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Sample records for surgical myocardial revascularization

  1. Radionuclide evaluation before and after medical or surgical myocardial revascularization

    International Nuclear Information System (INIS)

    Beller, G.A.

    1987-01-01

    Myocardial perfusion scintigraphy and radionuclide angiography performed in the resting state or during the course of exercise testing may provide clinically relevant information that is helpful in decision making in patients with coronary artery disease. These noninvasive techniques may be particularly useful in assessing the functional severity of coronary artery disease in patients presenting with chest pain, and could be employed to assist in differentiating between ischemic and infarcted or scarred myocardium. By the identification of high-risk and low-risk subsets based on certain radionuclide and exercise test findings, coronary arteriography with a view toward revascularization would be recommended in the former and medical therapy in the latter. Patients with mild symptoms and a low-risk scintigraphic pattern or functional response to stress could be spared an invasive procedure until symptoms became progressive and refractory to medical treatment. In this review, the value and limitations of /sup 201/Tl scintigraphy and radionuclide angiography in the patient being considered for coronary bypass surgery, transluminal angioplasty, or who receives thrombolytic therapy are discussed

  2. [Concordance between central venous and arterial blood gases in post-surgical myocardial revascularization patients in stable condition].

    Science.gov (United States)

    Santos-Martínez, Luis Efren; Guevara-Carrasco, Marlene; Naranjo-Ricoy, Guillermo; Baranda-Tovar, Francisco Martín; Moreno-Ruíz, Luis Antonio; Herrera-Velázquez, Marco Antonio; Magaña-Serrano, José Antonio; Valencia-Sánchez, Jesús Salvador; Calderón-Abbo, Moisés Cutiel

    2014-01-01

    The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P<.05. Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029±0.048 (-0018, 0.077) and -0.12±0.22 (-0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86±6.08 (15.9, 39.8) and oxygen saturation 33.02±6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. The best matching parameters between arterial and central venous blood samples were pH and lactate. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  3. Adverse events while awaiting myocardial revascularization

    DEFF Research Database (Denmark)

    Head, Stuart J.; da Costa, Bruno R.; Beumer, Berend

    2017-01-01

    OBJECTIVES: The aim of the current study was to estimate adverse event rates while awaiting myocardial revascularization and review criteria for prioritizing patients. METHODS: A PubMed search was performed on 19 January 2015, to identify English-language, original, observational studies reportin...

  4. Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization

    OpenAIRE

    Teixeira Sobrinho, Moises; Guirado, Gabriel Negretti; Silva, Marcos Augusto de Moraes

    2014-01-01

    Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Est...

  5. Comparative costs between myocardial revascularization with or without extracorporeal circulation.

    Science.gov (United States)

    Girardi, Priscyla B M A; Hueb, Whady; Nogueira, Célia R S R; Takiuti, Myrthes E; Nakano, Teryo; Garzillo, Cibele Larrosa; Paulitsch, Felipe da S; Góis, Aécio F T; Lopes, Neuza H M; Stolf, Noedir A

    2008-12-01

    Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC) have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. Between January 2002 and August 2006, 131 patients were randomized to surgery with ECC (SECC), whereas 128 were randomized to surgery without ECC (WECC). The basal characteristics were similar for both groups. The costs of surgical complications were significantly lower (p WECC when compared to the SECC group (606.00 +/- 525.00 vs. 945.90 +/- 440.00), as well as ICU costs: 432.20 +/- 391.70 vs. 717.70 +/- 257.70, respectively. The duration of the operating room stay were 4.9 +/- 1.1 h vs. 3.9 +/- 1.0 h, p < 0.001; at the ICU it was 48.2 +/- 17.2 h vs. 29.2 +/- 26.1h) (p < 0.001), with intubation time of 9.2 +/- 4.5 h vs. 6.4 +/- 5.1h, p < 0.001 for patients from the group with and without ECC, respectively. The present study allowed us to conclude that the myocardial revascularization surgery without extracorporeal circulation results in the decrease of operational costs and duration of the stay in each section related to the surgical treatment.

  6. Myocardial revascularization without extracorporeal circulation; Why hasn't it convinced yet?

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    Efstratios Apostolakis

    2017-01-01

    Full Text Available Extracorporeal circulation has led to a great development in cardiovascular surgery during the last five decades. Its time-proven efficacy and safety have made on-pump coronary artery bypass grafting (CABG the gold standard method of surgical revascularization. However, coronary revascularization on cardiopulmonary bypass and the accompanying aortic manipulation are related to plenty of deleterious complications. Therefore, off-pump CABG surgery was established to avoid complications. Nevertheless, despite the initial enthusiasm on this technique, only 20% of myocardial revascularization procedures worldwide are performed off-pump. Not only are off-pump cardiac procedures more technically difficult but also they do not provide better results in terms of graft patency, completeness of revascularization, repeat revascularization requirement, cost, and quality of life. Completeness of revascularization and anastomotic quality should not be compromised to avoid cardiopulmonary bypass.

  7. Hypotheses, rationale, design, and methods for prognostic evaluation of cardiac biomarker elevation after percutaneous and surgical revascularization in the absence of manifest myocardial infarction. A comparative analysis of biomarkers and cardiac magnetic resonance. The MASS-V Trial

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    Hueb Whady

    2012-08-01

    Full Text Available Abstract Background Although the release of cardiac biomarkers after percutaneous (PCI or surgical revascularization (CABG is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis. Methods/Design The study will include 150 patients with multivessel coronary artery disease (CAD with left ventricle ejection fraction (LVEF and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB; 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR. Discussion The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice

  8. Surgical revascularization induces angiogenesis in orthotopic bone allograft

    NARCIS (Netherlands)

    Willems, Wouter F.; Kremer, Thomas; Friedrich, Patricia; Bishop, Allen T.

    2012-01-01

    Remodeling of structural bone allografts relies on adequate revascularization, which can theoretically be induced by surgical revascularization. We developed a new orthotopic animal model to determine the technical feasibility of axial arteriovenous bundle implantation and resultant angiogenesis. We

  9. Improved regional wall motion 6 months after direct myocardial revascularization (DMR) with the NOGA DMR system

    NARCIS (Netherlands)

    G.J.J. van Langenhove (Glenn); H.L. Hamburger (Hans); P.W.J.C. Serruys (Patrick); D.P. Foley (David); P.C. Smits (Pieter); M. Albertal (Mariano)

    2000-01-01

    textabstractA60-year-old man was referred to our intervention laboratory for direct myocardial revascularization (DMR). He had received maximal medical therapy and had undergone coronary bypass surgery 10 years earlier, and his peripheral coronary anatomy was now found to be unsuited for surgical

  10. Revascularização miocárdica: estratégias para o enfrentamento da doença e do processo cirúrgico Myocardial revascularization: strategies for coping with the disease and the surgical process

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    Cintia Koerich

    2013-01-01

    Full Text Available OBJETIVO: Conhecer as estratégias utilizadas por pacientes no enfrentamento da doença cardíaca coronária e do processo cirúrgico de revascularização miocárdica. MÉTODOS: Utilizou-se a Teoria Fundamentada nos Dados como referencial metodológico para a releitura dos dados de um estudo mais amplo intitulado: Significando a experiência cirúrgica e o processo de viver do paciente submetido à revascularização do miocárdio. A coleta de dados foi realizada de outubro de 2010 a agosto de 2011, por meio de entrevista semiestruturada, com três grupos amostrais (pacientes, familiares de pacientes e profissionais de saúde e 23 participantes. RESULTADOS: Os resultados apontam as estratégias utilizadas pelos pacientes submetidos ao processo cirúrgico de revascularização miocárdica, quais sejam: apoio familiar, espiritual e profissional. CONCLUSÃO: A experiência da cirurgia cardíaca modifica o processo de viver do paciente cardíaco e as estratégias utilizadas tornam a vivência menos traumática ao paciente. Logo, tais dados fornecem base teórica para o cuidado de enfermagem.OBJECTIVE: To understand the strategies used by patients in coping with heart coronary disease and surgical process of myocardial revascularization. METHODS: It was applied the Data analyses in Grounded Theory studies as a methodological reference to perform a re-reading of data from a larger study entitled as: "Signifying the surgical experience and the life process in patients undergoing myocardial revascularization". Data collection was carried out based on semi-structured interviews, with 23 participants (patients, their families and health professionals, from October, 2010 to August, 2011. RESULTS: The results showed the strategies used by patients undergoing myocardial revascularization in addressing the surgical procedure and coronary heart disease such as family, spiritual and professional support. CONCLUSION: The experience of cardiac surgery modifies

  11. Risk factors for acute myocardial infarction during the postoperative period of myocardial revascularization

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    José Ribamar Costa Jr.

    2003-03-01

    Full Text Available OBJECTIVE: To identify risk factors for acute myocardial infarction during the postoperative period after myocardial revascularization. METHODS: This was a case-control study paired for sex, age, number, type of graft used, coronary endarterectomy, type of myocardial protection, and use of extracorporeal circulation. We assessed 178 patients (89 patients in each group undergoing myocardial revascularization, and the following variables were considered: dyslipidemia, systemic hypertension, smoking, diabetes mellitus, previous myocardial revascularization surgery, previous coronary angioplasty, and acute myocardial infarction. RESULTS: Baseline clinical characteristics did not differ in the groups, except for previous myocardial revascularization surgery, prevalent in the case group (34 patients vs. 12 patients; p = 0.0002. This was the only independent predictor of risk for acute myocardial infarction in the postoperative period, based on a multivariate logistic regression analysis (p=0.0001. Mortality and the time of hospital stay of the case group were significantly higher (19.1% vs. 1.1%; p<0.001 and 15.7 days vs. 10.6 days; p<0.05 respectively than those of the control. CONCLUSION: Only previous myocardial revascularization was an independent predictor of acute myocardial infarction in the postoperative period, based on multivariate logistic regression analysis.

