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Manuel Carrageta

Publications and source records attributed to Manuel Carrageta.

At least 19 recordsLinked to original sources
PubMed2006

Exercise stress echocardiography for detection of pulmonary arterial hypertension in a patient with systemic sclerosis.

The authors report the case of a 57-year-old patient, diagnosed with systemic sclerosis 16 years ago. She had been followed in the rheumatology outpatient clinic since 2003 and complained of marked fatigue and dyspnea on exertion. In addition to full medical evaluation, she also underwent standard Doppler echocardiography at rest, which was unremarkable, and exercise stress echocardiography. In the latter examination, she was diagnosed with pulmonary arterial hypertension, later confirmed during right heart catheterization. The authors discuss the potential value of this methodology for the study of patients with systemic sclerosis.

Echocardiography, Stress↗
PubMed2006

Left pulmonary artery evaluation through transesophageal echocardiography.

INTRODUCTION: Transesophageal echocardiography (TEE) has become increasingly useful in the study of patients with suspected pulmonary thromboembolism. OBJECTIVE: The aim of this study was to prospectively evaluate the usefulness of TEE in the study of the distal part of the left pulmonary artery (LPA) as well as the influence of this procedure on total echocardiographic exam duration. METHODOLOGY: A prospective study in two groups of consecutive patients referred for TEE with a one- year interval between evaluation of Group A: 33 patients, 17 male, mean age 54 +/- 24 years, and Group B: 42 patients, 20 male, mean age 48 +/- 27 years (p = NS). The procedure was considered long when it took more than 3 min to evaluate the distal part of the LPA. RESULTS: In group A we were able to visualize the distal part of the LPA in 24 patients (73%) without significant prolongation of total exam duration in 16 patients (48% of group A). In one of the patients with suspected pulmonary thromboembolism thrombi were only observed in the distal part of the LPA. In group B we were able to visualize the distal part of the LPA in 36 patients (86%) without significant prolongation of total exam duration in 26 patients (61% of group B). CONCLUSIONS: 1. Visualization of the distal part of the LPA was possible in more patients, and with TEE time prolongation in less patients, in group B. These differences can be accounted for by the training of the operator in this technique. 2. The importance of visualization of this part of the LPA in guiding treatment in the subset of patients with pulmonary thromboembolism confirms the usefulness of this specific procedure.

Adult↗
PubMed2006

Acute resynchronization with inhaled iloprost in a pregnant woman with idiopathic pulmonary artery hypertension.

We describe the case of a pregnant woman with idiopathic pulmonary arterial hypertension, a responder in right heart catheterization, followed since the first trimester in outpatient consultations, admitted to hospital at 23 weeks gestation. She was treated with inhaled iloprost until delivery (at 34 weeks gestation) and continuous infusion of iloprost throughout the perioperative period and following days. This line of therapy has proved efficacious in previous cases. The authors present echocardiographic images that document acute changes in ventricular synchrony during inhalation of iloprost.

Administration, Inhalation↗
PubMed2006

Suspected dysfunction of a Starr-Edwards aortic prosthesis implanted 33 years ago: the role of exercise stress echocardiography. Case report.

The authors present a case report of suspected dysfunction of a Starr-Edwards mechanical aortic prosthesis implanted in 1972. Its characteristic longevity, but also its disadvantageous hemodynamic profile, are discussed. Treadmill exercise echocardiography, whose role has yet to be clarified in the study of valve prosthesis, was used in the evaluation of the patient.

Aortic Valve↗
PubMed2005

Coronary-subclavian steal syndrome. A case report.

Coronary-subclavian steal is an unusual clinical syndrome after successful internal mammary-coronary artery bypass grafting. Proximal subclavian artery (SA) stenosis is present and atherosclerotic disease is the underlying pathophysiologic mechanism in the majority of cases. The authors report a case of a sixty-two-year old man with angina and ventricular fibrillation soon after myocardial revascularization with left internal mammary artery (LIMA) to left anterior descending coronary (LAD). Dobutamine stress echocardiography showed ischemia in the anterior myocardial territory with patent LIMA-LAD bypass in the angiographic evaluation. This procedure showed occlusion of the proximal SA with reversal of flow in the LIMA. The best therapeutic approach was discussed and a carotid-subclavian bypass was performed with restoration of antegrade blood flow and reversal of the clinical setting.

