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Biomedical subjects

R Seabra-Gomes

Publications and source records attributed to R Seabra-Gomes.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Reversibility in perfusion scintigraphy after myocardial infarct: a comparison between the protocol of single-day rest-stress with 99mTc sestamibi and reinjection with thallium-201].

OBJECTIVE: To compare thallium-201 stress-reinjection SPECT (TL) and single-day rest-stress 99mTc-sestamibi SPECT (MIBI) for detection of reversibility of perfusion defects after Q-wave myocardial infarction. DESIGN: Prospective study with the two scintigraphic methods. PATIENTS: We studied 31 patients with previous Q-wave myocardial infarction referred for assessment of myocardial viability. METHODS: Patients were studied with thallium-201 stress-reinjection SPECT and single-day rest-stress 99mTc-sestamibi SPECT. Tracer uptake was classified in a 0 to 4 intensity scale in each of 13 myocardial segments. RESULTS: Segmental comparison indicated that the identification of perfusion defects was similar by the two methods. Some reversibility was present in 51% of TL perfusion defects and in 26% of MIBI perfusion defects (p < 0.001). Twenty-seven percent of fixed perfusion defects in MIBI showed some reversibility by TL, but only 8% of the fixed perfusion defects by TL were reversible by MIBI (p < 0.001). In infarct-related perfusion defects, TL showed reversibility in 46% and MIBI in 22% (p < 0.001). TL detected reversibility in 84% of patients and MIBI in 48% (p = 0.007). CONCLUSIONS: Although the two methods were similar for perfusion defects identification, the present study suggests that thallium-201 reinjection is superior to single-day rest-stress 99mTc-sestamibi for the detection of reversibility. Clinical relevance of these differences, as a marker of viability, requires further evaluation of these patients after successful revascularization.

Adult↗
PubMed1993

[The catheter ablation of tachyarrhythmias. The experience of the Hospital de Santa Cruz].

BACKGROUND: First results of tachyarrhythmia's direct current (DC) and radiofrequency (RF) catheter ablation in Portugal (St. Cruz Hospital, Carnaxide). POPULATION AND METHODS: Retrospective analysis of the first 20 patients (P) submitted to catheter ablation in our Center: 11 males and 9 females, aging 36 years (SD 14), with drug-refractory symptomatic tachyarrhythmias. DC ablation was used in the first case and RF current in the nineteen subsequent P. RESULTS: Accessory pathway RF ablation: 92% successful rate (12/13 P); AV nodal modification: fast pathway--1 P (DC ablation), slow pathway--3 P (RF ablation) with one case of late clinical recurrence; two successful His bundle ablation (in paroxysmal atrial flutter/fibrillation) one standard right side and other from left ventricle outflow; one successful RF ablation of a verapamil-sensitive ventricular tachycardia. The mean follow-up was 3.5 months (1 to 7 months for RF and 20 months for DC ablation). CONCLUSIONS: Catheter ablation (mainly RF current) is highly effective in tachyarrhythmia's suppression, with 90% global success in our experience without morbidity.

Adolescent↗
PubMed1993

[Coronary artery ectasia: clinical and angiographic characteristics and prognosis].

OBJECTIVE: To evaluate the incidence of coronary ectasia and its distribution by coronary vessels, natural history and follow-up in coronary artery disease patients. DESIGN: Retrospective study from 1982 to 1985. SETTING: Hemodynamics Cardiology Department of a Central Hospital. PATIENTS: In 1100 patients with coronary artery disease, there were 40 patients, 39 men and 1 woman, with mean age of 53.98 +/- 7.49 years. MATERIAL AND METHODS: Coronary ectasia was defined by CASS criteria as: Diameter of a vessel in the coronarography up to one and half times the diameter of a adjacent normal branch. In the clinical profile, both risk factors and clinical parameters such as angina or myocardial infarction were evaluated. The distribution of coronary ectasia by segments and vessels was also noted. In follow-up we analysed major cardiac events, as well as the need for by-pass surgery. RESULTS: The incidence of coronary ectasia was 3.6%. Smoking was the most frequent risk factor. 42.5% of patients had anti-ischemic therapy and 87.5% has previous angina, 62.5% of whom had myocardial infarction. Angiographic findings showed only one ectatic coronary artery in 25 patients. Right coronary artery was the most frequent ectatic vessel (75%), and there was a higher prevalence of coronary ectasia in the proximal segments (p < 0.001). 33 patients had stenotic lesions associated to coronary ectasia. At a mean follow-up of 63.15 +/- 30.46 months, there were nine major cardiac events (one death, three myocardial infarctions and five new episodes of unstable angina), and eighteen patients underwent coronary by-pass surgery. There were no differences between "pure" ectatic and stenotic coronary associated groups, even in patients who needed bypass surgery. CONCLUSIONS: These results confirmed the usual incidence of coronary ectasia, as well as the predominance of right coronary artery ectasia. Proximal segments were more frequently ectatic. Although "pure" coronary ectasia can be implicated in angina or myocardial infarction, we think that a worse prognosis depends on the association of stenotic coronary artery disease.