  12. Surgical revascularization techniques for diabetic foot.

    Science.gov (United States)

    Kota, Siva Krishna; Kota, Sunil Kumar; Meher, Lalit Kumar; Sahoo, Satyajit; Mohapatra, Sudeep; Modi, Kirtikumar Dharmsibhai

    2013-06-01

    Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5-10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15-20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.

  13. Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization. Case report.

    Science.gov (United States)

    Nascimento, Maurício Serrano; Bernardes, Cassiano Franco; de Medeiros, Roberta Louro

    2002-04-01

    Bypassing heart blood and returning it oxygenated to systemic circulation is achieved at the expenses of major cardiopulmonary physiologic changes. The aim of this report was to present an anesthetic complication during CPB and to warn for the need of interaction of the whole anesthetic-surgical team to prevent adverse perioperative events. A brown female patient, 56 years old, 95 kg, height 1.65 m, physical status ASA IV, with chronic renal failure under hemodialysis was admitted for myocardial revascularization. Monitoring consisted of ECG, invasive blood pressure, pulse oximetry, capnography, esophageal temperature, central venous pressure and anesthetic gases analysis. Patient was premedicated with intravenous midazolam (0.05 mg kg(-1)). Anesthesia was induced with fentanyl (16 microg kg(-1)), etomidate (0.3 mg kg(-1)) and pancuronium (0.1 mg kg(-1)), and was maintained with O2, isoflurane (0.5 - 1 MAC) and fentanyl continuous infusion. Blood gas analysis after induction has shown: pH: 7.41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol L(-1); BE: 0 mmol L(-1); SatO2 100%. A second blood gases analysis, sampled soon after CPB, returned in 30 minutes, showing: pH 7.15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol L(-1); BE: -3 mmol L(-1); SatO2 99%. Thorough and urgent checking of anesthetic and perfusion equipment was performed and revealed that the gas blender was connected to the O2 line and to a CO2 cylinder, when it should be connected to the compressed air cylinder. Bypass circuit mechanical problems may occur in the intraoperative period, and demand prompt repairs. Technological advances in anesthesia equipment, monitoring and safety standards will lessen the possibility of cases such as this to be repeated, but will never replace anesthesiologists surveillance.

  14. Surgical revascularization of posterior coronary arteries without cardiopulomonary bypass

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    Lobo Filho J. Glauco

    1999-01-01

    Full Text Available OBJECTIVE: To assess the results observed during the early postoperative period in patients who had the posterior coronary arteries revascularized without cardiopulmonary bypass (CPB, in regard to the following parameters: age, sex,bypass grafts types, morbidity and mortality. METHODS: From January 1995 to June 1998, 673 patients underwent myocardial revascularization (MR. Of this total, 607 (90.20% MR procedures were performed without CPB. The posterior coronary arteries (PCA were revascularized in 298 (44.27% patients, 280 (93.95% without CPB. The age of the patients ranged from 37 to 88 years (mean, 61 years. The male gender predominated, with 198 men (70.7%. The revascularization of the posterior coronary arteries had the following distribution: diagonalis artery (31 patients, 10%; marginal branches of the circumflex artery (243 patients, 78.7%; posterior ventricular artery (4 patients, 1.3%; and posterior descending artery (31 patients, 10%. RESULTS: Procedure-related complications without death occurred in 7 cases, giving a morbidity of 2.5%. There were 11 deaths in the early postoperative period (mortality of 3.9%. CONCLUSION: Similarly to the anterior coronary arteries, the posterior coronary arteries may benefit from myocardial revascularization without CPB.

  15. Myocardial revascularization in patient with situs inversus totalis: case report

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    Soncini da Rosa George Ronald

    2002-01-01

    Full Text Available This is a report of an unusual case of a patient, with dextrocardia and a "situs inversus totalis". She presented angina pectoris during an ECG stress test. The coronary arteriography revealed severe obstruction in the main left coronary artery. The patient underwent coronary artery bypass grafting surgery. We did not find a similar case in the national medical literature. The myocardial revascularization performed utilizing the right mammary artery for anterior descending artery and saphenous vein grafts for first diagonal branch and first marginal branch.

  16. Routine myocardial revascularization with the radial artery: a multicenter experience.

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    Chen, A M; Brodman, R F; Frame, R; Graver, L M; Tranbaugh, R F; Banks, T; Hoffman, D; Palazzo, R S; Kline, G M; Stelzer, P; Harris, L; Sisto, D; Frymus, M; Frater, R W; Furlong, P; Wasserman, F; Cohen, B

    1998-01-01

    Current literature documents use of the radial artery (RA) for myocardial revascularization only as an alternative conduit in cases where the saphenous veins have been previously harvested or are unsuitable for use. Large-scale routine clinical use of the RA as the conduit of choice has not been reported. This prospective study evaluated the harvest of the RA from 933 patients and the subsequent use of the conduit as a preferred coronary artery bypass graft second only to the left internal thoracic artery in 930 of these patients. Unilateral RA harvest was performed in 786 patients and 147 patients had bilateral RA harvest. A total of 1080 RAs were harvested; 214 (19.8%) originated from the dominant forearm. There was a mean of 3.30+/-0.93 grafts per patient of which 2.43+/-0.83 were arterial grafts. The mean number of RA grafts was 1.43+/-0.53. Operative mortality was 2.3% with none due to the RA graft(s). There was no ischemia nor motor dysfunction in the operated hands. Thirty-two (3.4%) patients experienced transient thenar dysesthesia that resolved in 1 day to 6 weeks. Our results demonstrate that routine total or near total arterial myocardial revascularization may be achieved safely and effectively with the use of one or both RAs in conjunction with the internal thoracic artery.

  17. Myocardial revascularization surgery: hospitalization characteristics and changes related to hospitalization time

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    Cintia Koerich

    2017-12-01

    Full Text Available The study objective was to identify the hospitalization characteristics and changes presented by individuals submitted to Myocardial Revascularization Surgery and its association with hospitalization time for the surgery. We conducted a cross-sectional observational and epidemiological study, between March of 2013 and March of 2014, with 99 individuals submitted to Myocardial Revascularization Surgery. We verified chest pain and angina/thoracic pain pre-surgery and respiratory insufficiency, hypertermia, hypertension and arrythmias post-surgery as predictors for a longer hospital stay. The association between hospitalization characteristics and clinical changes with hospitalization time of individuals submitted to Myocardial Revascularization Surgery provides subsidies for nurses, all health professionals, and managers, to create early detection strategies for complications related to Myocardial Revascularization Surgery.

  18. Impaired myocardial microcirculation in the flow-glucose metabolism mismatch regions in revascularized acute myocardial infarction.

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    Fukuoka, Yoshitomo; Nakano, Akira; Tama, Naoto; Hasegawa, Kanae; Ikeda, Hiroyuki; Morishita, Tetsuji; Ishida, Kentaro; Kaseno, Kenichi; Amaya, Naoki; Uzui, Hiroyasu; Okazawa, Hidehiko; Tada, Hiroshi

    2017-10-01

    In successfully revascularized acute myocardial infarction (AMI), microvascular function in a myocardial flow-glucose metabolism mismatch pattern has not been reported. We aimed to elucidate myocardial flow reserve (MFR) and myocardial viability in mismatch segments. 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and adenosine stress 13 N-ammonia PET were performed in eighteen AMI patients to evaluate myocardial glucose metabolism, myocardial blood flow (MBF), and MFR. Infarct segments were classified into 3 groups: normal (preserved resting MBF), mismatch (preserved FDG uptake but reduced resting MBF), and match (reduced FDG uptake and resting MBF). Regional wall motion score (WMS) was assessed immediately after reperfusion and recovery periods. MFR in the mismatch group was significantly lower than that in non-infarct-related segments (1.655 ± 0.516 vs 2.282 ± 0.629, P mismatch group was significantly improved (3.07 ± 0.48 vs 2.07 ± 1.14, P = .003); however, in recovery periods, WMS in the mismatch group was significantly higher than that in the normal group (1.05 ± 1.04, P mismatch segments.

  19. Effect of revascularization strategy in patients with acute myocardial infarction and renal insufficiency with multivessel disease.

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    Park, Hyukjin; Hong, Young Joon; Rhew, Si Hyun; Kim, Sung Soo; Jeong, Young Wook; Jeong, Hae Chang; Cho, Jae Yeong; Jang, Soo Young; Lee, Ki Hong; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun

    2015-03-01

    The aim of this study was to compare the risk of complications and outcome between infarct-related artery (IRA)-only revascularization and multivessel (MV) revascularization in patients with acute myocardial infarction (MI) with renal insufficiency and MV disease. A total of 1,031 acute MI patients with renal insufficiency and MV disease who were registered in the Korea Working Group on Myocardial Infarction were enrolled. They were divided into two groups (IRA-only revascularization group, n = 404; MV revascularization group, n = 627), and investigated the cumulative incidence of major adverse cardiac events (MACE) and the incidence of complications after percutaneous coronary intervention (PCI). Complications after PCI occurred in 19.9% of all patients (206/1,031). Complications after PCI occurred more frequently in the MV revascularization group compared with the IRA-only revascularization group (20.1% [126/627] vs. 15.3% [62/404], respectively; p = 0.029]. The overall in-hospital mortality rate was 6.3%, and there was no significant difference between the groups (5.2% in the IRA-only revascularization group vs. 7.0% in the MV revascularization group; p = 0.241). The total incidence of MACE was 11.1%, and there was no significant difference between the groups (11.6% in the IRA-only revascularization group vs. 10.7% in the MV revascularization group; p = 0.636). The incidence of complications after PCI was significantly lower in the IRA-only revascularization group compared with the MV revascularization group. However, there were no significant difference in the 12-month outcomes between groups in patients with acute MI and renal insufficiency with MV disease.