Humans↗
PubMed2005

Adolescent and adult congenital heart disease assessed by real-time three-dimensional echocardiography: an initial experience.

Real-time three-dimensional (3D) echocardiography has enormous diagnostic potential, enabling acquisition of full-volume three-dimensional images in real time, which can be sliced in several planes and rotated in order to achieve a more accurate study of the target cardiac structures. It is particularly useful because it enables the heart to be visualized from multiple perspectives in the same way a surgeon would see it during an operation. We describe our echocardiographic laboratory's experience with real-time 3D ultrasound study of adolescent and adult congenital heart disease.

Adolescent↗
PubMed2005

Evaluation of hypertrophic obstructive cardiomyopathy by exercise stress echocardiography. New methodology.

Exercise echocardiography with image acquisition during treadmill exercise is the most common form of stress testing used in our department. The usual evaluation of patients with hypertrophic obstructive cardiomyopathy consists of serial echocardiographic studies at rest. The purpose of this study was to evaluate intraventricular gradients during exercise echocardiography in patients with a diagnosis of hypertrophic obstructive cardiomyopathy. We studied 13 patients, 8 male, mean age 56 +/- 9 years Intraventricular gradients were measured using continuous wave Doppler; two evaluations were performed at rest: one in left lateral decubitus and the other in orthostatic position after one minute in this position. The patients then underwent a treadmill exercise test using the modified Bruce protocol, during which intraventricular gradients were measured at peak exercise. Finally, a further measurement was taken in the first 90 seconds of the recovery period in left lateral decubitus. The intraventricular gradient in left lateral decubitus was 54 +/- 29 mmHg; in orthostatic position 69 +/- 30 mmHg (p < 0.001 versus gradient in left lateral decubitus); at peak exercise 109 +/- 47 mmHg (p < 0.001 versus gradient in orthostatic position); and during recovery in left lateral decubitus 78 +/- 33 mmHg (p < 0.001 versus gradient at peak exercise in orthostatic position). We conclude that intraventricular gradients increase significantly in orthostatic position and increase considerably during treadmill exercise testing. The gradients measured in the recovery period do not reflect what happens during effort or therefore during these patients' daily activities. This type of evaluation can help us to better understand the pathophysiology of patients with a diagnosis of hypertrophic obstructive cardiomyopathy and to optimize treatment.

Adult↗
PubMed2005

Intraventricular gradient during effort in a professional soccer player. Clinical significance.

The authors report the case of a 20-year-old professional soccer player who underwent medical evaluation because of atypical chest discomfort and dizziness precipitated by strenuous effort. The ECG and echocardiogram findings were normal. The young athlete did a treadmill stress test which was negative for myocardial ischemia. His myocardial perfusion imaging and coronary angiography were also normal. Later during the investigation, he underwent treadmill stress echocardiography, during which he developed an intraventricular gradient of over 100 mmHg with end-systolic peak and systolic anterior movement (SAM) of the mitral valve. These echocardiographic findings were not present at rest and disappeared shortly after termination of exercise. The authors discuss the significance of these findings and their potential link to sudden death.

Adult↗
PubMed2005

Stress echocardiography in the evaluation of exercise physiology in patients with severe arterial pulmonary hypertension. New methodology.