Coronary Aneurysm↗
PubMed1992

[Combined infarction: angiography and electrocardiographic diagnosis].

Combined infarction can be defined as the presence of ST segment elevation simultaneously in anterior and inferior leads. Their possible anatomical and physiopathological causes are suggested. Four cases of combined infarction, three of them in previously asymptomatic patients are presented, with their electrocardiographic and angiocoronarography patterns. Acute phase and 24 hours ECG ST changes are analysed and the possibility of an indirect approach to the angiographic diagnosis, is discussed.

Adult↗
PubMed1992

[Anomalous origin of the left coronary from the pulmonary artery in adults: diagnosis with bidimensional, pulsed and color Doppler echocardiography].

Anomalous origin of the left coronary artery (LCA) from the pulmonary trunk (PT) is an uncommon but frequently lethal congenital lesion of infancy. Clinically it may be difficult to distinguish from congestive cardiomyopathy, and the diagnosis is usually made by angiography. We describe the case of a 38 years old woman, in whom identification of this anomaly was achieved by 2D-Echo, pulsed Doppler and color flow mapping. She complained of fatigue, effort dyspnea and atypical chest pain. A II/VI systolic murmur at left sternal border was heard. There was cardiac enlargement on chest X-ray and ECG was suggestive of an old anterolateral myocardial infarction. The 2D-Echo study showed a dilated, poorly contracting left ventricle. A prominent right coronary ostium was recorded, but the LCA ostium could not be visualized. There was retrograde diastolic and systolic flow in proximal PT, where an anomalous vessel was seen in continuity with it by color flow mapping. Cardiac catheterization confirmed the diagnosis. The patient underwent successful reimplantation of the anomalous LCA, from the PT to the aorta. This case demonstrates usefulness of Echocardiography in the assessment of coronary artery anomalies.

Adult↗
PubMed1990

Comparison of the effects of a controlled-release formulation of isosorbide-5-mononitrate and conventional isosorbide dinitrate on exercise performance in men with stable angina pectoris.

Thirty-three men with stable exercise-induced angina pectoris entered a randomized, double-blind, crossover study in which controlled-release isosorbide-5-mononitrate 60 mg once daily was compared with conventional isosorbide dinitrate 20 mg 3 times daily. Each drug was given for 2 weeks. Twenty-eight patients completed the study and data on exercise variables are available in 23 patients. Treatment with either drug resulted in significant antianginal effects, when measured 6 hours after a single dose and after 2 weeks of therapy compared with baseline placebo; however, there were significantly fewer signs of myocardial ischemia during treatment with isosorbide-5-mononitrate. There was no evidence of tolerance to either drug treatment but a significant attenuation of resting blood pressure (but not of exercise blood pressure) was observed with both drugs. Headache was the only clinically significant adverse event during therapy and it occurred more frequently in the isosorbide dinitrate treatment group (p less than 0.05 vs placebo); 3 such patients had to withdraw from the study because of headache. Thus, once-daily, controlled-release isosorbide-5-mononitrate appears as effective as conventional isosorbide dinitrate 3 times daily in patients with stable angina pectoris. The once-daily administration is convenient and improves patient compliance.

Angina Pectoris↗
PubMed1990

[Amiodarone and propafenone: evaluation using serial Holter recordings in patients with ventricular arrhythmia].