  20. Improved myocardial perfusion after transmyocardial laser revascularization in a patient with microvascular coronary artery disease

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    Peyman Mesbah Oskui

    2014-03-01

    Full Text Available We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved. This case suggests that combination of ranolazine and transmyocardial revascularization can be applied to patients with microvascular coronary artery disease.

  1. Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Moises Teixeira Sobrinho

    2014-04-01

    Full Text Available Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. Results: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. Conclusion: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy.

  2. Arterial hypertension and associated factors in patients submitted to myocardial revascularization

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    Flávia Cortez Colósimo

    2015-04-01

    Full Text Available OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p1.3: (OR=1.37;CI:1.09-1.72. CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

  3. Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

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    Camila Stuchi Zarpelon

    2016-01-01

    Full Text Available Abstract Background: The high prevalence of atrial fibrillation (AF in the postoperative period of myocardial revascularization surgery increases morbidity and mortality. Objective: To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors. Methods: Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery. Results: The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271. There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363 and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490. However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007. Conclusion: The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr.

  4. Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization.

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    Zarpelon, Camila Stuchi; Netto, Miguel Chomiski; Jorge, José Carlos Moura; Fabris, Cátia Carolina; Desengrini, Dieli; Jardim, Mariana da Silva; Silva, Diego Guedes da

    2016-07-01

    The high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality. To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors. Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery. The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007). The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr.

  5. [Coronary revascularization in patients with ST-elevation myocardial infarction and multivessel disease].

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    Bugani, Giulia; Lanzillotti, Valerio; Filippini, Elisa; Di Pasquale, Giuseppe; Campo, Gianluca

    2017-12-01

    Forty to 60% of ST-elevation myocardial infarction (STEMI) patients present with multivessel coronary artery disease, identified during primary percutaneous coronary intervention (pPCI) of the culprit lesion. At present, data about revascularization of non-culprit coronary lesions are conflicting. Nevertheless, patients with multivessel coronary artery disease have a worse outcome. Recently, several randomized controlled trials and meta-analyses compared a strategy of culprit-only revascularization vs complete revascularization (during pPCI or staged PCI of the non-culprit lesion). The majority of data show a potential benefit of complete revascularization, in particular a reduction in the composite endpoint of major adverse cardiac events, in absence of certain data regarding long-term mortality and reinfarction. Besides, it is still controversial the optimal timing of complete revascularization (during pPCI or staged PCI), as well as the best method for evaluating the lesions to be treated (angiographic vs functional assessment of ischemia). Considering all these data, the only tested and safe approach to treat multivessel coronary artery disease patients remains optimization of medical therapy with long-term prescription of newer antiplatelet agents (ticagrelor and prasugrel) and aggressive lipid-lowering therapy (LDL <70 mg/dl). At the same time, a complete coronary revascularization strategy with PCI, especially guided by ischemia and based on patient lesions and comorbidity, may further improve outcomes.

  6. New Treatment Applying Low Level Laser Therapy for Acute Dehiscence Saphenectomy in Post Myocardial Revascularization.

    Science.gov (United States)

    Pinto, Nathali Cordeiro; Shoji, Nara; Junior, Mauro Favoretto; Muramatso, Mikiya; Chavantes, Maria Cristina; Stolf, Noedir A. G.

    2008-04-01

    Introduction: In Brazil, the main cause of death is the coronary heart disease and the surgical treatment applied in such cases is the Myocardial Revascularization (MR). Patients undergoing to MR through saphenous vein bypass development dehiscence in 10% of the cases. Dehiscence of surgical incision through Biomodulation treatment with Low Level Laser Therapy (LLLT) in patients who underwent to MR seems to be an unprecedented new therapy and a less invasive technique, which can benefit patients and Institutions, reducing costs. Methodology: It was analyzed 7 diabetic patients, mean age 51, 8 years old that post MR surgery presented dehiscence of the saphenectomy incision on lower limb with erithema, edema and pain. The wounds area varies from 2,2 until 34,8 cm and deep from 0,1 until 1,1 cm. It was used only Diode Laser C.W. (655 nm wavelength), Power = 25 mW, Time = 30 s, Fluence = 4 J/cm2 applied punctually around surgical wound's sore, by 2 cm distance. Results: It was observed granulated tissue all around the incision, as well as decreased inflammatory process, reduction fibrin and wound's size, besides analgesic effect since the first application. It was required in superficial wounds only 3 applications, while in the extensive wounds 8-10 applications were necessary. The LLLT has shown a remarkable role as a wound healing facilitated agent, reflecting the reduction of inflammatory process and improving analgesia. Conclusion: LLLT assisted dehiscence post saphenectomy showed a substantial improvement to the patient's quality of life, with a cost-effectiveness treatment that can benefit both patients and Institutions as an effective and less invasive therapy.

  7. Echocardiographic quantification of mitral valvular response to myocardial revascularization

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    Sapna Govindan

    2013-01-01

    Full Text Available Aims and Objectives: Mild and/or moderate ischemic mitral regurgitation (IMR may resolve after isolated coronary artery bypass grafting (CABG. It has been shown that the loss of saddle shape of the mitral valve is associated with IMR and is determined by an increase in the nonplanarity angle (NPA. The aim of this prospective, observational study was to test the hypothesis that NPA might decrease immediately after CABG alone in patients with mild to moderate IMR. Materials and Methods: This prospective, observational study was conducted in an academic, tertiary care hospital. Twenty patients underwent 2D and 3D transoesophageal echocardiography (TEE and mitral valve assessment before and immediately after the CABG. NPA, circularity index, and other geometric variables were obtained. They were compared using paired t test. The SPSS (Version 15.0, Chicago, IL, USA was used for statistical analysis. P <0.05 was considered significant. Results: The NPA was similar in the pre- and post-bypass periods (148° ± 15°, 148° ± 19°, P = 0.88. Circularity index (0.93 ± 0.13, 0.97 ± 0.11, P = 0.41 also was similar. Conclusions: There was no change in the mitral valve NPA with revascularization alone in patients with mild or moderate IMR. Mitral valve does not change its planarity (NPA with revascularization alone in patients with IMR.

  8. Myocardial protection from ischemia-reperfusion injury post coronary revascularization.

    Science.gov (United States)

    Binder, Andrew; Ali, Asghar; Chawla, Raveen; Aziz, Hammad A; Abbate, Antonio; Jovin, Ion S

    2015-01-01

    Effective primary and secondary prevention and advances in cardiac surgery have significantly improved the care and outcomes of patients with myocardial ischemia. While timely reperfusion has proved to be an invaluable tool, ischemia-reperfusion injury represents a mechanism that may limit its effectiveness. Numerous experimental studies have shown effective protection from ischemia-reperfusion injury in animal models, but translation into clinical practice has been less successful. This article summarizes the role of ischemia-reperfusion injury in the pathophysiology of ischemic heart disease and gives an overview of the various modalities that have been developed in order to provide myocardial protection from reperfusion injury in clinical practice.

  9. Myocardial revascularization in patients with multivessel coronary lesions

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    Л. С. Калугина

    2016-11-01

    Full Text Available The review is devoted to one of the challenges in coronary surgery — revascularization for multivessel lesions. Emphasis is placed on the results of retrospective and prospective studies on the efficacy and safety of different types of coronary surgery. The data of modern literature concerning the extent of operative intervention and the options for elimination and prevention of restenosis in the lumen of a stent are analyzed.Received 11 July 2016. Accepted 31 August 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.AcknowledgmentsThe authors thank the members of Cardiology Department at Surgut State University and the employees of Okrug Cardiology Dispensary of Khanty-Mansi Autonomous Okrug for assistance in article preparation.

  10. Arterial Myocardial Revascularization Using Bilateral Radial Arte 17 Years after Right Pneumonectomy

    Science.gov (United States)

    Erdil, Nevzat; Nisanoglu, Vedat; Toprak, Huseyin Ilksen; Erdil, Feray Akgul; Kuzucu, Akin; Battaloglu, Bektas

    2004-01-01

    We report the case of a 51-year-old man who underwent arterial myocardial revascularization with the use of bilateral radial arteries, 17 years after undergoing a right pneumonectomy. We used a fast-track anesthesia protocol for the procedure. There was no perioperative complication, and postoperative recovery was uneventful. The patient was discharged from the hospital 5 days after the operation. PMID:15061636

  11. Serum YKL-40 for monitoring myocardial ischemia after revascularization in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Harutyunyan, Marina Jurjevna; Johansen, Julia S; Mygind, Naja D

    2014-01-01

    AIM: The aim was to investigate the inflammatory biomarker YKL-40 as a monitor of myocardial ischemia in patients with coronary artery disease (CAD). METHODS: A total of 311 patients with stable CAD were included. Blood samples were taken at baseline, the day after coronary angiography and/or after...... percutaneous coronary intervention and after 6 months. RESULTS: A total of 148 (48%) patients were revascularized and 163 patients underwent only coronary angiography. In the entire population, serum YKL-40 increased significantly from baseline to 6 months (p = 0.05). This tendency was seen...... of disease progression but not of myocardial ischemia in patients with stable CAD....

  12. Quality of life of patients who undergone myocardial revascularization surgery

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    Hirla Vanessa Soares de Araújo

    Full Text Available ABSTRACT Objective: to evaluate the quality of life of patients who underwent revascularization surgery. Method: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL. Results: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021, and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021. Smoker (p=0,047, diabetic (p=0,002 and alcohol consumption (p=0,035 patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037, psychological (p=0,008, social relationship (p=0,006 domains and total score (p=0,009. Conclusion: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.