INTRODUCTION: Doppler echocardiography is usually performed when assessing a patient with severe pulmonary hypertension (PHT), since it enables accurate determination of the severity of the hypertension through evaluation of several morphologic and hemodynamic variables. Echocardiograms are usually performed in left lateral decubitus (LLD). However, symptoms often arise only in a standing position and particularly during exercise. OBJECTIVE: To evaluate a group of patients with severe PHT using Doppler echocardiography during treadmill exercise testing. METHODS: We studied 8 patients (group A), mean age 43.88 +/- 14 years, 7 women; three had idiopathic pulmonary hypertension, 2 pulmonary thromboembolic disease, 2 Eisenmenger syndrome, and one pulmonary hypertension associated with celiac disease. We also studied an 8-patient control group (group B) with similar demographic characteristics, who had tricuspid regurgitation but no known cardiac disease, including pulmonary hypertension (excluded by echocardiogram). In addition to the ergometric variables of stress test duration using the modified Bruce protocol, resting heart rate, peak heart rate (PHR), resting systolic blood pressure (RSBP) and peak systolic blood pressure (PSBP), we evaluated the following echocardiographic variables: pressure gradient between right ventricle and right atrium (RV/RAg) and systolic volume (SV) in left lateral decubitus, in a standing position (SP) and at peak workload (PW). Stress testing was stopped in cases of fatigue and/or dyspnea. RESULTS: In group A, the RV/RAg in LLD was 100 +/- 20 mmHg, 98 +/- 20 mmHg in SP (p = NS) and 129 +/- 27 mmHg at PW (p = 0.003 vs. SP). In group B, the RV/RAg in LLD was 19.8 +/- 3.5 mmHg, 14.6 +/- 2.1 mmHg in SP (p = 0.0005) and 29.5 +/- 3.3 mmHg at PW (p < 0.0001 vs. SP). In group A, SV was 38 +/- 11 ml in LLD, 35 +/- 10 ml in SP and 32 +/- 9 ml at PW (p = NS); in group B, it was 63 +/- 5 ml in LLD, 55 +/- 5 ml in SP and 64 +/- 7 ml at PW (p < 0.0001). PHR was 114 +/- 10 bpm in group A and 145 +/- 8 (p < 0.0001) in group B. RSBP was 113 +/- 13 mmHg and PSBP 112 +/- 21 mmHg (p = NS) in group A, and 116 +/- 18 mmHg and 161 +/- 25 mmHg respectively (p < 0.0001) in group B. In four patients from group A, symptomatic falls in systolic blood pressure and SV occurred at PW. During a mean follow-up of 27 months (between 6 and 44 months), two of these four patients died and one is awaiting lung transplantation. CONCLUSIONS: 1. RV/RAg did not diminish in the standing position and rose significantly with orthostatic isotonic exercise during exercise testing in patients with severe PHT, with pulmonary artery systolic pressure reaching suprasystemic values. 2. Systolic volume and systolic blood pressure did not rise during exercise in patients with severe PHT, and patients with a decrease in systolic volume had worse clinical evolution. 3. Patients with severe PHT appeared to have chronotropic incompetence during exercise compared to the control group.

Adult↗
PubMed2004

Myocardial infarction in a patient with congenital coronary anomaly.

The authors describe the clinical case of a 38-year-old patient, with a history of smoking and hypercholesterolemia, who was admitted for non-Q wave acute myocardial infarction, and in whom coronary angiography revealed severe coronary disease and a congenital coronary anomaly. Unlike many congenital coronary anomalies that are manifested in ischemic disease, the nature of this patient's anomaly may have contributed to its benign clinical evolution, and influenced the therapeutic approach.

Adult↗
PubMed2004

Coronary spasm in acute myocardial infarction.

The authors present a clinical case of coronary spasm in acute myocardial infarction in a 22-year-old patient, admitted to the emergency department with chest pain. Angiography revealed normal coronary arteries and during the procedure a coronary spasm occurred.

Adult↗
PubMed2003

Congenital absence of left pericardium.

The authors present a clinical case of right chamber dilatation in a 34-year-old patient with no symptoms, investigation of which led to a diagnosis of congenital absence of left pericardium, established by magnetic resonance imaging (MRI). They also present a review on absence of the pericardium, and discuss associated congenital abnormalities, the clinical presentations and findings in diagnostic tests, with particular emphasis on MRI.

Adult↗