Biomedical subjects
Publications and source records attributed to V Barriales.
Retinal embolism is a highly infrequent complication of cardiac catheterization of thrombotic, lipidic, and calcific etiology. We provide the first reported clinical case of retinal embolism caused by cholesterol crystal without systemic adverse effects as a severe complication of diagnostic cardiac catheterization. Cathet. Cardiovasc. Intervent. 51:323-325, 2000.
BACKGROUND: In inhibiting platelet function, aspirin seems to reduce the risk of cerebrovascular accidents, death, and acute coronary events in patients with nonrheumatic atrial fibrillation. Aspirin given on alternate days might have the advantage of not hindering prostacyclin synthesis. Thus a study was performed to evaluate whether aspirin used in this way might improve the results reported with daily treatment. METHODS: To test this hypothesis 285 patients (age range 40 to 82 years) with primary atrial fibrillation were randomly allocated in an open multicenter trial to 3 groups: (1) group A1, treated with 125 mg aspirin daily (n = 104); (2) group A2, treated with 125 mg aspirin on alternate days (n = 90), (3) group C (controls), who were not treated with anticoagulants or platelet inhibitors (n = 91). RESULTS: Inclusion took place from January 1990 to July 1994, and follow-up ended in May 1996 (range 1 to 62 months). Sudden cardiac death in association with heart failure or angina was the most common final event: 4.8%, 1.1%, and 6.6% in groups A1, A2, and C, respectively. Both cardiovascular mortality rate and the incidence of main events were reduced, in relative terms, by 80% (1. 1% in group A2 vs 6.6% in group C). The differences were smaller between group A1 and C but did not reach statistical significance. The reduction of main cardiovascular events between groups A1 and A2 was statistically significant (7.7% vs 2.2% = 5.5%; 95% confidence limits 1%, 11%; P <.05). The difference did not reach statistical significance when other end points were analyzed. CONCLUSION: In this trial low-dose aspirin given on alternate days seemed to be an efficient intervention in preventing major cardiovascular events. Regarding strokes, however, aspirin was less efficient. Mortality rate in the 3 groups as a whole was associated with heart failure and the development of ischemic heart disease.
A new Cordis Long Brite Tip 6F guiding catheter (I.D. .064") is described. Because of its technical characteristics, this product provides greater balloon catheter support by means of deeper intubation of the right coronary artery (RCA). We present our experience with a Shepherd's Crook RCA lesion PTCA procedure.
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The long-term follow-up of 35 patients with mean age of 74.3 +/- 8 years (64-86) who underwent percutaneous aortic valvuloplasty (PAV) is presented. The mean duration of the follow-up study was 33 months (range 1-48). Global mortality was 42% (14 patients) and was related to post-PAV aortic valvular area (47% mortality in less than 0.7 cm2 area group vs 28% in greater than or equal to 0.7 cm2 group) and left ventricular ejection fraction (67% in EF less than 35% group vs 35% in EF greater than or equal to 35% group). The actuarial probability of remaining alive and free of symptoms and of cardiac surgery or new PAV was 57, 41, 33, and 20% at 1, 2, 3 and 4 years. After PAV clinical improvement was obtained in most of the patients (68%), but only 42% of those with successful dilatation remain asymptomatic after a 24 months period (85 +/- 28 mmHg, p = NS). Transvalvular gradient studied by Doppler decreased immediately after PAV (92.8 +/- 26 mmHg vs 51 +/- 16 mmHg, p less than 0.001), but returned to baseline values after 12 months. These results show that PAV yields a clinical improvement in most of the patients, but this improvement is transitory, does not modify the natural history of the disease and has a high degree of restenosis. Thus, its use must be limited to a reduced group of patients who are not candidates for cardiac surgery.
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