Biomedical subjects
Publications and source records attributed to M Gil Moreno.
Left ventricular volume and ejection fraction were determined by two methods of one plane angiography in 50 cases of ischemic heart disease. Statistical analysis of the results obtained by both methods showed no significant differences.
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.
We present the long term follow-up of two groups of patients under 16 years of age in whom two different types of mitral valve prostheses were used for the treatment of mitral valve disease. Group I was formed by 74 patients with Starr-Edwards (6120) prosthesis and group II by 36 cases with Bjork-Shiley prosthesis. Group I was followed for a mean period of 11 years and group II for a mean period of 7.5 years. The clinical evolution of both groups assessed according to the New York Heart Association criteria showed improvement of the functional class (p less than 0.006). Twenty seven cases of group I and 21 of group II underwent cardiac catheterization for the evaluation of surgical results. In group I, the mean pulmonary arterial systolic pressure (PASP) decreased from 57 mmHg to 33 mmHg (p less than 0.001) and the mean pulmonary arterial wedge pressure (PAWP) from 20.8 mmHg to 12.1 mmHg (p less than 0.05). In group II, the mean PASP decreased from 59.2 mmHg to 28.5 mmHg (p less than 0.001) and the mean PAWP from 24.6 mmHg to 8.5 mmHg (p less than 0.001). There was statistically significant difference for a greater incidence of thromboembolism in group I (p = 0.037). No differences were found for bacterial endocarditis, dysfunction and death.
This study describes the initial experience of the Instituto Nacional de Cardiología "Ignacio Chávez", with percutaneous aortic balloon valvuloplasty for calcified aortic valve stenosis in adults. Five patients, 4 males and a female (mean age 54 +/- 7 years), were included. All of them had poor ventricular function, and were not surgical candidates. Although it is in fact a small group, the results are promising, with a success rate of 80%, and without mortality. In only one case, the transvalvular gradient could not be modified.
To evaluate the importance of early initiation of fibrinolytic therapy with intravenous streptokinase (IVSK), we studied 34 consecutive patients, within less than six hours of the onset of acute myocardial infarction, who were treated with 1.5 million units of intravenous streptokinase. All the patients had coronary angiograms in the first seventy two hours. We correlated the angiograms with the time of onset of the IVSK. The patients were divided into 3 groups: Group num. 1: From zero to two hours (twelve patients); Group num. 2: From two to four hours (13 patients); and Group num. 3: From four to six hours (nine patients). We had angiographic reperfusion in twenty-four patients (70.2%) P less than 0.05. We observed reopening in the patients of group num. 1 (83.3%); in group 2, nine patients (69%) and in group num. 3, five patients, (55.5%), with statistical significance only in group num. 1 (p less than 0.05). We also demonstrated the utility of the electrocardiographic and enzymatic criteria to predict reperfusion. No mortality was related to the procedure. We concluded that a higher percentage of reperfusion is obtained the sooner intravenous streptokinase therapy is initiated.
In order to analyze the angiographic characteristics associated with left ventricular hypertrophy in patients with coronary insufficiency, the left ventriculography was used to calculate the ventricular volumes, the ejection fraction (EF) and the ventricular mass (LVM) in 31 patients with clinical diagnosis of ischemic heart disease. Patients were divided into three groups: A) Those with normal coronaries and (EF), B) Those with coronary lesion and EF greater than 50% and C) Those with coronary lesions and EF less than 50%. The following results were obtained for the telediastolic volume (ml/m2), the EF (%) and the LUM (g/m2): Group A = 85 +/- 19, 73 +/- 7 and 41 +/- 13. Group B = 102 +/- 25, 61 +/- 8 and 50 +/- 9. Group C = 154 +/- 27, 39 /+- 7 and 74 +/- 17 respectively. Comparing the FEV with the LVM in the patients studied, a negative correlation was found with an r index of -0.7894 (p less than or equal to 0.001). The correlation index for the diastolic volume and the LVM was r = 0.6806; and -0.6991 for the EF and the telediastolic volume. These findings suggest that hemodinamic changes, especially an increase in the ventricular volume and subsequently in the tension of the ventricular wall, act as a stimulus in initiating a metabolic chain leading to ventricular hypertrophy. This process is compensatory in the initial phases of the disease (groups A and B) but insufficient in the advanced stage (group C).
Two cases of double-outlet left ventricle with ventricular septal defects and pulmonic stenosis are described. Both had atrial situs solitus, one with concordant and another with discordant atrioventricular connections. Considering the clinical behaviour of the malformation, the diagnosis is difficult. Although the echocardiographic findings suggest the abnormality, angiocardiography is the best procedure for the accurate diagnosis.
1. In the presence of normal coronaries, it is possible to find--or not CAI, in patients with arteriosclerose cardiopathy. 2. When coronary obstructions are present, we also could find a clear dominance of CAI. It is necessary to emphasize the fact that every patient of these series who suffered of trivascular coronary illness presented CAI. 3. When CAI shows in at rest ECG of a patient clearly showing ischemic cardiopathy, more often than not we also find important coronary obstructions, but when this sign is not present it doesn't necessarily mean that we should discard the possibility of a vascular disease, it only points to us the presence of a trivascular coronary pathology. 4. Frequently we find a CVP between normal levels when CAI is not present. 5. We found CAI in every patient showing dysinesia and also in most of the patients with dysinergia.
