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Biomedical subjects

P Widimský

Publications and source records attributed to P Widimský.

At least 19 recordsLinked to original sources
PubMed2004

[Huge sinus of Valsalva aneurysm in patient with cystic medial necrosis of the aorta].

In this case we present a patient with unruptured non-coronary sinus of Valsalva aneurysm associated with diverse clinical findings, caused by acquired degenerative changes of the aortic wall. A previously healthy 36-year-old female was admitted to the neurological clinic of our hospital having suffered from an episode of unconsciousness prior to admission, with accompanying seizures. For the preceding two months she had also been suffering from dyspnoea and palpitation. Neurological examination, computed tomography of the head and electroencephalography were with normal findings. Thereafter, due to paroxysm of supraventricular tachycardia she was referred to cardiology clinic. On routine physical examination a diastolic murmur was detected and the patient was referred for transthoracic echocardiography. This examination revealed a large, unruptured noncoronary sinus of Valsalva aneurysm, which was thereafter confirmed by transoesophageal echocardiography a angiography. The patient was indicated for surgical correction with aortic valve and aortic root replacement by Bentall procedure. Histological examination of the part of resected aneurysm found cystic medial degeneration of the aortic wall, also called cystic medial necrosis.

Adult↗
PubMed2003

Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial--PRAGUE-2.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted. METHODS: The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n=421) or immediate transport for primary percutaneous coronary intervention (PCI group, n=429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0-3 h and 3-12 h after symptom onset. Maximum transport distance was 120 km. RESULTS: Five complications (1.2%) occurred during the transport. Randomization-balloon time in the PCI group was 97+/-27 min, and randomization-needle time in the TL group was 12+/-10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P=0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n=551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003). CONCLUSIONS: Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.

Angioplasty, Balloon, Coronary↗
PubMed2002

Value of first day angiography/angioplasty in evolving Non-ST segment elevation myocardial infarction: an open multicenter randomized trial. The VINO Study.

AIMS: Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. METHODS: One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). RESULTS: All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2% vs 22.3% (P<0.001). Six month mortality in the first day angiography/angioplasty group was 3.1% vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs. 14.9% (P<0.02). CONCLUSIONS: First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy.

Aged↗
PubMed2002

[Echocardiographic quantification of changes in left ventricular kinetics in patients during hospitalization for a first myocardial infarct and treated with direct angioplasty].

UNLABELLED: The authors quantified the changes of left ventricular kinetics during hospitalization after a first transmural myocardial infarction treated by direct percutaneous coronary angioplasty. For accurate quantification a group as close as possible to experimental conditions was selected. 64 patients (43 men), mean age 67.3 years (44-86) were investigated. The echocardiographic examination was made within 24 hours after admission and on discharge (9.8 days). A 16-segment of the left ventricle was used, the kinetics were evaluated by 4-grade score. The ejection fraction was calculated by Simpson's method from 4 cycles, the wall motion score index was calculated by the standard procedure. During the follow up period significant improvement of left ventricular kinetics occurred. The ejection fraction improved from the original 46 +/- 11% (median 41.5) to 51 +/- 11% (median 50.0) (p < 0.005), the wall motion score index from 1.6 +/- 0.3 (median 1.65) improved to 1.5 +/- 0.3 (median 1.60) (p < 0.005). Improvement of the investigated parameters correlated with the clinical course, 87% of the patients being free of any complications. CONCLUSION: Successful direct angioplasty leads in patients with a first myocardial infarction to improvement of the ejection fraction and wall motion score index already during the first 10 days.

Adult↗
PubMed2002

[The ECG in prediction of the infarcted artery and left ventricular dysfunction].

OBJECTIVE: To assess the possibilities of ECG in prediction of an infarcted artery in patients with acute myocardial infarction (AIM) and evaluate the relationship of left ventricular function to the number of pathological Qs. METHOD: The trial comprises 216 patients with acute myocardial infarction (AMI) treated by primary PTCA. The diagnosis of AIM was confirmed in addition to ECG also by coronarography and elevation of cardiospecific enzymes. On the baseline 12-lead ECG denivelization of the ST segment > 1 mm was considered significant. The number of pathological Q waves on the ECG tracing on discharge was compared with left ventricular function according to the ejection fraction assessed echocardiographically before discharge. RESULTS: Elevation of ST in leads V1-V4 predicts occlusion of LAD with a sensitivity of 96% and specificity of 69% (p < 0.001 vs. RC segment with a sensitivity of 80% and specificity of 48% (p < 0.001). In inferior AMI the ST elevation in III > II develops in 70% in occlusion of RCA vs. 27% in occlusion of LCX. The mean left ventricular ejection fraction before discharge was in patients with four or fewer pathological Q waves 49 +/- 10% vs. 32 +/- 9% in the presence of pathological Q waves in > 4 leads. CONCLUSION: In patients with AMI according to ECG changes in different leads conclusions may be drawn on the infarcted artery. The presence of pathological Q waves in more than 4 leads predicts severe left ventricular dysfunction.

