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M Aquilina

Publications and source records attributed to M Aquilina.

At least 19 recordsLinked to original sources
PubMed2001

Frequency of atrial septal aneurysm in patients with recent stroke: preliminary results from a multicenter study.

BACKGROUND: The role of atrial septal aneurysm (ASA) as a risk factor for cerebral ischemia of unknown etiology is controversial. Recent studies have found an association between ASA and focal ischemic events, while results from other studies suggest a low incidence of embolism in patients with ASA. HYPOTHESIS: The present study was designed to evaluate the frequency of ASA, a minor cardioembolic source, in patients with a recent stroke presenting with normal carotid arteries. METHODS: In all, 394 patients with cerebral ischemic stroke were referred to our institutions. Patients underwent transthracic and transesophageal echocardiography and carotid artery ultrasound examination. The study population included 215 patients without significant arterial disease. Frequency and morphologic characteristics of ASA were evaluated. RESULTS: Transthoracic examination showed ASA in 39 patients (18%), while transesophageal echocardiography showed ASA in 61 patients (28%). A patent foramen ovale was found in 47 patients (21.8%) and was associated with ASA in 40 patients (65.5%). We observed an increased thickness of the aneurysmatic wall (3.80 +/- 1.7 mm) in all patients with ASA. CONCLUSIONS: The present study confirms the relationship between ASA and stroke in patients with normal carotid arteries. The most common abnormality associated with ASA was patent foramen ovale. We suggest that patients who have a stroke in the absence of significant carotid disease undergo transesophageal echocardiography to identify possible underlying septal abnormalities.

Aged↗
PubMed2001

Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study.

BACKGROUND: Atrial septal aneurysm has been considered a potential source of cardiogenic embolism for many years. The present study evaluated the prevalence and characteristics of atrial septal aneurysm in a patient population with stroke and normal carotid arteries compared to a control population without stroke. METHODS: A total of 606 patients were enrolled between November 1990 and December 1996. The study group included 245 patients who had experienced cerebral ischaemic attack but had normal carotid arteries. The control group included 316 age- and sex-matched patients undergoing transoesophageal echocardiography for indications other than a search for a cardiac source of embolism. The prevalence and morphological characteristics of atrial septal aneurysm were evaluated and compared. Results We reported a higher prevalence of atrial septal aneurysm in the group with cerebral ischaemia; 68 patients (27.7%) vs 36 patients (9.9%) from the control group; P<0.001. A patent foramen ovale was detected with contrast injection in 69.2% of the patients with atrial septal aneurysm. Atrial septal aneurysm predicted the presence of a patent foramen ovale (odds ratio of patent foramen ovale 4.2; 95% CI 1.03-9.8). Multivariate analysis showed that atrial septal aneurysm was an independent predictor of an embolic event. In the 95% of patients with atrial septal aneurysm and cerebral ischaemia aged less than 45 years, transoesophageal echocardiography did not detect a source of embolism other than an associated patent foramen ovale. CONCLUSIONS: The prevalence of atrial septal aneurysm in patients with cerebral ischaemia and normal carotid arteries was 27.7%, higher than the control group. Atrial septal aneurysm was frequently associated with patent foramen ovale. In patients less than 45 years old, atrial septal aneurysm was the only potential cardiac source of embolism detected with transoesophageal echocardiography.

Adult↗
PubMed2001

Ultrasound-assisted stent implantation in small size coronary arteries: a pilot study.