  13. Fibrinogênio sérico pré-operatório como preditor de infarto do miocárdio na cirurgia de revascularização miocárdica Preoperative serum fibrinogen as a predictor of myocardial infarction in the surgical myocardial revascularization

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    Cristiano Pederneiras Jaeger

    2006-09-01

    Full Text Available OBJETIVO: Determinar o valor preditivo do nível sérico de fibrinogênio pré-operatório para a ocorrência de infarto do miocárdio (IM no período perioperatório de cirurgia de revascularização miocárdica (CRM, bem como para outros desfechos de impacto, como acidente vascular encefálico isquêmico (AVEI, tromboembolismo pulmonar (TEP e morte, isoladamente e de maneira composta. MÉTODOS: Estudo de coorte retrospectivo com análise do banco de dados de cirurgia cardíaca do Hospital São Lucas da PUC-RS, com 1.471 pacientes consecutivos que realizaram CRM com circulação extracorpórea entre janeiro de 1998 e dezembro de 2002. RESULTADOS: IM perioperatório ocorreu em 14% dos pacientes da amostra. Não foi observada associação entre o fibrinogênio pré-operatório e IM perioperatório (410,60 ± 148,83 mg/dl para o grupo em estudo x 401,57 ±135,23 mg/dl para o grupo controle - p = 0,381 - RC = 1,000 - IC95%: 0,998-1,002 - p = 0,652, o desfecho combinado de IM, AVEI, TEP e morte (411,40 ± 153,52 mg/dl para o grupo com o desfecho x 400,31 ± 131,98 mg/dl para o grupo sem o desfecho - p = 0,232 e nem com cada um destes isoladamente. CONCLUSÃO: Nesta amostra, o nível sérico de fibrinogênio pré-operatório não apresentou associação com a ocorrência de IM perioperatório nas CRM, nem mesmo com outros desfechos de impacto, incluindo AVEI, TEP e morte, isoladamente ou em conjunto.OBJECTIVE: Determine the predictive level of preoperative serum fibrinogen level for the occurrence of MI in perioperative surgical myocardial revascularization (SMR, as well as for other impacting outcomes, such as stroke, pulmonary thromboembolism (PTE, and death, separately or in combination. METHODS: A retrospective cohort study based on the heart surgery database analysis from São Lucas Hospital, at Rio Grande do Sul Catholic University with 1,471 consecutive patients submitted to extracorporeal SMR between January, 1998 and December, 2002. RESULTS

  14. Quality of life of women submitted to myocardial revascularization surgery in a public hospital

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    Rafaela Melo de Oliveira

    2010-09-01

    Full Text Available Objective: To analyze the sociodemografic profile, risck factors and the quality of life of women submitted to myocardial revascularization surgery. Methods: We conducted a qualitative study by applying a questionnaire on lifestyle and risk factors and an interview with four guiding questions to 15 revascularized inpatients of cardiology units of a referral public hospital and who had no manifestations of depression prior to surgery. Results: The patients profile showed that 9 (60% were Caucasian, 8 (54% had incomplete primary education, 4(27% were housewives, 9 (60% lived in urban area, 10 (67% were married, all had a family income lower than three minimum wages and 4(27% had only two kids. From the content analysis of the interviews, the following categories aroused: religiosity, disruption with everyday life, family and quality of life. Conclusion: We found out that the knowledge about the psychosocial structure of each patient helps in the treatment of the individual submitted to myocardial revascularization. By identifying the lifestyle and risk factors, women promote self-knowledge, which can avoid habits that lead to cardiovascular diseases. We suggest the development of strategies for prevention and health promotion involving the patients and their families so that there is an extension of hospital care at home and a betteradaptation to the new condition.

  15. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery.

    Science.gov (United States)

    Lazzeroni, Davide; Bini, Matteo; Camaiora, Umberto; Castiglioni, Paolo; Moderato, Luca; Bosi, Davide; Geroldi, Simone; Ugolotti, Pietro T; Brambilla, Lorenzo; Brambilla, Valerio; Coruzzi, Paolo

    2018-01-01

    Background High levels of serum uric acid have been associated with adverse outcomes in cardiovascular diseases such as myocardial infarction and heart failure. The aim of the current study was to evaluate the prognostic role of serum uric acid levels in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. Design We performed an observational prospective cohort study. Methods The study included 1440 patients with available serum uric acid levels, prospectively followed for 50 ± 17 months. Mean age was 67 ± 11 years; 781 patients (54%) underwent myocardial revascularization, 474 (33%) cardiac valve surgery and 185 (13%) valve-plus-coronary artery by-pass graft surgery. The primary endpoints were overall and cardiovascular mortality while secondary end-points were combined major adverse cardiac and cerebrovascular events. Results Serum uric acid level mean values were 286 ± 95 µmol/l and elevated serum uric acid levels (≥360 µmol/l or 6 mg/dl) were found in 275 patients (19%). Overall mortality (hazard ratio = 2.1; 95% confidence interval: 1.5-3.0; p uric acid levels, even after adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate, atrial fibrillation and medical therapy. Moreover, strong positive correlations between serum uric acid level and probability of overall mortality ( p uric acid levels predict mortality and adverse cardiovascular outcome in patients undergoing myocardial revascularization and/or cardiac valve surgery even after the adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate and medical therapy.

  16. Myocardial revascularization in the elderly patient: with or without cardiopulmonary bypass?

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    Iglézias José Carlos Rossini

    2003-01-01

    Full Text Available OBJECTIVE: To verify if there is advantage in myocardial revascularization the elderly without cardiopulmonary bypass (CPB in relation to the use of the same, being considered the viability of complete myocardial revascularization (MR and the hospital morbidity and mortality. METHOD: We prospectively studied a hundred consecutive, no randomized patients, with age > or = 70 years, submitted to the primary and isolated myocardial revascularization between January and December of 2000. The patients were divided in two groups, G1 - 50 patients operated with CPB and G2 - 50 patients operated without CPB. Univariate testing of variables was performed with chi-squared analysis in the SPSS 10.0 Program and a p value less than 0.005 was considered significant. RESULTS: There was no renal failure or myocardial infarction (MI in both groups; the incidence of respiratory failure was identical in the two groups (4%; two patient of G1 they had Strokes, and 12 presented low output syndrome, occurrences not registered in G2. The need of ventilatory support > 24 hs was not significant between groups. Medium time of hospital stay was 21.8 and 11.7 days respectively (NS and the survival after 30 days were similar in the two groups. The patients' of G1 eighty percent had more than two approached arteries, against only 48% of G2 (p < 0.0001. CONCLUSION: Because the largest number of grafts in the patients of G1, we can affirm that the use of CPB can provide a larger probability of complete RM.

  17. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  18. Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

    International Nuclear Information System (INIS)

    Miranda, Matheus; Hossne, Nelson Américo Jr.; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Fonseca, José Honório de Almeida Palma da; Pestana, José Osmar Medina de Abreu; Juliano, Yara; Buffolo, Enio

    2014-01-01

    Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions

  19. Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Miranda, Matheus, E-mail: matheus10miranda@gmail.com; Hossne, Nelson Américo Jr.; Branco, João Nelson Rodrigues; Vargas, Guilherme Flora; Fonseca, José Honório de Almeida Palma da; Pestana, José Osmar Medina de Abreu [Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil); Juliano, Yara [Universidade de Santo Amaro, São Paulo, SP (Brazil); Buffolo, Enio [Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP (Brazil)

    2014-02-15

    Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.

  20. Quantitative electroencephalographic monitoring during myocardial revascularization predicts postoperative disorientation and improves outcome.

    Science.gov (United States)

    Edmonds, H L; Griffiths, L K; van der Laken, J; Slater, A D; Shields, C B

    1992-03-01

    We evaluated computerized quantitative electroencephalography for the intraoperative detection of cerebral dysfunction. The quantitative electroencephalogram was recorded continuously during 96 myocardial revascularizations involving hypothermic cardiopulmonary bypass using Cerebrovascular Intraoperative MONitor (CIMON) software. CIMON relies on an adaptive statistical approach to detect subtle, but clinically relevant, changes in electroencephalographic activity indicative of cerebrocortical dysfunction. Relative (percent of total) low-frequency (1.5 to 3.5 Hz) power was chosen as the single quantitative electroencephalographic descriptor because it is an established hallmark of cortical dysfunction and is surprisingly insensitive to moderate changes in body temperature and level of opioid anesthesia. Reference values for this measure were established for each patient after anesthetic induction before sternotomy. The large sample variance often seen in low-frequency power was dramatically decreased by using log-transformed data and allowing each patient to serve as his own control. Quantitative electroencephalographic changes in standard deviation units or z-scores were determined from the individualized reference self-norm. Prolonged (greater than 5 minutes) and statistically significant (greater than 3 standard deviation) focal increases in relative low-frequency power were temperature-corrected to determine a standardized cerebrocortical dysfunction time at 37 degrees C. (CDT37). In phase I (n = 48), this objective quantitative electroencephalogram-based numeric descriptor was used to predict neuropsychologic outcome. These CDT37 greater than 5-minute episodes occurred 38 times in 19 patients. The quantitative electroencephalogram-based descriptor predicted the occurrence of such disorientation (n = 14 or 29%) with a 68% false positive rate but only an 8% false negative rate. Since these intraoperative quantitative electroencephalographic episodes were often

  1. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Abildstrøm, Steen Z; Hansen, Peter R

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the clinical efficacy of clopidogrel treatment on death and recurrent myocardial infarction (MI) among MI patients revascularized by coronary artery bypass graft surgery (CABG). BACKGROUND: The benefit from post-operative clopidogrel in CABG...