Angioplasty, Balloon, Coronary↗
PubMed2000

Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study.

BACKGROUND: Primary coronary angioplasty is an effective reperfusion strategy in acute myocardial infarction. However, its availability is limited, and transporting patients to an angioplasty centre in the acute phase of myocardial infarction has not yet been proved safe. METHODS: The PRAGUE study (PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis) compared three reperfusion strategies in patients with acute myocardial infarction, presenting within 6 h of symptom onset at community hospitals without a catheterization laboratory: group A - thrombolytic therapy in community hospitals (n=99), group B - thrombolytic therapy during transportation to angioplasty (n=100), group C - immediate transportation for primary angioplasty without pre-treatment with thrombolysis (n=101). RESULTS: No complications occurred during transportation in group C. Two ventricular fibrillations occurred during transportation in group B. Median admission-reperfusion time in transported patients (group B 106 min, group C 96 min) compared favourably with the anticipated >90 min in group A. The combined primary end-point (death/reinfarction/stroke at 30 days) was less frequent in group C (8%) compared to groups B (15%) and A (23%, P<0. 02). The incidence of reinfarction was markedly reduced by transport to primary angioplasty (1% in group C vs 7% in group B vs 10% in group A, P<0.03). CONCLUSIONS: Transferring patients from community hospitals to a tertiary angioplasty centre in the acute phase of myocardial infarction is feasible and safe. This strategy is associated with a significant reduction in the incidence of reinfarction and the combined clinical end-point of death/reinfarction/stroke at 30 days when compared to standard thrombolytic therapy at the community hospital.

Aged↗
PubMed1999

[Emergency myocardial revascularization during a developing myocardial infarct].

In 1996-1998 in our Cardiocentre urgent revascularizations were made in 28 patients with developing acute myocardial infarction (AIM) with manifestations of different grades of acute circulatory failure up to developed cardiogenic shock and cardiac arrest. In all patients complete revascularization with a mean number of 2.9 bypasses per patient was made, in one patient at the same time a rupture of the interventricular septum was closed and in two patients an insufficient mitral valve was replaced. From the whole group two patients died during the early postoperative period, two were revised on account of postoperative haemorrhage and two had signs of low cardiac output. Twenty-two patients had a postoperative course without complications. Urgent surgical revascularization in patients developing AIM and circulatory deterioration is the method of primary and definite treatment when primary PTCA is not suitable.

Adult↗
PubMed1995

Pericardial involvement during the course of myocardial infarction. A long-term clinical and echocardiographic study.

STUDY OBJECTIVE: This study investigated the long-term course of infarct-related pericarditis and pericardial effusion. Focus was given to the following issues: incidence and timing of pericarditis and pericardial effusion during the acute phase and 3 years follow-up, size, hemodynamic and clinical consequences of effusions, and potential risk of thrombolytic or anticoagulant therapy in patients with pericardial effusion. PATIENTS AND STUDY DESIGN: Serial echocardiographic examinations were performed in 192 consecutive patients with first myocardial infarction during the acute phase (day 1, 5, 10, 21) and during 3 years' follow-up (year 1, 2, and 3 after infarction). The follow-up was 100%. Clinical, angiographic, and autopsy data were analyzed. RESULTS: Pericardial effusion was detected at least once during serial echocardiographic examinations in 82 of 192 patients (43%). The incidence in different subgroups (with or without thrombolysis, open or closed artery at 3 weeks, infarction in left anterior descending, left circumflex, or right coronary artery perfusion bed) was similar. Most (48%) effusions were first detected on the fifth day, and most (50%) disappeared between days 21 and 365. However, in nine patients, the effusion persisted beyond 1 year (up to 3 years in three patients). Only systolic separation of pericardial layers was detected in 59% of effusions, circular effusion in 3.6% of all effusions. No cardiac tamponade developed. Heart failure or death complicated 49% of infarctions with pericardial involvement and 16% of infarctions without effusion (p < 0.01). Mortality alone was 8% among patients without effusion and 15% among those with more than minimal effusion (not significant). CONCLUSIONS: Pericardial effusion can be detected by serial echocardiographic examinations in 43% of myocardial infarctions. It appears during the initial 5 days and disappears slowly during several weeks to several months. Anticoagulant and thrombolytic therapy does not increase the frequency or the size of effusions.

