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Biomedical subjects

U Deligonul

Publications and source records attributed to U Deligonul.

At least 37 records · Page 2Linked to original sources
PubMed1996

Provocation of coronary spasm by dobutamine stress echocardiography in a patient with angiographically minimal coronary artery disease.

Dobutamine stress echocardiography (DSE) has been widely used for the noninvasive diagnosis of obstructive coronary artery disease. The ST-segment elevation during DSE has been reported as an infrequent event, caused by old myocardial infarction and/or critical coronary narrowings. The patient presented here was a 35-year-old man with a recent history of nonexertional chest pain. He had hypercholesterolemia and a history of heavy smoking as risk factors. The patient developed ST-segment elevation with chest pain during 40 mcg/min dobutamine infusion for the stress echocardiographic examination. Subsequent coronary angiograms revealed only mild coronary atherosclerosis. It is speculated that coronary spasm occurred in this patient as a paradoxical response to increased coronary blood flow with dobutamine administration.

Adult↗
PubMed1996

Myocardial perfusion abnormalities during low-dose dobutamine after coronary reperfusion can be demonstrated with intravenous perfluorocarbon-exposed sonicated dextrose albumin ultrasound contrast.

We measured background-subtracted peak myocardial videointensity (PMVI) in the left anterior descending and left circumflex perfusion zones in open-chest dogs after intravenous injection of perfluorocarbon-exposed sonicated dextrose albumin ultrasound contrast (PESDA) after reperfusion of a coronary occlusion. These measurements were repeated during low-dose dobutamine (LDD). The ratio of PMVI in the reperfused zone (RZ) compared with the adjacent normal zone (NZ) was measured at baseline and during LDD. Dogs with a >50% diameter residual stenosis were group I (n = 10), and those with <50% residual stenosis were group II (n = 13). Wall-thickening (WT) responses to LDD were not different between groups. Although the PMVI ratio (PMVI(RZ)/PMVI(NZ)) was the same in both groups at baseline, it decreased by >0.1 during LDD in 8 of 10 in group I compared with only 3 of 13 in group II dogs (p = 0.01). PMVI in the RZ increased by > or = 1.5 U in 12 of 13 group II dogs during LDD, but only in 3 of 10 group I dogs. Therefore, intravenous PESDA can be combined with WT responses to define both myocardial function and flow after reperfusion.

Adrenergic beta-Agonists↗
PubMed1996

Detection of regional perfusion abnormalities during adenosine stress echocardiography with intravenous perfluorocarbon-exposed sonicated dextrose albumin.

Although perfluorocarbon-exposed sonicated dextrose albumin (PESDA) microbubbles produce myocardial contrast after intravenous injection, it is unknown whether their use can accurately identify myocardial blood-flow abnormalities during stress echocardiography. Accordingly, we compared the background-subtracted peak myocardial videointensity (PMVI) after intravenous injections of PESDA before and during adenosine stress (100 to 140 units/kg/min) in 10 open-chest dogs with angiographically significant left circumflex artery disease. The ratios of PMVI in the ischemic region compared with the adjacent normal left anterior descending perfusion bed were measured, as were wall-thickening and coronary-flow ratios. In the dogs with a >50% diameter stenosis, there was a decrease in PMVI ratio during adenosine stress by >0.20 in 9, whereas wall-thickening ratios decreased in only 5. PMVI in the ischemic zone increased by <1.5 units during adenosine infusion in 8 of 10 dogs, whereas it increased by >1.5 units in 8 of 1O adjacent normal zones. We conclude that regional myocardial-perfusion abnormalities can be detected with intravenous PESDA during adenosine stress echocardiography.

Adenosine↗
PubMed1995

Segmental analysis of coronary arteries with equivalent plaque burden by intravascular ultrasound in patients with and without angiographically significant coronary artery disease.

These IVUS-derived data indicate that failure of compensatory dilation is an important factor in the development of clinically and angiographically significant coronary artery disease independent of plaque burden. We observed an actual reduction in total vessel area at the most stenotic site in coronary arteries that had a quantitatively significant angiographic lesion.

Aged↗
PubMed1995

Importance of a non-dominant right coronary artery occlusion presenting as sudden cardiac death with prolonged right ventricular dysfunction and malignant arrhythmias.