  2. Current strategies in surgical myocardial revascularization: Indian perspective

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    Sameer Kumar

    2013-01-01

    A retrospective analysis was carried out of 172 patients who underwent CABG at INHS Asvini between 01 Jan 2008 and 31 May 2013.39% had Left Main Coronary artery disease, 85% patient had triple vessel disease, 56% were diabetics, 12% had undergone stenting in recent past. Beating heart strategy was used in 10%, average no of grafts per patient was 2.3 with LIMA and Radial artery being used as a conduit in 84% and 4% respectively. 4.6% patients succumbed in post-operative period.

  3. Successful coronary revascularization improves prognosis in patients with previous myocardial infarction and evidence of viable myocardium at thallium-201 imaging

    International Nuclear Information System (INIS)

    Cuocolo, A.; Petretta, M.; Nicolai, E.; Pace, L.; Bonaduce, D.; Salvatore, M.; Trimarco, B.

    1998-01-01

    This study was designed to evaluate the effects of successful revascularization on survival and left ventricular (LV) function in patients with previous myocardial infarction and evidence of dysfunctional but still viable myocardium at rest-redistribution 201 Tl imaging. Seventy-six consecutive patients with LV dysfunction related to previous myocardial infarction and evidence of viable myocardium at rest-redistribution 201 Tl tomography were followed for 17±8 months. LV ejection fraction (EF) was assessed by radionuclide angiography at baseline and after 13±2 months. Thirty-nine patients were revascularized (group A) and 37 treated medically (group B). During the follow-up there were nine cardiac deaths. Survival rate was 97% in group A and 66% in group B (P 2 of the model from 14.1 to 21.9. At follow-up, EF had improved by ≥5% in 16 patients. By multivariate logistic analysis, the extent of viable myocardium was the best predictor of EF improvement and provided additional information to clinical and functional data. The inclusion of revascularization as a variable improved the global χ 2 of the model from 16.8 to 22.5 (P 201 Tl uptake is the strongest predictor of cardiac death in patients after myocardial infarction. Successful revascularization of dysfunctional but viable myocardium improves survival and LVEF in such patients.(orig./MG) (orig.)

  4. CT perfusion imaging for childhood moyamoya disease before and after surgical revascularization

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    Sakamoto, Shigeyuki; Ohba, Shinji; Shibukawa, Masaaki; Kiura, Yoshihiro; Arita, Kazunori; Kurisu, Kaoru

    2006-01-01

    Moyamoya disease is a progressive occlusive disease of the circle of Willis with prominent collateral arterial formation. We report on a 12-year-old girl with moyamoya disease presenting with transient ischemic attacks (TIAs). Surgical indirect revascularization was performed. The patient did not suffer further TIAs at 12 month follow-up. Pre and postoperative cerebral perfusion were studied in quantitative single photon emission computerized tomography (SPECT) and CT perfusion imaging. CT pe...

  5. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Kelbæk, Henning

    2017-01-01

    BACKGROUND: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location......, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete...... Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. In patients with 3-vessel disease, fractional flow reserve-guided complete revascularization reduced...

  6. Scintigraphic, electrocardiographic, and enzymatic diagnosis of perioperative myocardial infarction in patients undergoing myocardial revascularization

    International Nuclear Information System (INIS)

    Burdine, J.A.; DePuey, E.G.; Orzan, F.; Mathur, V.S.; Hall, R.J.

    1979-01-01

    To assess the incidence of perioperative myocardial infarction, 214 consecutive patients were evaluated 1 to 5 days after coronary bypass surgery, using Tc-99m pyrophosphate (TcPPi) myocardial imaging, serial electrocardiograms (ECG), and enzyme levels (SGOT, LDH, CPK). On the basis of the clinical course and scintigraphic, enzymatic, and ECG changes, the diagnosis of perioperative infarction was definite in 17 of 214 cases (7.9%) and probable in six of 214 (2.8%). In all of these 23 patients, TcPPi scans were abnormal; one additional patient had a false-positive scintigram. Only 13 of the 23 had ECG evidence of infarction, but there were no false positives. We set the threshold for abnormality of enzyme changes quite high, owing to experience in more than 900 postoperative patients (SGOT > 200, LDH > 500, CPK > 500 on the same day). Using these criteria, 22 of the 23 infarct patients had abnormal enzymes, and six others were falsely positive. These results indicate a relatively low sensitivity for the ECG in diagnosing perioperative infarction, but the lack of false positives suggests high specificity. The sensitivity and specificity of the enzymes and the TcPPi image were both excellent and quite similar; the main difference was a reduction of certainty of infarction with the enzyme criteria, caused by the six patients whose enzyme values were falsely positive. Considering its sensitivity,specificity, and ability to locate and to a certain extent quantitate necrosis, TcPPi imaging is probably the most valuable means of diagnosing perioperative myocardial infarction

  7. Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

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    Ramkumar Nirupama

    2005-03-01

    Full Text Available Abstract Background Surgical treatment of peripheral vascular disease (PVD in dialysis patients is controversial. Methods We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. Results Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896 or amputation (n = 2,046 in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR 19.0, 95% CI (confidence interval 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71 in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (rd percentile of propensity score and moderate likelihood of amputation (33rd to 66th percentile but not in high likelihood group (>66th percentile. The number of hospital days in the amputation and revascularization groups was not different. Conclusion Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

  8. Myocardial injury in diabetic patients with multivessel coronary artery disease after revascularization interventions

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    Paulo Cury Rezende

    2017-11-01

    Full Text Available Abstract Background Diabetic patients may be more susceptible to myocardial injury after coronary interventions. Thus, the aim of this study was to assess the release of cardiac biomarkers, CK-MB and troponin, and the findings of new late gadolinium enhancement (LGE on cardiac magnetic resonance (CMR in patients with type 2 diabetes mellitus after elective revascularization procedures for multivessel coronary artery disease (CAD. Methods Patients with multivessel CAD and preserved systolic ventricular function underwent either elective percutaneous coronary intervention (PCI, off-pump or on-pump bypass surgery (CABG. Troponin and CK-MB were systematically collected at baseline, 6, 12, 24, 36, 48 and 72 h after the procedures. CMR with LGE was performed before and after the interventions. Patients were stratified according to diabetes status at study entry. Biomarkers and CMR results were compared between diabetic and nondiabetics patients. Analyses of correlation were also performed among glycemic and glycated hemoglobin (A1c levels and troponin and CK-MB peak levels. Patients were also stratified into tertiles of fasting glycemia and A1c levels and were compared in terms of periprocedural myocardial infarction (PMI on CMR. Results Ninety (44.5% of the 202 patients had diabetes mellitus at study entry. After interventions, median peak troponin was 2.18 (0.47, 5.14 and 2.24 (0.69, 5.42 ng/mL (P = 0.81, and median peak CK-MB was 14.1 (6.8, 31.7 and 14.0 (4.2, 29.8 ng/mL (P = 0.43, in diabetic and nondiabetic patients, respectively. The release of troponin and CK-MB over time was statistically similar in both groups and in the three treatments, besides PCI. New LGE on CMR indicated that new myocardial fibrosis was present in 18.9 and 17.3% (P = 0.91, and myocardial edema in 15.5 and 22.9% (P = 0.39 in diabetic and nondiabetic patients, respectively. The incidence of PMI in the glycemia tertiles was 17.9% versus 19.3% versus 18.7% (P = 0

  9. Relationship between infarct tissue characteristics and left ventricular remodeling in patients with versus without early revascularization for acute myocardial infarction as assessed with contrast-enhanced cardiovascular magnetic resonance imaging

    NARCIS (Netherlands)

    Olimulder, Marlon; Olimulder, M.A.G.M.; Galjee, M.A.; Wagenaar, L.J.; van Es, J.; van der Palen, Jacobus Adrianus Maria; von Birgelen, Clemens

    2012-01-01

    Left ventricular (LV) remodeling following myocardial infarction (MI) is the result of complex interactions between various factors, including presence or absence of early revascularization. The impact of early revascularization on the relationship between infarct tissue characteristics and LV

  10. Myocardial revascularization: factors intervening in the reference and counter-reference in Primary Health Care.

    Science.gov (United States)

    Cunha, Kamylla Santos da; Higashi, Giovana Dorneles Callegaro; Erdmann, Alacoque Lorenzini; Kahl, Carolina; Koerich, Cintia; Meirelles, Betina Hörner Schlindwein

    2016-01-01

    Understanding the factors that influence the reference and counter-reference process of people indicated/submitted to Myocardial Revascularization surgery in the Primary Health Care scenario. A qualitative research anchored in the Grounded Theory, totaling 41 participants subdivided into three groups (patients, health professionals and managers) in the Metropolitan and West Region of Santa Catarina. Two categories elucidate the intervening factors found, contrasting the potentialities and obstacles in (creating) the bond between people affected by cardiovascular diseases and primary health care for the reference process, highlighting weaknesses in the primary health care services provided, with failures in the counter-reference for people submitted to myocardial revascularization surgery. Strengthening the potentialities presented in this study is essential for the reference process of people affected by Cardiovascular Disease, as well as strategic actions focused on solving the evidenced obstacles which contribute to deficiencies in the referral and counter-referral process, thus impeding integral care in the health care network. Compreender os fatores que influenciam o processo de referência e contrarreferência da pessoa com indicação/submetida à Cirurgia de Revascularização Miocárdica no cenário da Atenção Primária à Saúde. Pesquisa qualitativa ancorada na Teoria Fundamentada nos Dados, totalizando 41 participantes subdivididos em três grupos (pacientes, profissionais de saúde e gestores) na Região Metropolitana e Região Oeste de Santa Catarina. Duas categorias elucidam os fatores interventores encontrados, Contrastando as potencialidades e entraves no vínculo da pessoa acometida por doenças cardiovasculares com a atenção primária à saúde para o processo de referência e Destacando fragilidades nos serviços disponibilizados na atenção primária à saúde, com insucessos da contrarreferência da pessoa submetida à cirurgia de

  11. Myocardial Revascularization Surgery with Regional Anesthesia Without an Endotracheal Tube in Conscious Patients

    Directory of Open Access Journals (Sweden)

    Souto Gladyston Luiz Lima

    2002-01-01

    Full Text Available OBJECTIVE: To report initial experience with myocardial revascularization surgery (MRS performed on patients who were totally awake and without an endotracheal tube.METHODS: Between January 1994 and May 2001, 272 patients underwent MRS without extracorporeal circulation. In 24, the operations were performed without the use of an endotracheal tube and with the patients totally awake and breathing normally. The age ranged from 51-75 years with the predominant male sex. Epidural thoracic administratios of the anesthesia was performed. Surgery was performed through a habitual anterolateral thoracotomy. During the entire procedure, the left lung remained partially collapsed.RESULTS: The 24 patients progressed well through the surgery. Pneumothorax time ranged from 70-190 minutes. No electrocardiographic, echocardiographic, or enzymatic alterations occurred that characterized pre- and postoperative infarcts. Twenty-three patients were stable enough to be released after 24 hours.CONCLUSION: This technique could be performed on an large number of selected patients. However, more experience is necessary.