Adult↗
PubMed1993

Recent atrial fibrillation in acute myocardial infarction: a sign of pericarditis.

The association between recent atrial fibrillation during the course of acute myocardial infarction and pericarditis or pericardial effusion occurring during the hospital phase of myocardial infarction was studied by means of serial echocardiographic examinations in 192 patients presenting with their first myocardial infarction. Clinical pericarditis was found in 8%, echocardiographic effusion in 43%, and atrial fibrillation in 5% of all patients. Atrial fibrillation was present in only 2% of patients without pericardial effusion compared to 15% of patients with more than minimal effusion (p = 0.0094). Thus, pericarditis might play a role in the development of recent atrial fibrillation during the course of myocardial infarction. Recent atrial fibrillation may be a sign of pericardial effusion which may be otherwise silent.

Atrial Fibrillation↗
PubMed1993

The course of myocardial hypertrophy in hypertrophic cardiomyopathy. Results of a 10-year follow-up.

Sixty-nine patients with hypertrophic cardiomyopathy were followed up for a minimum period of 10 years, with detailed quantitation of myocardial hypertrophy using two-dimensional echocardiography at a two-year interval. The parameters determined included maximum myocardial wall thickness, mean myocardial wall thickness (defined as the arithmetic mean of myocardial wall thickness values measured in ten areas of approximately the same size the LV and septal myocardium had been divided into), and the extent of hypertrophy (percentage of the myocardium affected by hypertrophy). Other echocardiographic parameters as well as clinical, ECG and Holter data were also assessed. Seven patients (10%) showed a gradual increase in mean myocardial wall thickness (associated with an increase in maximum myocardial wall thickness and in the extent of hypertrophy in two). By contrast, a progressive decrease in hypertrophy was observed in six patients (9%). In either case, the observed changes tended to involve areas in segments outside the zone of maximum wall thickness. Generally, the changes in hypertrophy were not related to the development of clinical or Holter manifestations, and were unaffected by verapamil or beta-blocker therapy. There was no death among these patients unlike the five deaths in a group with stationary hypertrophy. Based on their results, the authors conclude that changes in myocardial hypertrophy (regardless of whether there is progression or regression) probably make part of natural variations in the course of the disease, and have no clinical or prognostic implications for the majority of patients.

Adult↗
PubMed1993

[The optimal diagnostic approach in myocardial infarct].

In the submitted review the authors discuss rational criteria for the diagnosis of myocardial infarction, indications for thrombolysis, coronarography and possibly PTCA, the method of indirect (non-invasive) assessment of an occluded coronary artery and the most frequent mistakes in the diagnosis of infarction. Essential examinations in the acute stage of myocardial infarction are: case-history, ECG, CK-MB (possibly echocardiography). For indication of thrombolysis of acute PTCA case-history and ECG (or echocardiography) are sufficient. Indications of early coronarography before discharge from hospital: postinfarction angina pectoris, malignant arrhythmia (except on the first day), haemodynamic instability, evidence of myocardial ischaemia (restricted symptoms) during a maximal load before discharge.

Humans↗
PubMed1992

[Immunogenetic study in hypertrophic cardiomyopathy].

Results of assessment of HLA antigens in hypertrophic cardiomyopathies in the world literature are very controversial. Work dealing with this problem in sufficiently large groups of patients is lacking, i.e. work which takes into account different functional and morphological forms of the disease. The authors made therefore a detailed investigation of 60 class 1 and 2 antigens in 117 patients with this disease. Values of the relative risk and chi 2 test revealed a number of possible associations. After correction for the number of examined antigens a significantly higher prevalence was proved only in HLA-B21 in patients with the obstructive form and in patients with advanced myocardial hypertrophy (thickness of more than 30 mm). Examination of HLA antigens can have in the mentioned cases a certain importance during comprehensive examinations of not quite typical forms of the disease. Carriership of antigen B21 is associated with an increased risk of serious cardiological disease, manifested already in young age.

Adolescent↗