We report a case of a patient who presented with sudden cardiac death secondary to a subtotal occlusion of a small non-dominant right coronary system. Catheterization several weeks following the initial episode revealed persistent severe right ventricular dysfunction with moderate hemodynamic compensation. Continued unstable arrhythmogenic potential at this point led to placement of an AICD device. The case highlights the potential hazard and often complacency involved in dealing with benign appearing lesions as this one.

Arrhythmias, Cardiac↗
PubMed1995

Defibrillator patch electrode constriction: an underrecognized entity.

Pericardial constriction associated with the placement of intrapericardial defibrillator patches is a rare occurrence that is reported only one tenth as often in defibrillator patients as in patients undergoing other types of cardiac operations. Although this discrepancy may be attributable to a lower incidence of constriction with the defibrillator patch electrode procedure, it may also indicate a failure to recognize that progressive right heart failure and signs of low cardiac output that could be due to pericardial constriction and not progressive systolic dysfunction. Because surgical removal of the patches and decortication of the epicardial surface is the only effective therapy, it is important to recognize this uncommon, but profoundly debilitating entity.

Adult↗
PubMed1994

Left ventricular volume changes during dobutamine stress echocardiography identify patients with more extensive coronary artery disease.

OBJECTIVES: We hypothesized that patients with more extensive coronary artery disease could be identified by abnormal left ventricular volume changes during dobutamine stress echocardiography. BACKGROUND: In patients with more than one significant coronary artery stenosis, the typical hypercontractile function during dobutamine infusion may not occur. This may result in a smaller decrease or even an increase in left ventricular volumes at peak dobutamine infusion. METHODS: We measured end-diastolic and end-systolic volumes in 61 patients undergoing dobutamine stress echocardiography and quantitative coronary analysis. Stress echocardiographic findings were positive in 39 patients (Group I) and negative in 22 (Group II). The percent change in these volume measurements from baseline to peak infusion were compared with quantitative coronary analysis jeopardy scores and incidence of two- or three-vessel coronary artery disease. An abnormal response was defined as < 15% decrease in end-diastolic or end-systolic volume. RESULTS: Among the 39 patients with positive findings on dobutamine stress echocardiography (Group I), 11 had an abnormal end-diastolic volume response (< 15% decrease). Nine of these patients had two- or three-vessel coronary artery disease compared with 11 of 28 patients with a normal volume response (p < 0.05). In the 22 patients with negative findings on dobutamine stress echocardiography (Group II), an abnormal end-diastolic volume response was seen in 12 patients, 8 of whom had two- or three-vessel coronary artery disease, whereas none of the 10 patients with a normal volume response had two- or three-vessel coronary disease (p < 0.005; sensitivity 100%, specificity 68%). In the 12 patients with no significant coronary artery disease, end-diastolic and end-systolic volumes decreased by > 15% in all but 1. CONCLUSIONS: Failure of end-diastolic volume to significantly decrease during dobutamine stress echocardiography identifies a group of patients with more extensive significant coronary artery disease.

Aged↗
PubMed1994

Transverse coronary dissection resulting in abrupt vessel closure following directional coronary atherectomy: clinical, angiographic, and intracoronary ultrasound findings.

A 60-year-old man underwent directional coronary atherectomy (DCA) of the mid portion of a large, anatomically dominant left circumflex coronary artery, resulting in propagating transverse dissection and subsequent complete distal occlusion. Intravascular ultrasound imaging (IVUS) of the dissected segment demonstrated the entry point of the dissection, and systolic compression of the true vessel lumen, prior to angiographic deterioration of distal coronary flow.

Atherectomy, Coronary↗
PubMed1994

Hemodynamic profile of a post-infarct ventricular septal defect: left atrial a-waves rather than v-waves may be a prominent feature.

The presence of prominent left atrial v-waves following interventricular septal rupture in acute myocardial infarction have been reported in the past. Hemodynamic profile obtained in one particular case highlighted some of the varying aspects of pressure wave, oxygen saturation, and compliance abnormalities that may also be present in such cases. The presence of large left atrial a-waves rather than v-waves was one of the findings.

Aged↗
PubMed1992

The effects of ionic and nonionic radiographic contrast media on coronary hyperemia in patients during coronary angiography.