  12. The influence of chronic kidney disease and age on revascularization rates and outcomes in acute myocardial infarction - a cohort study.

    Science.gov (United States)

    Kotwal, Sradha; Ranasinghe, Isuru; Brieger, David; Clayton, Philip A; Cass, Alan; Gallagher, Martin

    2017-06-01

    There is a paucity of data on the complex interaction between chronic kidney disease, age and its impact on management and outcomes in acute myocardial infarction. A state based claims dataset that collects data on all hospitalizations (representing 32.3% of the Australian population) was used to identify all patients admitted with a principal diagnosis of acute myocardial infarction (ICD10 codes: I21.0-I21.4) over a four-year period. Patients were linked to the state death registry and followed until death or end of follow-up (31 December 2009). Chronic kidney disease was defined as the presence of any of 65 ICD10 diagnostic codes for chronic kidney disease. The primary outcomes were receipt of revascularization, length of hospital stay and mortality adjusted for age, comorbidities and prior revascularization at presentation. Of the 40,472 patients with acute myocardial infarction, chronic kidney disease was present in 4814 patients (11.9%). Median follow-up was 2.8 years (range 0-5.5 years). In the multivariable model, there was a marked interaction between chronic kidney disease and age ( pChronic kidney disease was a powerful marker of lower revascularization rates (median age group of 70-79 years: odds ratio 0.68; 95% confidence interval 0.59-0.78; pchronic kidney disease on length of stay (median age group of 70-79 years vs. referent age group 18-39 years: incidence rate ratio 1.41; 95% confidence interval 1.32-1.51; pChronic kidney disease is an important deterrent for the receipt of revascularization in older patients, but age is the primary determinant of length of stay and mortality.

  13. Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups.

    Science.gov (United States)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring; Lamberts, Morten; Hansen, Morten Lock; Karasoy, Deniz; Christiansen, Christine Benn; Torp-Pedersen, Christian; Sorensen, Rikke

    2017-09-01

    Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

  14. Effective surgical revascularization improves cerebral hemodynamics and resolves headache in pediatric Moyamoya disease.

    Science.gov (United States)

    Kawabori, Masahito; Kuroda, Satoshi; Nakayama, Naoki; Hirata, Kenji; Shiga, Toru; Houkin, Kiyohiro; Tamaki, Nagara

    2013-11-01

    Headache is one of the major clinical presentations in pediatric Moyamoya disease. However, the clinical features and underlying mechanisms are not fully understood. This study aimed to clarify the clinical feature of headache in pediatric Moyamoya disease and the effect of surgical revascularization. This study included 29 pediatric patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass for Moyamoya disease. Their medical records were precisely evaluated to identify the clinical features of their headache. The findings on magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography also were analyzed. Preoperative headache was documented in 11 (38%) of 29 patients. The majority of them complained of severe headache in the frontal or temporal region in the morning. Headache was significantly related to more advanced disease stage and to the decreases in cerebral blood flow and its reactivity to acetazolamide. Surgical revascularization completely resolved headache in all 11 patients. These findings strongly suggest that disturbed cerebral hemodynamics may play key roles in developing severe headache in pediatric Moyamoya disease. STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis may be effective procedures to rapidly resolve headache by widely supplying collateral blood flow to the operated hemispheres. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Prediction of wall motion improvement after coronary revascularization in patients with postmyocardial infarction. Diagnostic value of dobutamine stress echocardiography and myocardial contrast echocardiography

    International Nuclear Information System (INIS)

    Waku, Sachiko; Ohkubo, Tomoyuki; Takada, Kiyoshi; Ishihara, Tadashi; Ohsawa, Nakaaki; Adachi, Itaru; Narabayashi, Isamu

    1997-01-01

    The diagnostic value of dobutamine stress echocardiography, myocardial contrast echocardiography and dipyridamole stress thallium-201 single photon emission computed tomography (SPECT) for predicting recovery of wall motion abnormality after revascularization was evaluated in 13 patients with postmyocardial infarction. Seventeen segments showed severe wall motion abnormalities before revascularization. Nine segments which had relatively good Tl uptake on delayed SPECT images despite severely abnormal wall motion were opacified during myocardial contrast echocardiography, and showed improved wall motion after revascularization. In contrast, three segments which had poor Tl uptake and severely abnormal wall motion were not opacified during myocardial contrast echocardiography, and showed no improvement in wall motion during dobutamine stress echocardiography and after revascularization. The following three findings were assumed to be signs of myocardial viability: good Tl uptake on delayed SPECT images, improved wall motion by dobutamine stress echocardiography, and positive opacification of the myocardium by myocardiai contrast echocardiography. Myocardial contrast echocardiography had the highest sensitivity (100%) and negative predictive value (100%). Delayed SPECT images had the highest specificity (100%) and positive predictive value (100%). Dobutamine stress echocardiography had a sensitivity of 83.0%, specificity of 80.0%, positive predictive value of 90.9%, and negative predictive value of 66.7%, respectively. Myocardial contrast echocardiography showed the lowest specificity (60.0%). The techniques of dobutamine stress echocardiography and SPECT, though noninvasive, may underestimate wall motion improvement after revascularization. Further examination by myocardial contrast echocardiography is recommended to assess myocardial viability for determining the indications for coronary revascularization in spite of its invasiveness. (author)

  16. High-Intensity Inspiratory Protocol Increases Heart Rate Variability in Myocardial Revascularization Patients

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    Flavia Cristina Rossi Caruso

    2016-02-01

    Full Text Available Abstract Objective: To evaluate heart rate variability during an inspiratory muscle endurance protocol at three different load levels [30%, 60% and 80% of maximal inspiratory pressure], in patients who had previously undergone coronary artery bypass grafting. Methods: Nineteen late postoperative myocardial revascularization patients participating in a cardiovascular rehabilitation program were studied. Maximal inspiratory pressure maneuvers were performed. An inspiratory muscle endurance protocol at 30%, 60% and 80% of maximal inspiratory pressure was applied for four minutes each, in random order. Heart rate and RR intervals were recorded and heart rate variability was analyzed by time (RMSSD-the mean of the standard deviations for all R-R intervals, and RMSM-root-mean square differences of successive R-R intervals and frequency domains indices (high and low frequency in normalized units. ANOVA for repeated measurements was used to compare heart rate variability indices and Student t-test was used to compare the maximal inspiratory pressure and maximal expiratory pressure values. Results: Heart rate increased during performance of maximal respiratory pressures maneuvers, and the maximal inspiratory pressure and maximal expiratory pressure mean values were significantly lower than predicted values (P <0.05. RMSSD increased significantly at 80% in relation to rest and 30% of maximal inspiratory pressure and RMSM decreased at 30% and 60% of maximal inspiratory pressure in relation to rest (P <0.05. Additionally, there was significant and progressive decrease in low frequency and increase in high frequency at 30%, 60% and 80% of maximal inspiratory pressure in relation to the resting condition. Conclusion: These results suggest that respiratory muscle training at high intensities can promote greater parasympathetic activity and it may confer important benefits during a rehabilitation program in post-coronary artery bypass grafting.

  17. Efficacy of the direct myocardial revascularization performed on the beating heart or performed with the use of extra corporal circulation - comparison by means of myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Kwinecki, P.; Jemielity, M.; Dyszkiewicz, W.; Czepczynski, R.; Sowinski, J.

    2002-01-01

    Introduction. In the recent years, new techniques of direct myocardial revascularization: OPCAB - off pump coronary artery bypass and MIDCAB - minimal invasive coronary artery bypass were developed. Aim of this study was to compare the efficacy of these methods with that of CABG performed with the use of extracorporal circulation. Material and methods. 20 patients operated on the beating heart (group 1; 16 men and 4 women; aged 40 to 65 years; mean 53,0 ±8,6 years) and 36 patients operated in the extracorporal circulation (group 2; 33 men and 3 women; aged 34 to 69 years, mean 52,5 ±8,6 years). In all the patients myocardial SPECT using 99mTc-MIBI at rest and after stimulation with dipyridamole (0,56 mg/kg) was performed twice: before and 4-7 months after revascularization. Myocardial perfusion was evaluated in 9 segments using following scale: from 1 (normal) to 5 points (no uptake). The average score in all nine segments constituted a perfusion index (PI). The differences of PI before and after operation, both at rest and after dipyridamole were compared. Results. In none of the patients of group 1 a perioperational ischemia was found by ECG or enzymatic (CK-MB) measurements. In a part of group 2 signs of transient ischemia were found. Global evaluation of perfusion in SPECT is presented. PI were similar in both groups, both at rest and after dipyridamole. Conclusion: Efficacy of the direct myocardial revascularization performed on the beating heart is similar to that of the CABG operations performed with the use of extracorporal circulation. The OPCAB and MIDCAM operations are less traumatizing

  18. Effectiveness of surgical revascularization for stroke prevention in pediatric patients with sickle cell disease and moyamoya syndrome.