BACKGROUND: Many studies have indicated that a small lumen size is one of the most important predictors of acute events and of late restenosis after balloon angioplasty or stent implantation. In the last few years many studies have shown that intravascular ultrasound (IVUS) guidance makes it possible to optimize stent implantation. The aim of this pilot study was to evaluate the feasibility and safety of IVUS imaging of small vessels. Secondary endpoints were the immediate and long-term results of IVUS-guided elective BeStent implantation in small vessels. METHODS: Fourteen symptomatic patients with small coronary vessel (mean angiographic reference diameter 2.3 +/- 0.2 mm) disease underwent IVUS-guided BeStent implantation. IVUS success was defined as the achievement of a final minimal intrastent cross-sectional area (CSA) > 90% of the smaller reference lumen CSA. RESULTS: IVUS evaluation was feasible in all patients without any clinical or angiographic adverse events. Procedural success was achieved in all patients with implantation of a BeStent 15 mm. No major complication (death, myocardial infarction, stent acute or subacute thrombosis, coronary artery bypass, re-coronary angioplasty) occurred during the in-hospital phase. Two non-flow-limiting, asymptomatic coronary dissections were detected after stent expansion. The post-stenting lesion stenosis rate decreased from 72.9 +/- 12.9% to 0.75 +/- 11.7% with an acute gain of 1.8 +/- 0.4 mm. The final IVUS minimal stent CSA was 5.6 +/- 1.1 mm2. The IVUS criteria of adequate stent expansion were reached in 11 (78.6%) patients. At 6 months of follow-up, the rate of angiographically diagnosed in-stent restenosis was 30.7%; the 6-month late loss in stent diameter was 1.1 +/- 0.6 mm. No patient died or presented with a myocardial infarction. The target lesion revascularization rate was 30.7%. CONCLUSIONS: Coronary IVUS-guided stenting can be performed in small vessels with a high success rate and low incidence of in-hospital complications. However, despite these encouraging short-term results, the long-term clinical and angiographic outcome is less favorable. Further larger and randomized IVUS studies, probably employing more aggressive IVUS criteria, are needed to clarify the true role of IVUS guidance in this particular field.

Aged↗
PubMed1997

Defective development of pristane-oil-induced plasmacytomas in interleukin-6-deficient BALB/c mice.

Interleukin (IL)-6 is known to be an essential growth factor for myeloma cells, both in vitro and in vivo. In mice, IL-6 is required for development of B cell tumors upon infection with a retrovirus expressing the myc/raf oncogenes. In the present study, we used the pristane-oil-induced plasmacytoma model, which more closely mimics tumor transformation and progression in human multiple myeloma. Also using this system, we found that IL-6-deficient BALB/c mice are protected against tumor development. Although the pristane-induced inflammatory reaction was less pronounced in IL-6-deficient mice versus their wild-type littermates, both B cell differentiation and plasma cell formation took place, and even morphological evidence of plasma cell transformation was detected, albeit at a low frequency. However, in the absence of IL-6, there were never signs of uncontrolled proliferation of either normal B lymphocytes or tumor cells, suggesting that the role of IL-6 in murine plasmacytoma and possibly also in human multiple myeloma is to ensure abnormal survival and proliferation of previously transformed tumor cells and therefore tumor development and progression.

Animals↗
PubMed1995

[Transesophageal echocardiography in patients free of carotid disease with an ischemic stroke].

BACKGROUND: Cardioembolism is the cause of cerebral infarct in 15 to 30% of cases. The aim of the present work is to detect, by transesophageal echocardiography (TEE), potential cardioembolic sources in patients with cerebral ischemia without atherosclerotic carotid disease at duplex carotid ultrasound examination. METHODS: From 1991 onwards, 420 consecutive patients who presented with cerebral ischemia, detected by computerized axial tomography, underwent an echotomography examination of the cerebral afferent vessels and a transthoracic echocardiogram (TTE). Three hundred and thirty out of these patients were excluded since they had carotid plaques; of the remaining 90, 80 (mean age 61.6 years range: 25-86, 50 males and 30 females) underwent a transesophageal examination. The patients were studied with an HP Sonos 1000 system with 2.5 and 3.5 MHz frequency probes for TTE; 7.5 and 5 MHz probes were used for echotomography and TEE respectively. RESULTS: The TEE identified cardioembolic sources in 81% of the cases, versus 46.2% using TTE (p < 0.0001) with a significant statistical difference for thrombus, spontaneous echo contrast and paradoxic shunt (p < 0.0001). When the patients with cerebral ischemic events (group A) were compared with the 156 cardiac patients (group B) (mean age: 59.7, range: 19-86, 92 males and 64 females), without ischemic events, group A showed a significant higher prevalence of thrombus, spontaneous echo contrast, calcification of the mitral anulus, interatrial aneurysm and paradoxic shunt. CONCLUSIONS: Our experience confirms that TEE is very useful and more sensitive than TTE for diagnosing cardioembolic sources; so, this new diagnostic tool should become a useful part of the diagnostic iter for patients with ischemic stroke and normal carotid vessels. The prevalence of some heart conditions in the stroke group poses the problem of whether to advise anticoagulant or antiplatelet therapy and, in selected cases, a surgical approach. The absence of heart and vascular conditions in the extracranial regions of patients who have had a cerebral stroke, suggests an intracranial condition and the problem of performing an angiographic examination arises.