The purpose of this study was to compare the differential effects of ionic, high-osmolar meglumine diatrizoate; ionic, low-osmolar ioxaglate meglumine; and nonionic, low-osmolar iohexol (all radiographic contrast agents) on coronary blood flow velocity and hyperemic responses during diagnostic coronary angiography. Coronary flow velocity and arterial pressure were measured at baseline and during maximal hyperemia after contrast media were randomly injected (4 to 6 ml into left coronary artery) in 22 patients with the use of a Judkins-style 20 MHz Doppler-tipped angiographic catheter. Contrast media-induced hyperemic responses were compared to those induced with intracoronary nitroglycerin (200 micrograms) and papaverine (10 mg). There were no significant differences in systolic, diastolic, or mean arterial pressure measurements among the three contrast agents. The increase in mean coronary flow velocity during hyperemia was 118 +/- 93%, 133 +/- 73%, and 136 +/- 86% for iohexol, ioxaglate meglumine, and diatrizoate, respectively (p = NS among agents vs 264 +/- 109% for papaverine; p less than 0.05 for all). Coronary vasodilatory reserve (calculated as the ratio of hyperemic to basal mean flow velocity) was also similar among agents. It was comparable to the coronary vasodilatory reserve with nitroglycerin (2.1 +/- 1.0 to 2.2 +/- 1.1) and significantly less than that with papaverine (3.3 +/- 2.2, p less than 0.05). These data indicate that the clinical advantages of nonionic or low-osmolar contrast media are not mechanistically related to significant attenuation of the coronary hyperemic response.

Blood Flow Velocity↗
PubMed1992

Smoking is a risk factor for coronary spasm in young women.

BACKGROUND: Risk factors for pure coronary spasm are not known. Clinical observations have pointed to cigarette smoking, a known risk factor for obstructive coronary artery disease. METHODS AND RESULTS: We conducted a case-neighborhood control study of premenopausal women, a population segment with the lowest prevalence of obstructive coronary artery disease. The cases were 21 premenopausal women (age range, 36-41 years) with angiographically proven coronary spasm. All coronary arteriograms were analyzed by two independent experienced cardiologists on two occasions. There were no differences between analyses; all cases had normal baseline coronary angiogram except for two, who had less than 20% coronary luminal stenosis in segments other than the site of the focal vasospasm. All cases had normal hemodynamics at rest, normal left ventricular function, and were in sinus rhythm. Ascertainment of the cases was done by angiographic demonstration of focal coronary spasm spontaneously or by ergonovine provocation. Six cases developed spontaneous coronary spasm before catheter engagement, and in 15, coronary spasm was induced by ergonovine provocation. Each case was asked to name as many as possible female neighborhood acquaintances of similar age and racial background who were willing to answer the same standardized questionnaire. The same standardized questionnaire was completed for each case and each control (n = 63). The standardized questionnaire was designed to obtain information on health characteristics, habits, socioeconomic status, and education. Only cigarette smoking was significantly more prevalent among coronary spasm cases. Cigarette smokers were 13 cases (62%) and 11 controls (17.5%) (p less than 0.001). The odds ratio was 7.7, with a 95% confidence interval of 2.6-23.1. CONCLUSIONS: These findings suggest that there is a very strong association between cigarette smoking and pure coronary spasm in young women.

Adult↗
PubMed1991

Predictors of cardiac survival after percutaneous transluminal coronary angioplasty in patients with severe left ventricular dysfunction.

To assess the outcome of percutaneous transluminal coronary angioplasty (PTCA) in patients with severe left ventricular (LV) dysfunction and to determine the predictors of mortality, 73 patients with LV ejection fraction less than or equal to 40% who underwent initial PTCA were analyzed. The majority of patients had prior (greater than 1 week) myocardial infarction (62 patients, 85%). Congestive heart failure and unstable angina were present in 24 (45%) and 49 (67%) patients, respectively. Multivessel coronary artery disease was present in 60 (83%). The LV ejection fraction ranged from 14 to 40% (mean 34%). Intraaortic balloon pump (15%) and percutaneous cardiopulmonary bypass support (4%) was used infrequently. Angiographic success was obtained in 109 of 128 lesions (85%) attempted. Complete revascularization was obtained in 16 of 60 patients with clinical success. Procedure-related mortality was 5% (4 patients). All patients were followed from greater than or equal to 6 to less than or equal to 71 months (average 26). The estimated survival was 79 +/- 5%, 74 +/- 6%, 66 +/- 7% and 57 +/- 8% at 1, 2, 3 and 4 years, respectively. A Cox regression analysis revealed that the presence of congestive heart failure, a lower LV ejection fraction and a higher myocardial jeopardy score for contractile myocardium were independent predictors of survival after PTCA in patients with LV dysfunction. In conclusion, a high-risk subset can be identified among patients with severe LV dysfunction who undergo PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1991