OBJECTIVE: To review the experience of the Arrhythmology Department in evaluating antiarrhythmic therapy for ventricular arrhythmias with serial Holter electrocardiographic recordings (ECG-H). To compare the results obtained with the most used drugs in this Department: amiodarone and propafenone (groups AMIO and PROP). DESIGN: Retrospective study. No statistically significant differences between the two groups were found in respect to age, sex, underlying disease, functional class, left ventricular function and associated therapy. SETTING: Arrythmology Department at a Cardiology Service. PATIENTS: 105 sequential patients with ventricular arrhythmias in a basal ECG-H recording, that were evaluated within 1 year with a new recording on amiodarone or propafenone, without major clinical events or therapeutic changes between the two recordings. INTERVENTIONS (daily oral doses): Amiodarone 200-600 (mean 270) mg or propafenone 300-900 (mean 602) mg. RESULTS: No statistically significant differences were found between the two groups, in either the basal ECG-H or that recorded on therapy. The two drugs were similar in the degree of suppression of ventricular premature complexes per hour (VPCH): equal or superior to 75% in 64.3% of the patients on amiodarone and in 63.9% of those on propafenone. The following reductions on therapy were statistically significant (p less than 0.001 if not specified): VPCH, from 346 +/- 480 to 86 +/- 158 on amiodarone and from 418 +/- 524 to 110 +/- 215 on propafenone; most complex arrhythmia recorded, on both drugs; number of patients with pairs, from 72.1 to 34.9% on amiodarone and from 69.4 to 33.9% on propafenone; number of patients with runs of nonsustained ventricular tachycardia (VT), from 27.9 to 2.3% on amiodarone (p less than 0.01); number of runs of VT per recording, from 3 +/- 5 to 1 on amiodarone (p less than 0.06); and maximum number of complexes per run of VT, from 8 +/- 8 to 4 on amiodarone and from 7 +/- 4 to 5 +/- 1 on propafenone (both with p less than 0.06). CONCLUSIONS: Holter recordings were useful in evaluating antiarrhythmic therapy. The effectiveness of amiodarone and propafenone in treating ventricular arrhythmias was not significantly different. The choice between one of these drugs must rely on their collateral effects profile.

Adult↗
PubMed1990

[Intervention cardiology in acute myocardial infarct].

At the time when thrombolysis in acute myocardial infarction is well established, some controversy still exists about the exact role of coronary angioplasty in this setting. The rationale for a more aggressive intervention after thrombolysis lies in the fact that in a high proportion of the patients the infarct related artery remains occluded or there is a significant residual stenosis. In the latter case this would predispose to reocclusion and recurrent infarction and, by impeding coronary flow, it would limit the extent of myocardial salvage and the rate of myocardial healing. Angioplasty (PTCA) can be performed as an early procedure or late after thrombolysis. Early PTCA can be done as a primary procedure (Direct PTCA), following successful IC or IV thrombolysis (Immediate PTCA) or following unsuccessful thrombolysis (Rescue or salvage PTCA). Late PTCA can be used as a prophylactic (Deferred PTCA) selectively for recurrent angina or positive functional provocative test for ischemia. Direct PTCA has shown to be highly successful both in totally occluded arteries and in subtotal occlusions, with reduced incidence of access site, artery intimal and intramyocardial hemorrhage, but requires a 24-hour cardiac catheterization stand-by with high costs. It is certainly indicated in patients with contra indications to thrombolysis. Immediate PTCA has been evaluated in 3 large scale multicenter randomized controlled trials (TAMI, TIMI II A and ECSG) after IV rt-PA, and although with different design, they concluded that immediate PTCA offers no advantage over a deferred strategy.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1990

[Effects of coronary surgery on silent ischemia].

In order to assess the effects of coronary artery bypass surgery on silent myocardial ischemia, we studied a group of 39 consecutive patients, 38 male and 1 female with a mean age of 56 + 7 years, with stable chronic angina pectoris, by 48 hours-Holter monitoring and maximal treadmill exercise test before and after operation. The reduction of angina was 92% (p less than 0.0001) and of ischemia 57% (p less than 0.0001) after operation. Silent myocardial ischemia was detected in 21 patients (54%) before operation, 13 by Holter, 4 by exercise test and 4 by the two methods. After operation 13 patients (36%) continue to have silent ischemia depicted in 7 by Holter and in 7 by exercise test. No new patient developed silent ischemia after operation. The group of patients with silent ischemia preoperatively was not significantly different from the group without silent ischemia based on clinical and angiographic characteristics, results of surgery and exercise test parameters with exception of ST segment depression. In conclusion, silent myocardial ischemia may persist after successful coronary artery bypass surgery for the relief of angina pectoris, and should be monitored by serial Holter recordings and treated medically, if its prognosis and consequences proved to be similar to manifest symptomatic ischemia.