    Science.gov (United States)

    Yang, Wuyang; Xu, Risheng; Porras, Jose L; Takemoto, Clifford M; Khalid, Syed; Garzon-Muvdi, Tomas; Caplan, Justin M; Colby, Geoffrey P; Coon, Alexander L; Tamargo, Rafael J; Huang, Judy; Ahn, Edward S

    2017-09-01

    OBJECTIVE Sickle cell disease (SCD) in combination with moyamoya syndrome (MMS) represents a rare complication of SCD, with potentially devastating neurological outcomes. The effectiveness of surgical revascularization in this patient population is currently unclear. The authors' aim was to determine the effectiveness of surgical intervention in their series of SCD-MMS patients by comparing stroke recurrence in those undergoing revascularization and those undergoing conservative transfusion therapy. METHODS The authors performed a retrospective chart review of patients with MMS who were seen at the Johns Hopkins Medical Institution between 1990 and 2013. Pediatric patients (age < 18 years) with confirmed diagnoses of SCD and MMS were included. Intracranial stroke occurrence during the follow-up period was compared between surgically and conservatively managed patients. RESULTS A total of 15 pediatric SCD-MMS patients (28 affected hemispheres) were included in this study, and all were African American. Seven patients (12 hemispheres) were treated with indirect surgical revascularization. The average age at MMS diagnosis was 9.0 ± 4.0 years, and 9 patients (60.0%) were female. Fourteen patients (93.3%) had strokes before diagnosis of MMS, with an average age at first stroke of 6.6 ± 3.9 years. During an average follow-up period of 11.6 years, 4 patients in the conservative treatment group experienced strokes in 5 hemispheres, whereas no patient undergoing the revascularization procedure had any strokes at follow-up (p = 0.029). Three patients experienced immediate postoperative transient ischemic attacks, but all recovered without subsequent strokes. CONCLUSIONS Indirect revascularization is suggested as a safe and effective alternative to the best medical therapy alone in patients with SCD-MMS. High-risk patients managed on a regimen of chronic transfusion should be considered for indirect revascularization to maximize the effect of stroke prevention.

  19. Factor Analysis of Predicting Cardiovascular Death in the Remote Period after Myocardial Revascularization

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    Valentina V. Gul'chenko

    2015-09-01

    Full Text Available The aim of the present study was to analyze the impact of traditional and renal risk factors (RFs on the probability of cardiovascular death in CHD patients in the remote period after myocardial revascularization (MR. Materials and Methods: The present study included 90 CHD patients (80 men and 10 women; mean age 56.1±0.9 years with indications for MR. The prevalence of major cardiovascular RFs (old age, gender, duration of CHD, arterial hypertension, diabetes mellitus, another localization of atherosclerotic lesions, and the presence and duration of smoking and the main echocardiographic parameters and the parameters of renal function (MAU and GFR were assessed. Fatal cardiovascular outcomes were the only endpoint of the study. Results: Cardiovascular death (CVD occurred in 10/12.3% patients. The studied RFs, such as the patient's age, duration of smoking, and presence of angina with low tolerance to physical stress, had a significant impact on the probability of death in CHD patients. Risk of CVD (rCVD over a long-term period increases by 18.1% in patients with elevated levels of total cholesterol, by 16.2% in patients with stable angina pectoris class III, by 50.5% in patients with atherosclerotic lesions of lower limb and cerebral arteries, and by 69.3% in patients suffering from overweight. Left atrial size, LVPWT, and LVMI were also significant predictors of adverse cardiovascular prognosis. The increase in the number of coronary arteries with clinically significant stenosis, including subtotal narrowing of the vessel lumen, increases rCVD in the long-term period. The important role of a highly reliable level of glucose in the urine for the risk score was found. The presence of CKD stage 3 and the impaired GFR also significantly increased rCVD. Conclusion: Our data demonstrate a high medical and social importance of a comprehensive and integrated analysis not only of traditional RFs, but also of markers of renal dysfunction in risk

  20. CHANGE OF ARRHYTHMIC EVENTS IN ACUTE MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION AFTER PHARMACOINVASIVE REVASCULARIZATION

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    V. E. Oleynikov

    2017-01-01

    Full Text Available Aim. To study changes in course of arrhythmias, depending on the efficacy of coronary blood flow restoration due to pharmacoinvasive revascularization in patients with ST segment elevation myocardial infarction (STEMI.Material and methods. STEMI-patients (n=117 with an effective (according to ECG criteria thrombolytic therapy (TLT and the subsequent (after 3-24 hours percutaneous coronary  intervention (PCI, were included into the study. Telemetry ECG was performed before  and after PCI with analysis of the arrhythmias and cardiac conduction disorders.Results. Patients (n=84; 71.8% with an effective TLT, confirmed by the coronary angiography (CAG, and with subsequent effective PCI were included into the group "without rethrombosis" (RT(–. Patients (n=33; 28.2% with CAG proven rethrombosis of the infarct-related coronary artery and subsequent effective PCI were included into the group "with rethrombosis" (RT(+. Regardless of the stability of coronary blood flow restoration after the TLT, PCI was associated with an increased incidence of ventricular tachycardia (VT (p<0.01, sinus tachycardia (p=0.01, paroxysmal supraventricular tachycardia (SVT (p<0.05 and paired ventricular extrasystoles (p<0.01. Compared to the RT(– group, in the RT(+ group after PCI VT were recorded more frequently (44% vs 63.6%, respectively; p<0.05 as well as AV-block 3 degree (3.6% vs 12.1%, respectively; p<0.05. Episodes of sinus tachycardia were detected significantly more frequently before PCI in RT(– group compared with RT(+ group (67.9% vs 45.4% respectively; p<0.01. The number of patients with episodes of sinus bradycardia increased (from 19% to 32.1%; p=0.02 after PCI in RT(– group.Conclusion. The incidence of VT and SVT paroxysms, episodes of sinus tachycardia, atrioventricular conduction disturbances and ventricular extrasystoles increased in all patients after the effective PCI due to reperfusion. However, VT episodes and paroxysmal atrioventricular block

  1. Clinical outcomes of percutaneous coronary intervention in patients turned down for surgical revascularization.

    Science.gov (United States)

    Sukul, Devraj; Seth, Milan; Dixon, Simon R; Zainea, Mark; Slocum, Nicklaus K; Pielsticker, Elizabeth J; Gurm, Hitinder S

    2017-07-01

    We examined clinical outcomes following percutaneous coronary intervention (PCI) in patients turned down for surgical revascularization across a broad population. Prior studies suggest that surgical ineligibility is associated with increased mortality in patients with unprotected left main or multivessel coronary artery disease undergoing PCI. This study included consecutive patients who underwent PCI in a multicenter registry in Michigan from January 2010 to December 2014. Surgical ineligibility required documentation indicating that a cardiac surgeon deemed the patient ineligible for surgery. In-hospital outcomes included mortality (primary outcome), cardiogenic shock, cerebrovascular accident, contrast-induced nephropathy (CIN), and a new requirement for dialysis (NRD). Of 99,370 patients at 33 hospitals with on-site surgical backup, 1,922 (1.9%) were surgically ineligible. The rate of ineligibility did not vary by hospital (range: 1.5-2.5%; P = 0.79). Overall, there were no major differences in baseline characteristics or outcomes between surgically ineligible patients and the rest (i.e., nonineligible patients): mortality (0.52% vs. 0.52%; P > 0.5), cardiogenic shock (0.68% vs. 0.73%; P > 0.5), cerebrovascular accident (0.05% vs. 0.19%; P = 0.28), NRD (0.16% vs. 0.19%; P > 0.5), CIN (2.7% vs. 2.3%; P = 0.27). Among 1,074 patients who underwent unprotected left main PCI, 20 (1.9%) were surgically ineligible and experienced increased rates of mortality (20.0% vs. 5.3%; P = 0.022; adjusted OR = 7.38; P < 0.001) and other complications as compared to the remainder. PCI in a broad population of surgically ineligible patients is generally safe. However, among patients who underwent unprotected left main PCI, those deemed surgically ineligible experienced significantly worse outcomes as compared to the rest. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  2. Prediction of revascularization after myocardial perfusion SPECT by machine learning in a large population.