Adult↗
PubMed1992

[Evaluation of atrial septum aneurysm with transesophageal echocardiography in cardioembolic cerebral ischemia].

The prevalence and characteristics of atrial septal aneurysm were identified by transesophageal echocardiography (TEE) in a multicenter prospective study. One hundred and seventy-seven consecutive patients were evaluated in 2 years and 2 groups were compared: Group 1, 51 patients with documented cerebral ischemia event; Group 2, 126 patients affected by cardiac disease referred for other reasons. Group 1 included patients selected among 352 patients admitted to the Neurological and Geriatric Division of our Hospital in the period of this study. Patients with stroke-related carotid lesions and patients with a negative TC scan were excluded from this study. Atrial septal aneurysm was identified in 15 patients: 8 in Group 1 (16%), and 7 in Group 2 (5%), with a significant statistical difference between the groups (p = 0.02). All patients with atrial septal aneurysm underwent before TEE transthoracic echocardiography, leading to a correct diagnosis in 10 of 15 cases (66%); all patients underwent 24-hours ECG monitoring. A right to left shunt was detected by contrast echocardiography in 9 patients, 6 in Group 1 and 3 in Group 2, (NS). A more pronounced shunt was evident in Group 1. There was no difference between the 2 groups with regard to associated cardiac disease, arrhythmias and type of atrial septal aneurysm. The thickness of the septum was greater in Group 1, with significant statistical difference (p = 0.002). It is concluded that atrial septal aneurysm, diagnosed by TEE, is a potential source of embolic events.

Adult↗
PubMed1990

Doppler hemodynamic characteristics of four widely used aortic valve prostheses.

Fifty-one patients with normofunctioning aortic prosthetic heart valves were evaluated by Doppler-Echocardiography to determine type-related flow characteristics. The four mechanical valves tested were: Starr-Edwards (1200-1260 aortic), Bjork-Shiley (60 degrees-60 degrees cc aortic), Medtronic-Hall (aortic) and St. Jude Medical (aortic). The most significant dynamic indexes were calculated: Peak (PG) and Mean (MG) Gradient across the valve, Cardiac Index (CI) or Cardiac Output (CO), Regurgitant Jets, Effective Orifice Area (EOA), Spectral Diagram Systolic Trend (SDST) and PVRT (time required to reach peak velocity during systole)/LVET (left ventricular ejection time) Ratio. Patients with Doppler assessed prosthetic dysfunction were dropped out of the study group. As expected, significant reverse correlation (-0.70) was found when transvalvular pressure gradients were compared with valve size. Significant direct correlation (0.82) was found when EOA was compared with valve size, thus suggesting the high reliability of the continuity equation in the assessment of the real orifice area. The Starr-Edwards valve, when compared with the other prostheses of the same size, showed the highest calculated transvalvular gradient; the St. Jude Medical showed the lowest. On the other hand, the Starr-Edwards valve was not commonly associated with regurgitation, while the St. Jude valve was usually moderately incompetent. Those hemodynamic differences should guide the selection of the ideal prosthetic valve for elective surgical indications. Doppler measurements provided noninvasive information similar to that given by cardiac catheterisation, which was reproducible and specific for valve function. According to this high sensitivity and specificity and to the absolute innocuity of the procedure, Doppler-Echocardiography should be considered the elective technique for long-term follow-up in patients with aortic prosthetic heart valves.

Adolescent↗
PubMed1986

Echo-phonocardiographic evaluation of the Björk-Shiley mitral prosthesis.

