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Biomedical subjects

P Rocha

Publications and source records attributed to P Rocha.

At least 55 records · Page 3Linked to original sources
PubMed1986

Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement?

Percutaneous transluminal balloon catheter aortic valvuloplasty (PTAV) was carried out in three elderly patients with acquired severe aortic valve stenosis. Transvalvular systolic pressure gradient was considerably decreased at the end of the procedure, during which there were no complications. Increased valve opening was confirmed by angiography and echocardiography. Subsequent clinical course showed a pronounced functional improvement. PTAV is recommended as a simple alternative to aortic valve replacement in elderly and/or high-risk patients.

Aged↗
PubMed1986

Hemodynamic effects of intravenous diltiazem in patients treated chronically with propranolol.

In the search for any deleterious hemodynamic effects of the acute administration of intravenous diltiazem (0.25 mg/kg), in patients on beta blockers, studies were performed in two comparable groups of eight patients with chronic coronary heart disease without clinical signs of heart failure. In the first group, with no previous treatment, the only significant variations observed were a decrease in systemic vascular resistance (p less than 0.01) and an increase in cardiac index (p less than 0.01), which were noted only at 5 minutes. In the second group, receiving long-term oral doses of 120 to 240 mg/day of propranolol, at 5 minutes, despite a slight decrease in peak positive first derivative of left ventricular pressure (p less than 0.05), cardiac index and systolic index increased (p less than 0.05 and p less than 0.01) with decreases in systemic vascular resistance (p less than 0.01) and mean blood pressure (p less than 0.05); at 15 minutes, systemic vascular resistance was still decreased (p less than 0.05) and cardiac index and systolic index were still increased (p less than 0.05). In conclusion, intravenous administration of diltiazem (0.25 mg/kg) to patients with chronic coronary heart disease and no evidence of congestive heart failure, who were receiving propranolol, was safe and prevented, in these patients, the potential deleterious effects of beta blockers, that is, increased peripheral vascular resistance and decreased cardiac output.

Adult↗
PubMed1986

[Percutaneous transluminal aortic valvuloplasty using a balloon catheter. A new therapeutic option in aortic stenosis in the elderly].

Aortic valvular dilatation with a balloon catheter was performed in 44 patients, 20 men and 24 women, most of whom were very elderly (average age 77 years). The indication for valvular replacement had not been retained in these cases because of surgical contra-indications or a very high operative risk and in 3 cases because of patient refusal. Twenty-nine patients were in functional classes III or IV of the NYHA classification; 12 had syncopal episodes and 18 had invalidating angina. The dilatation was performed by a femoral arterial approach in 34 cases, and by a brachial arterial approach in 10 cases. MEDI-TECH catheters with 15, 18 or 20 mm diameters when inflated were used in the majority of cases. Several inflations lasting 10 to 240 seconds were performed in each case with balloons of increasing size. This was well tolerated in all but one patients who had a sharp syncope. The immediate results confirmed valvular dilatation. The average transvalvular pressure gradient fell from 76 +/- 25 mmHg to 30 +/- 13 mmHg (p less than 0.001). The aortic valve surface area calculated by the Gorlin formula increased from 0.5 +/- 0.18 cm2 to 1 +/- 0.42 cm2 (p less than 0.01). After dilatation the gradient was less than or equal to 40 mmHg in 37 cases; aortic valve surface area was greater than or equal to 1 cm2 in 14 cases and less than or equal to 0.7 cm2 in only 5 cases. The left ventricular ejection fraction increased immediately after valvuloplasty from 44 +/- 16 p. 100 to 49 +/- 15 p. 100 (p less than 0.01). In the 18 cases in which it was less than 40 p. 100 before valvuloplasty, it increased from 30 +/- 6 p. 100 to 36 +/- 9 p. 100 (p less than 0.02). Residual aortic regurgitation was only observed in one case. Two patients died in the hospital period (4.6 p. 100). There were no other serious complications. During an average follow-up period of 60 days (3 weeks to 6 months) there was a big improvement in symptoms in the great majority of cases and, in particular, syncopal and anginal attacks disappeared. Only 4 patients remained in functional classes III or IV after valvuloplasty. Percutaneous aortic valvuloplasty is a new, relatively simple, low risk, economic and very effective therapeutic procedure in all cases in which aortic valve replacement is contra-indicated or refused by the patient.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1985

Arteriovenous shunt measured by bolus dye dilution: reproducibility and comparison between two injection sites.

Twenty-eight brachial arteriovenous fistulae (AVF) flows were assessed by the Stewart and Hamilton method by bolus dye injection. These measurements were divided in two groups: a first group with dye injection into the AVF artery and a second group with dye injection into the efferent vessel of the AVF in close proximity. The increase and the decrease of dye concentration were regular and the circulation occurred very late in both groups. Reproducibility was assessed by the usual index: the mean of the differences between two successive measurements of each series related to the first of these two and expressed as a percentage, m(Qn - Qn - 1)/Qn%. In the two groups, the reproducibility index was at 10.1%, similar to the index applied to Grimby's results, measuring successive cardiac output by dye bolus injection at 9.8%. Theoretical criteria of validity of the Stewart and Hamilton method were checked for all measurements. Even when the duration of the measurement was very short, arteriovenous flow fulfilled the criteria of validity in the same way as cardiac output. Two AVF flows were measured successively at both injection sites with no difference between the obtained values. The same reproducibility of the efferent vessel injection site group suggests that an arterial puncture is not necessary for a correct assessment of AFV flow.