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We present here a program of ventricular volumes measurements in which an area-lenght procedure and a digital computer were used. The results were compared with those obtained by the manual method using the same formula. The correlative estatistical analysis of these results showed a high index of 0.95 when compared to the telediastolic volumes obtained by both technics, while the index reached 0.99 in reference to the telesistolic volumes and the ejection fraction.
A modified Rackley et al technique for left ventricular mass calculations is applied to patients with concentric hypertrophy originated by hypertensive cardiopathy and to normal subjects. The values found in 8 normal subjects were 41 +/- 16 g/m2 of body surface and in 20 patients with hypertensive cardiopathy were 63 +/- 20 g/m2 (p = 0.01). The results obtained allow us to state that there is a clear difference between the ventricular mass of the two groups studied even though the values of ventricular volumes and of ventricular ejection fraction were not statistically significant in its variation.
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Retrospectively, we studied 66 consecutive patients in whom we implanted an intravenous DDD pacemaker. The indications were: AV block in 52 patients (79%), sick sinus syndrome in 5 patients (7.5%), both AV block and sick sinus syndrome in 4 patients (6%), and other causes in 5 (7.5%). The venous access route was by subclavian punction in 38 cases (57.5%) and by cephalic vein dissection in 28 (42.5%). With a mean follow-up of 16 months, there were complications in 11 patients (17%), in 9 of them, it was necessary a change in pacing mode different to DDD, and was possible to maintain a DDD pacing mode in 2 patients with a minimal reprogramming. The complications were: A) lost of sense and/or atrial capture in 10 patients (3 of them, had also loss of ventricular capture, one had pacemaker-mediated tachycardia, other had diaphragmatic stimulation and other had a severe infection of the pocket), B) atrial fibrillation appeared in another patient. At the implantation time there were significant differences between patients with and without complications on follow-up, the P wave amplitude was 1.86 +/- 0.75 mV in the first group vs. 3.06 +/- 1.52 mV in the latter group, p < 0.005, and the atrial pacing threshold was 1.10 +/- 1.17 microJ in the first group vs. 0.65 +/- 0.66 microJ in the latter group, p < 0.005. We consider that dual chamber stimulation is a well established form of therapy, although, it requires a more laborious implantation and specialized personal for its follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Percutaneous closure of the patent ductus arteriosus (PDA) has been recently reported to be an effective alternative in the treatment of patients with ductal shunting. We report the initial experience and results during follow-up of percutaneous ductal occlusion with the Rashkind occluder (USCI) in six patients with isolated PDA. Ages ranged from 3 to 23 years. Diagnosis was corroborated with two dimensional and Doppler echocardiography in all patients. During cardiac catheterization systolic pulmonary artery pressure oscillated between 22 and 64 mmHg and Qp/Qs ratio between 1.3 and 4.1. In two patients prosthesis of 12 mm were used and in the remaining prosthesis of 17 mm. Only one patient demonstrated total occlusion during immediate control aortography, the other patients presented central residual shunting over the occluder. In the three patients occlusion with balloon-catheter was added to the procedure, resulting in total occlusion in two and significant reduction of the shunt magnitude in one. Two technical problems were resolved satisfactorily. None of the cases presented device embolization. Mean follow-up was 23.8 months with control echocardiograms at 24 hours, 1, 4, 12 and 24 months. In all patients immediate reduction of the left atrial dimension was demonstrated. Three patients presented residual shunts in the first 24 hours. In two of them total occlusion had occurred after one month and the other patient persisted with a small residual shunt until one year after the procedure. In conclusion, in this small study group good results were obtained with percutaneous ductal closure.
The percutaneous balloon valvulotomy is nowadays the treatment of choice for isolated pulmonary stenosis. Forty two patients with congenital pulmonary stenosis underwent balloon valvulotomy at the Instituto Nacional de Cardiología "Ignacio Chávez". Ages 1 month to 24 years, mean 7.6 +/- 5.9 years, with a follow-up of 28.3 +/- 14.8 months. With an infundibular gradient of 50 mm Hg or more a treatment with propranolol was given. After valvulotomy the total basal pressure gradient decrease from 82.9 +/- 40.6 mm Hg to 31.2 +/- 27.1 mm Hg (p < 0.00001). The patient's results were divided in two groups: with and without reactive infundibular obstruction. The 31 patients without infundibular obstruction had a total initial gradient of 71.6 +/- 33.5 mm Hg, and after valvulotomy the gradient was reduced to 18.9 +/- 11.2 mm Hg (p < 0.00001). The 11 patients with infundibular obstruction had a total initial gradient of 114.8 +/- 43.2 mm Hg, and after valvulotomy the valvular gradient was 12.4 +/- 8.5, the infundibular gradient 53.4 +/- 22.9 and the total gradient 65.9 +/- 29.1 mm Hg (p = 0.002 in relation to the basal gradient). All patients with infundibular obstruction (8 treated with Propranolol) and a follow-up of 8.5 +/- 9.8 months underwent Doppler examination, showing a progressive reduction of the total gradient. By six months no one had a total gradient greater than 50 mm Hg. These data confirm that balloon valvulotomy in valvular pulmonary stenosis is safe and effective, and that restenosis is very low. Good results relay on the use of proper balloon diameters (balloon diameter/pulmonary annulus relation of 1.2 to 1.5).(ABSTRACT TRUNCATED AT 250 WORDS)
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