Ninety patients were studied with combined echophonocardiography after Björk-Shiley disc prosthetic mitral valve replacement. They were evaluated every 6 months (mean follow-up 6 years). Nine cases of left ventricular (LV) failure and 6 cases of prosthetic malfunction (5 paravalvular leaks and 1 thrombosis) were detected; 1 case was confirmed at necropsy and the other 5 cases were surgically verified and repaired. The following measures of prosthetic malfunction were evaluated: opening and closing velocity, maximal amplitude of the prosthesis, septal motion 6 months after operation, LV diastolic diameter, protodiastolic hump, variations during same record of the interval between aortic valve closure sound to the phono and mitral valve opening to the echo, and interval between aortic valve closure sound and maximal excursion of the LV posterior wall. All measures studied were useful for detecting prosthetic malfunction, but 2 are more useful in individual cases: variations of the interval between second heart sound and mitral valve opening and the interval between the aortic valve closure sound and LV posterior wall motion. These 2 intervals also allow discrimination between normal function, prosthetic malfunction and LV failure.

Adult↗
PubMed1986

Left ventricular dysfunction versus paravalvular leak in patients with mitral disc prostheses.

UNLABELLED: Left ventricular dysfunction and prosthesis malfunction are the main causes of hemodynamic deterioration following prosthetic mitral valve replacement. The aim of this study is to reassess the usefulness of a combined echo-phonocardiographic technique to differentiate these different situations in order to select medical or surgical treatment in patients with a mitral disc prosthesis. Two patient groups were studied. The first group consists of five patients with paravalvular leak (PL), surgically or pathologically verified. Second group: nine patients with left ventricular failure (LVF) and normal functioning prosthesis. The diastolic diameter of the left ventricle (LV) was significantly increased in the LVF group compared with the PL group. A protodiastolic hump was present in four cases of PL. The variability of the interval between A2 and the mitral valve opening (delta A2-MVO) was less than 30 msec in the LVF group and greater than 30 msec in the PL group. The interval between A2 and maximal LV posterior wall (A2-PW) exceeded 60 msec in the PL group and was shorter than 60 msec in the LVF group. IN CONCLUSION: the echo-phonocardiographic technique, especially when by using two newly proposed parameters, seems to be very useful to discriminate between PL and LVF.

Adult↗
PubMed1980

[Vectorcardiographic evolution after a valve replacement operation].

The vectorcardiograms of 35 patients with valvular heart disease were recorded before and after prosthetic valve replacement. The spatial magnitude of the 40 msec and maximum QRS vectors were decreased postoperatively in patients with mitral insufficiency aortic stenosis and aortic insufficiency. 9 patients were studied postoperatively by right heart catheterization.

Cardiac Catheterization↗
PubMed1980

[Malfunction of disc prostheses. Echocardiographic study of 5 cases (author's transl)].

78 patients who underwent disc prostheses replacement, 36 in mitral area, 58 in aortic area were studied by echocardiography. The Authors found 5 cases of malfunction, 3 in mitral area and 2 in aortic area. Regarding mitral malfunctions in 1 case a valve thrombosis was found; in 2 cases there was a partial leak. Regarding aortic malfunctions there was paravalvular leak. In mitral area malfunctions the Authors found alterations of the disc morphology during diastolic opening time associated with alteration of opening time. An increased diastolic closure velocity in 2 cases of paraprosthetic leak was found. A diagnostic element in the case with thrombosis was variability of maximal disc escursion during the same recording, because opening time variability never got over 10 m. seconds. In aortic area malfunctions the Authors found a constant fluttering of anterior mitral leaflet, a sinergic septal motion with the posterior wall and in 1 case the presence of disc opening before the first component of the first sound. The Authors underline the importance of simultaneous eco-phonocardiographic examination and the check-ups for the time to be.

Adult↗
PubMed1978

[Electrophysiological evaluation of the aberrant pathways of intraventricular conduction obtained by means of premature atrial stimulation].

12 patients with normal QRS either in basal condition or during atrial pacing, undergone on single premature atrial stimulation, showed several types of intraventricular aberrancies. These have been revalued with atrial premature stimulation introduced over a progressively increasing frequency of fixed atrial stimulation (extrastimulus method), sometimes after atropine. In 9 cases it was possible to eliminate completely the above mentioned aberrancies, having thus a clear reduction of the refractory periods regarding their responsible structures. In 3 cases this was not possible, owing to a less significant reduction of the refractory periods. Such fenomenon is considered as the only parameter able to identify probable initial organic facts of the His-Purkinje system.

Adult↗