Adult↗
PubMed1983

[Two-dimensional contrast echocardiography during the drainage of hemopericardium with tamponade].

In patients with cardiac tamponade, withdrawing blood during pericardiocentesis raises questions as to its origin: pericardium or cardiac cavities? These questions can be answered by bidimensional contrast echocardiography after reinjection of a few millilitres of the blood-stained fluid removed. Microcavitations surrounding the heart and vanishing within a few minutes indicate that blood comes from the pericardium. Microcavitations obscuring the right atrium or ventricle and washed away by the blood flow in a matter of seconds indicate that these cavities have been punctured.

Adult↗
PubMed1981

[Left ventricular performance in chronic hemodialysis patients studied during intense exercise and during a dextran infusion test (author's transl)].

In 14 chronic hemodialysis patients with recent circulatory pulmonary congestion or pulmonary edema, left ventricular failure was suspected. Left ventricular function was studied by a sitting exercise test and a dextran infusion test. According to the left ventricular function curves the left ventricular function was not altered in chronic hemodialysis patients compared to normal subjects. It is possible that on average the left ventricular performances is higher in chronic hemodialysis patients than in normal subjects. These results indicate that circulatory pulmonary congestion and pulmonary edema are not reliable signs of left ventricular failure in chronic hemodialysis patients.

Adult↗
PubMed1981

Hemodynamic effects of arteriovenous fistulae in chronic hemodialysis patients at rest and during exercise.

The effects of arteriovenous fistulae (AVF) on cardiac output (CO) and cardiac filling pressures were studied at rest and during exercise in 16 chronic hemodialysis patients. After the occlusion of the AVF, average CO fell but cardiac filling pressures remained unchanged, seven patients had a drop in CO greater than or equal to 1.0 l/min (group A) and nine patients had a drop in CO less than or equal to 0.9 l/min (group B). At rest, average CO was higher in group A than in group B, but cardiac filling pressures were the same in group A and in group B. During maximal exercise, average CO and cardiac filling pressures were the same in both groups.

Adult↗
PubMed1979

Reversibility of alcoholic cardiomyopathy with abstention from alcohol.

A 46-year-old chronic alcoholic patient with typical and severe congestive cardiomyopathy was studied hemodynamically on two separate occasions. The second study followed after a 1 1/2-year period of virtually complete abstention from alcohol and revealed that the left ventricular dysfunction had disappeared. Depsite persisting atrial fibrillation, the response to moderate exercise and to plasma volume expansion was within the normal range. When last seen, 29 months after initial hospitalization, the patient was symptom-free and was not given any treatment.

Cardiomyopathy, Alcoholic↗
PubMed1979

Regional left ventricular function assessed by contrast angiography in acute myocardial infarction.

The relationship of segmental left ventricular (LV) wall motion abnormalities to LV function 2-6 days after acute transmural myocardial infarction (MI) was investigated in 45 patients by quantitative contrast ventriculography. Patients were divided into four classes according to the MIRU criteria. Segmental wall motion was assessed by determining the percentage of systolic shortening (deltaS) along nine hemiaxes and the extent of akinetic or dyskinetic abnormally contracting segments (% ACS) expressed as a percentage of end-diastolic perimeter. When compared with that in 17 normal control-subjects, the LV end-diastolic volume was increased only in patients in class III and class IV; the LV end-systolic volume increased progressively from normal through class IV. Ejection fraction had a negative linear correlation with %ACS (r = 0.97). The size of ACS was larger in anterior (34 +/- 14%) than in inferior MIs (23 +/- 7%), resulting in greater LV dysfunction. However, for a comparable size of ACS, infarct location alone did not influence LV function parameters. In the noninfarcted zone, deltaS was increased when the size of ACS was less than 25% and reduced when the size of ACS was greater than 25%. Thus, the size of ACS is a major determinant of LV dysfunction in acute MI. The compensatory mechanisms operate either through an augmented mechanical function of residual myocardium when the infarct is small, or through the Frank-Starling mechanism when the infarct is large.

Angiocardiography↗
PubMed1979

Treatment of early postinfarction ventricular aneurysm by intra-aortic balloon pumping and surgery.

In nine patients with medically refractory left ventricular failure and/or ventricular arrhythmias, secondary to acute formation of a ventricular aneurysm, intra-aortic balloon pumping (IABP) was instituted 24 to 36 hours before diagnostic angiographic studies. Ventricular irritability was reduced and heart failure was controlled in all patients. Eight patients underwent operation, four within 3 weeks of an acute myocardial infarction and four within 3 months. All had resection of the recent infarction and two had myocardial revascularization as well. Two of the eight patients died in the early postoperative period from intractable ventricular fibrillation. All six patients who survived the operation (mean follow-up 12 months) had excellent clinical results. Ventricular irritability was suppressed and only one patient had residual heart failure. However, there was one late death 7 months after operation. The results suggest that surgical therapy may be effective in the management of medically unresponsive arrhythmias and/or congestive heart failure in the acute or intermediate postinfarction phase. IABP assistance was helpful in supporting the circulation and reducing ventricular irritability during the preoperative and postoperative periods.