Adult↗
PubMed1989

[Computerized precordial mapping--the Mapcard system].

A computerized Data Acquisition System conceived and built by LNETI/DEE in cooperation with Department of Cardiology of Hospital Santa Cruz, and its application to processing and representation of cardiac precordial maps (MAPCARD SYSTEM), was described. A description was made about the evolution on cardiac maps, their main areas of interest, pointing to future ways. With this economic and easy to use system, important perspectives of hospital utilization are opened, in the fields of non invasive diagnostic and clinical research technics.

Cardiology↗
PubMed1987

Evaluation of 2 intravenous thrombolytic agents (anisoylated plasminogen streptokinase activator complex versus streptokinase) in patients with acute myocardial infarction.

Ten patients with symptoms of acute myocardial infarction of less than 6 hours duration were randomised to receive either anisoylated plasminogen streptokinase activator complex [APSAC] (30U) or streptokinase (1,500,000U) intravenously. The aims of the study were to compare the angiographic patency of the infarct-related coronary arteries and to monitor drug safety and tolerance for up to 24 hours. The left anterior descending artery was occluded in 3, the left circumflex in 3 and right coronary artery in 4 patients. Time between onset of pain and treatment ranged from 150 to 330 minutes. At 90 minutes, 8 patients, 3 of 5 (60%) of the APSAC group and all of the streptokinase group, had patent arteries. No significant differences were found in measurements of coagulation. There were no haemorrhagic complications. One patient of the APSAC group had reinfarction 6 hours after treatment and died in cardiogenic shock. APSAC seems safe and is easier to use than streptokinase, and both agents result in patency in the majority of patients, although too few patients were included to allow a valid comparison. However, thrombolysis should be considered only a temporary solution in acute myocardial infarction, associated mainly with 3-vessel disease.

Aged↗
PubMed1979

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic stenosis.

The effect of preoperative left ventricular function on early and late prognosis was assessed in 103 patients with aortic stenosis who underwent left ventricular cineangiography before homograft replacement of the aortic valve. The patients were separated into two groups: Group A (58 patients) with an ejection fraction of 0.46 or more and Group B (45 patients) with an ejection fraction of 0.45 or less. The two groups were compared with respect to clinical and hemodynamic data as well as operative result. There was poor correlation between clinical data and left ventricular function. In Group A there were three early deaths (5.2 percent) and three late deaths (5.2 percent) compared with no early and six late deaths (13.3 percent) in Group B during the follow-up period of 12 to 102 months (mean 43 months). Most patients in Group B showed considerable symptomatic improvement but less than that observed in Group A. Forty-two patients (13 in Group A and 29 in Group B) underwent repeat cardiac catheterization and coronary angiography. Improvement in left ventricular function as assessed by radial analysis of segmental wall motion and ejection fraction was observed in 20 of the 29 patients in Group B. Failure of left ventricular function to improve was associated with additional coronary artery disease in the majority of patients. It is concluded that poor left ventricular function does not increase the risk of aortic valve replacement for aortic stenosis and that improvement in left ventricular function can be expected in the majority of patients.

Adolescent↗
PubMed1979

Influence of preoperative left ventricular function on results of homograft replacement of the aortic valve for aortic regurgitation.

The effect of preoperative left ventricular function on eraly and late prognosis was assessed in 69 patients with aortic regurgitation who underwent homograft replacement of the aortic valve. Patients were divided into two groups: Group A (38 patients) had an ejection fraction of 0.46 or more and Group B (31 patients) had an ejection fraction of 0.45 or less. Clinical data, hemodynamic data, and operative results were compared in the two groups. In Group A there was one early death (2.6%) and there were two late deaths (5.3%) compared to two early deaths (6.5%) and seven late deaths (22.6%) in Group B during a follow-up period of 13 to 98 months (mean, 49 months). Actuarial analysis showed a 94% survival at 6 years in Group A compared to 80% in Group B. Twenty-four patients were reinvestigated by repeat cardiac catheterization and coronary angiography at a mean time of 38 months following valve replacement. Left ventricular function was assessed by computerized quantitative radial analysis of segmental wall motion. Improvement in left ventricular function occurred in eight of the 14 patients reinvestigated in Group B, and appeared to be closely related to the etiology of the initial valve lesion. Despite the higher mortality rate in patients with poor left ventricular function, most derived considerable benefit from operation.

Adolescent↗