arbitrarily evalued as less than 50%, between 50 and 75%, and over 75% of the lumen.

Coronary Disease↗
PubMedDate not supplied

[Clinical development of the in-hospital phase of acute myocardial infarction in patients treated with intravenous streptokinase].

In order to determine the clinical in-hospital course of patients with acute myocardial infarction treated with intravenous Streptokinase (SK), 132 patients were studied divided as follows: Group I: 44 patients who arrived to the hospital within 6 hours from the onset of symptoms and received fibrinolytic therapy. Group II: 44 patients who arrived more than 6 hours delay and did not receive SK. Group III: 44 patients who arrived less than 6 hours delay but they did not receive SK. The overall hospital mortality was 2.2% in the SK recipients versus 4.4% in the group II (Odd ratio 0.95, p = NS) and 13.6% in group III (Odd ratio 0.79, p greater than 0.05). The incidence of hemorrhagic episodes was not increased in SK recipients. In-hospital period differences between groups were explained by protocol studies and postoperative complications in patients that needed further revascularization procedures.

Aged↗
PubMedDate not supplied

[Study of the left coronary trunk by 2-dimensional echocardiography in ischemic cardiopathy].

The study of the left main coronary artery (LMCA) obstruction is very important in view of the risk that it represents for coronarography, the high mortality that it has and its indication of early surgical treatment. For these reasons we studied LMCA obstruction by two-dimensional echocardiography (2-D Echo). The study was blind, prospective and included of 50 unselected patients with coronary artery disease proved by coronarography. The LMCA obstruction was recognized in 5 patients (10%) by 2-D Echo, in two of them it was seen as non-obstructive atheroma and in 3 as a significant obstruction. This LMCA correlated with angiographic findings. We had not false negatives. The patients with LMCA obstruction had higher frequency of positive treadmill test and anteroseptal myocardial infarction. Three patients had bypass surgery with good results. Two had not surgery, one of them died and the other one has angina and heart failure. The 2-D Echo is a useful procedure in the study of LMCA obstruction.

Adult↗