Aged↗
PubMed1979

Clinical assessment of infarct size by serial determinations of serum creatine phosphokinase activity.

Infarct size (IS) was estimated from serial total creatine phosphokinase (CK) changes in 82 patients with acute myocardial infarction (MI). Anteroseptal and inferior MI involved a relatively small mass of myocardium (16.0 +/- 6.4 and 24.7 +/- 10.0 CK-g-eq respectively); anteroapical and inferoposterior MI had an average IS of 35.9 +/- 15.9 and 32.8 +/- 13.8 CK-g-eq respectively (NS); extensive anterior and inferoposterolateral MI had an average IS of 57.8 +/- 20.1 and 51.1 +/- 11.5 CK-g-eq respectively (NS). Left ventricular failure (LVF) correlated with estimated IS and not with location of the infarct. In patients with an IS ranging from 30 to 50 CK-g-eq, the incidence of LVF was 33%. In patients with an IS greater than 50 CK-g-eq, the incidence of LVF was 65%. Out of the 6 patients who died, 3 had an IS greater than 60 CK-g-eq. 3 groups of patients could be identified from the duration of the CK release time: in group I (mean = 20 +/l h; n = 61), infarct size was highly correlated with peak CK activity (r = 0.93); in group II (mean = 39 +/- 7 h; n = 17) the correlation between IS and peak CK activity was poor (r = 0.59) and might indicate a gradual necrosis; in group III (n = 4) patients with reinfarction showed a second peak on the descending limb of the CK activity curve. Follow-up information was available in 96% of the 76 survivors. At the end of the follow-up (18.1 +/- 10.8 mth) IS was not significantly different in patients with LVF (42.7 +/- 17.5 CK-g-eq) and in those without LVF (34.7 +/- 19.7 CK-g-eq).

Adult↗
PubMed1978

[Patients on chronic hemodialysis. Hemodynamic study at rest and during exercise before dialysis, in hypertensive and normotensive patients (author's transl)].

In twenty chronic hemodialyzed patients a hemodynamic study was carried out just before dialysis at bed rest and during sitting bicycle exercise. At bed rest, cardiac index (mean +/- standard deviation = 5.2 +/- 1.1/mn/m2) and pulmonary wedge pressure (17.4 +/- 6.8 mmHg) were increased. At the highest level performed (60 ou 90 W) cardiac index increased in all patients and reached on average normal values as compared to normal sedentary subjects, but heart rate less increased than in normal subjects during maximum effort. These data suggest that these patients had no patent heart failure. Pulmonary wedge pressure was more increased in hypertensive patients (20.7 +/- 6.7 mmHg) than in normotensive patients (13.3 +/- 4.4 mmHg). Since cardiac index was similarly increased in both groups of patients the higher values of pulmonary wedge pressure in hypertensive patients could be related to either an increase in total blood volume, or a reduction in left ventricular compliance or an increase in cardiopulmonary blood volume.

Adult↗
PubMed1978

[Surgical treatment by valve replacement and aorto-coronary bypass in mitral valve insufficiency caused by chronic dysfunction of the posterior papillary muscle].

Nine patients with cardiac failure which was refractory to medical treatment, and which was caused by chronic malfunction of the posterior papillary muscle, as a result of a myocardial infarction, were studied by cardiac catheterisation and coronary arteriography. The mean pulmonary capillary pressure was 31+/-16 mm of mercury with a nu wave at 51+/-27 mm of mercury. The end diastolic volume was increased (141+/-68 ml/m2) and the ejection fraction lowered (0.40+/-0.13). The left ventricle had overall hypokinesia in 5 patients and akinesia of the inferior wall, representing 21+/-24% of the end diastolic perimeter, in 3 others. All these patients had significant lesions of two or three of the main coronary trunks. At operation lengthening of the posterior papillary muscle and/or the cordae was found. All patients had a replacement mitral valve of the Starr-Edwards type, associated with an aorto-coronary bypass of the anterior descending artery. The operative mortality was zero. At a mean follow-up period of 21 months, there had been no late death, and all the patients were improved.

Aged↗
PubMed1978

[Moderate aortic incompetence due to traumatic rupture of a cusp].

The authors recall a case of moderate aortic incompetence caused by traumatic rupture of an aortic cusp occurring in a man of 36 years of age. Anatomical lesions of the aortic valve usually lead to severe incompetence for which surgical treatment is required. In this case, the lesion was well tolerated from the clinical and haemodynamic points of view, and surgery was not required; this tolerance has extended into the mid term. The authors emphasise the importance of echocardiography in the diagnosis of disturbance of an aortic valve, and also in following up the progress of the subsequent aortic incompetence.

Adult↗