Predictors of long-term cardiac survival in patients with multivessel coronary artery disease undergoing percutaneous transluminal coronary angioplasty.

The predictors of 5-year cardiac survival in patients with multivessel coronary artery disease (CAD) undergoing percutaneous transluminal coronary angioplasty (PTCA) were analyzed in a series of 637 consecutive patients. The average age was 59 +/- 11 years in 472 men and 165 women. Diabetes mellitus, previous myocardial infarction and unstable angina were present in 119 (19%), 261 (41%) and 305 (47%) patients, respectively. Angiographically, 460 patients had 2-vessel and 177 patients had 3-vessel CAD. The left ventricular contraction score was greater than or equal to 12 in 55 patients. Angiographic success (less than 50% residual stenosis) was achieved in 85% of the 1,343 narrowings and clinical success was obtained in 526 (83%) of the 637 patients. Complete revascularization was obtained in 177 (34%) of 526 successful patients. Procedure-related complications resulted in death in 9 patients (1.4%), in Q-wave myocardial infarction only in 6 patients (0.9%) and in emergency bypass surgery in 44 patients (6.9%) (of whom 10 had Q-wave myocardial infarction). Follow-up for greater than or equal to 1 year and up to 6 years after PTCA was obtained in 608 (95%) of the 637 patients. To determine the predictors of 5-year cardiac survival, 28 clinical, angiographic and procedural variables were analyzed by Cox proportional-hazards regression. The estimated 5-year survival after PTCA was 88 +/- 2% in successful patients and 77 +/- 5% in patients in whom PTCA was unsuccessful (p less than 0.001). When clinical success was forced into the Cox regression, the left ventricular contraction score of greater than or equal to 12, diabetes mellitus and age greater than or equal to 65 years showed additional adverse effects on survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

Preliminary experience with 5 and 6 French diagnostic catheters as guiding catheters for coronary angioplasty.

With the reduction in profile of balloon dilation catheters, until recently, it has been the internal dimensions and performance of the guiding catheter that has mandated the use of 7, 8 or 9 French (F) systems for the performance of percutaneous transluminal coronary angioplasty (PTCA). A new 5F catheter design (Sherwood Medical Co., St. Louis, MO) provided a large inner lumen (0.4") permitting use of 0.20-0.22" fixed-wire PTCA balloon catheters with good coronary visualization. Potential advantages include reduced coronary artery ostial trauma and catheter induced damping and enhanced patient comfort. We report our initial experience in 14 patients undergoing PTCA with a 5 and 6F guide/fixed-wire system. Mean age was 63 +/- 10 (43-78 years). PTCA indications: Cardiogenic shock (1), post-myocardial infarction angina pectoris (2), grade III angina (5) and unstable angina pectoris (6). Vessel attempted: Left anterior descending (3), circumflex (4), obtuse marginal (2), diagonal (1), right coronary artery (3), and internal thoracic artery (1). Twelve patients had femoral approach; two brachial approach. The USCI Probe (USCI Division, Billerica, MA) was used in 8 lesions and SCIMED ACE (SCIMED Life Systems, Maplegrove, MN) catheter in 7 lesions. Successful 5 or 6F guide/fixed-wire dilations reduced the stenosis (77 +/- 14 to 37 +/- 30%) and were successfully performed in 79% (11/14). One 5F patient required 8F guiding catheter and was dilated with 2.0 fixed-wire balloon. A second failed 5F PTCA could not be dilated with any larger conventional system. A third total occlusion could not be crossed with a guidewire or fixed wire balloon. No patient had a complication.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