    Science.gov (United States)

    Arsanjani, Reza; Dey, Damini; Khachatryan, Tigran; Shalev, Aryeh; Hayes, Sean W; Fish, Mathews; Nakanishi, Rine; Germano, Guido; Berman, Daniel S; Slomka, Piotr

    2015-10-01

    We aimed to investigate if early revascularization in patients with suspected coronary artery disease can be effectively predicted by integrating clinical data and quantitative image features derived from perfusion SPECT (MPS) by machine learning (ML) approach. 713 rest (201)Thallium/stress (99m)Technetium MPS studies with correlating invasive angiography with 372 revascularization events (275 PCI/97 CABG) within 90 days after MPS (91% within 30 days) were considered. Transient ischemic dilation, stress combined supine/prone total perfusion deficit (TPD), supine rest and stress TPD, exercise ejection fraction, and end-systolic volume, along with clinical parameters including patient gender, history of hypertension and diabetes mellitus, ST-depression on baseline ECG, ECG and clinical response during stress, and post-ECG probability by boosted ensemble ML algorithm (LogitBoost) to predict revascularization events. These features were selected using an automated feature selection algorithm from all available clinical and quantitative data (33 parameters). Tenfold cross-validation was utilized to train and test the prediction model. The prediction of revascularization by ML algorithm was compared to standalone measures of perfusion and visual analysis by two experienced readers utilizing all imaging, quantitative, and clinical data. The sensitivity of machine learning (ML) (73.6% ± 4.3%) for prediction of revascularization was similar to one reader (73.9% ± 4.6%) and standalone measures of perfusion (75.5% ± 4.5%). The specificity of ML (74.7% ± 4.2%) was also better than both expert readers (67.2% ± 4.9% and 66.0% ± 5.0%, P < .05), but was similar to ischemic TPD (68.3% ± 4.9%, P < .05). The receiver operator characteristics areas under curve for ML (0.81 ± 0.02) was similar to reader 1 (0.81 ± 0.02) but superior to reader 2 (0.72 ± 0.02, P < .01) and standalone measure of perfusion (0.77 ± 0.02, P < .01). ML approach is comparable or better than

  3. Open surgical revascularization for wound healing: past performance and future directions.

    Science.gov (United States)

    Neville, Richard F

    2011-01-01

    The goal of lower extremity revascularization is to relieve pain, heal wounds, and prevent amputations by restoration of arterial perfusion. This necessarily brief overview will discuss the indications for vascular reconstruction and the diagnosis of peripheral arterial disease, and review of the "open" vascular procedures used for revascularization.

  4. Trends in surgical revascularization for renal artery disease: ten years' experience

    International Nuclear Information System (INIS)

    Novick, A.C.; Ziegelbaum, M.; Vidt, D.G.; Gifford, R.W. Jr.; Pohl, M.A.; AGoormastic, M.

    1987-01-01

    The authors reviewed their experience with surgical revascularization (SR) for renal artery disease (RAD) in 361 patients from 1975 through 1984 to illustrate the evolving role of SR in the management of these patients. The time intervals selected for comparison were 1975 through 1980 and 1981 through 1984. Since 1981, in patients with atherosclerosis, SR has been done more often in elderly patients (30% vs 10.4%), in patients with generalized atherosclerosis (87% vs 73%), and for the sole purpose of preserving renal function (36% vs 14%). Since 1981, fewer patients with atherosclerosis have undergone SR solely to treat renovascular hypertension (26% vs 41%). Since 1981, in patients with fibrous dysplasia, SR has been done in more patients with branch renal artery disease (70% vs 28%). These trends in performance of SR have been due to the advent of percutaneous transluminal angioplasty as effective therapy for certain patients, improved results of SR in elderly patients with atherosclerosis, an enhanced appreciation of advanced atherosclerotic RAD as a correctable cause of renal failure, and the development of more effective techniques for SR in patients with severe aortic atherosclerosis and branch RAD. The overall clinical results of SR remain excellent in properly selected patients with RAD

  5. Indocyanine green visualization of middle meningeal artery before craniotomy during surgical revascularization for moyamoya disease.

    Science.gov (United States)

    Tanabe, Nozomu; Yamamoto, Shusuke; Kashiwazaki, Daina; Akioka, Naoki; Kuwayama, Naoya; Noguchi, Kyo; Kuroda, Satoshi

    2017-03-01

    The middle meningeal artery (MMA) is well known to function as an important collateral channel to the territory of the anterior cerebral artery in moyamoya disease. This study was aimed to evaluate whether indocyanine green (ICG) videoangiography could visualize the anterior branch of the MMA before craniotomy during surgical revascularization for moyamoya disease. This study included 19 patients who developed TIA, ischemic stroke or hemorrhagic stroke due to moyamoya disease. Plain CT scan and three-dimensional time-of-flight MR angiography were performed in all patients before surgery. All of them underwent superficial temporal artery to middle temporal artery anastomosis and indirect bypass on 27 sides in total. ICG videoangiography could clearly visualize the anterior branch of the MMA in 10 (37%) of 27 sides. The patients with a "visible" MMA are significantly younger than those without. Radiological analysis revealed that ICG videoangiography could visualize it through the cranium when the diameter of the MMA is >1.3 mm and the sphenoid bone thickness over the MMA is craniotomy in all "visible" MMAs, but not in 4 (23.5%) of 17 "invisible" MMAs. The results strongly suggest that ICG videoangiography can visualize the anterior branch of the MMA before craniotomy in about one-third of patients with a large-diameter MMA (>1.3 mm) and thin sphenoid bone (craniotomy for moyamoya disease.

  6. Prospective assessment of regional myocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy

    International Nuclear Information System (INIS)

    Gibson, R.S.; Watson, D.D.; Taylor, G.J.; Crosby, I.K.; Wellons, H.L.; Holt, N.D.; Beller, G.A.

    1983-01-01

    Because thallium-201 uptake relates directly to the amount of viable myocardium and nutrient blood flow, the potential for exercise scintigraphy to predict response to coronary revascularization surgery was investigated in 47 consecutive patients. All patients underwent thallium-201 scintigraphy and coronary angiography at a mean (+/- standard deviation) of 4.3 +/- 3.1 weeks before and 7.5 +/- 1.6 weeks after surgery. Thallium uptake and washout were computer-quantified and each of six segments was defined as normal, showing total or partial redistribution or a persistent defect. Persistent defects were further classified according to the percent reduction in regional thallium activity; PD25-50 denoted a 25 to 50% constant reduction in relative thallium activity and PD greater than 50 denoted a greater than 50% reduction. Of 82 segments with total redistribution before surgery, 76 (93%) showed normal thallium uptake and washout postoperatively, versus only 16 (73%) of 22 with partial redistribution (probability [p] . 0.01). Preoperative ventriculography revealed that 95% of the segments with total redistribution had preserved wall motion, versus only 74% of those with partial redistribution (p . 0.01). Of 42 persistent defects thought to represent myocardial scar before surgery, 19 (45%) demonstrated normal perfusion postoperatively. Of the persistent defects that showed improved thallium perfusion postoperatively, 75% had normal or hypokinetic wall motion before surgery, versus only 14% of those without improvement (p less than 0.001). Whereas 57% of the persistent defects that showed a 25 to 50% decrease in myocardial activity demonstrated normal thallium uptake and washout postoperatively, only 21% of the persistent defects with a decrease in myocardial activity greater than 50% demonstrated improved perfusion after surgery (p . 0.02)

  7. The Relationship between Proliferative Scars and Endothelial Function in Surgically Revascularized Patients

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    Murat Ziyrek

    2015-12-01

    Full Text Available Background: Proliferative scars are benign fibrotic proliferations which demonstrate abnormal wound healing in response to skin injuries. As postulated in the “response to injury hypothesis”, atherosclerosis is also triggered by an endothelial injury. Keloid and atherosclerotic processes have many pathophysiological and cytological features in common. Aims: In this study, we investigated the relationship between proliferative scars and endothelial function in surgically revascularized patients. We aimed to test the hypothesis that atherosclerosis is a wound healing abnormality. Study Design: Cross-sectional study. Methods: Consecutive patients who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grafting operation were evaluated. Thirty-three patients with proliferative scars at the median sternotomy site formed the keloid group, and 36 age- and sex-matched patients with no proliferative scar at the median sternotomy site formed the control group. Endothelial function was evaluated by flow-mediated vasodilatation of the brachial artery via ultrasonograhic examination. Results: There is no signicant difference according to the demographic data, biochemical parameters, clinical parameters and number of grafts between keloid and control groups. Endothelial-dependent vasodilatory response was lower in the keloid group than the control group (9.30±3.5 and 18.68±8.2, respectively; p=0.001. Conclusion: This study showed that endothalial dysfunction, which is strongly correlated with atherosclerosis, was more prominent in patients with proliferative scars. As proliferative scars and atherosclerosis have many features in common, we might conclude that atherosclerosis is a wound healing abnormality.

  8. Revascularization Trends in Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease Presenting With Non-ST Elevation Myocardial Infarction: Insights From the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (NCDR ACTION Registry-GWTG).

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    Pandey, Ambarish; McGuire, Darren K; de Lemos, James A; Das, Sandeep R; Berry, Jarett D; Brilakis, Emmanouil S; Banerjee, Subhash; Marso, Steven P; Barsness, Gregory W; Simon, DaJuanicia N; Roe, Matthew; Goyal, Abhinav; Kosiborod, Mikhail; Amsterdam, Ezra A; Kumbhani, Dharam J

    2016-05-01

    Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014. Factors associated with use of CABG versus PCI were identified using logistic multivariable regression analyses. A total of 29 769 patients from 539 hospitals were included in the study, of which 10 852 (36.4%) were treated with CABG, 13 760 (46.2%) were treated with PCI, and 5157 (17.3%) were treated without revascularization. The overall use of revascularization increased over the study period with an increase in the proportion undergoing PCI (45% to 48.9%; Ptrend=0.0002) and no change in the proportion undergoing CABG (36.1% to 34.7%; ptrend=0.88). There was significant variability between participating hospitals in the use of PCI and CABG (range: 22%-100%; 0%-78%, respectively; P value treatment of adenosine diphosphate receptor antagonists at presentation, older age, female sex, and history of heart failure. Among patients with diabetes mellitus and multivessel coronary artery disease presenting with non-ST-segment-elevation myocardial infarction, only one third undergo CABG during the index admission. Furthermore, the use of PCI, but not CABG, increased modestly over the past 6 years. © 2016 American Heart Association, Inc.

  9. Long-term prognosis of diabetic patients with acute myocardial infarction in the era of acute revascularization

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    Shiga Tsuyoshi

    2010-01-01

    Full Text Available Abstract Background The long-term prognosis of diabetic patients with acute myocardial infarction (AMI treated by acute revascularization is uncertain, and the optimal pharmacotherapy for such cases has not been fully evaluated. Methods To elucidate the long-term prognosis and prognostic factors in diabetic patients with AMI, a prospective, cohort study involving 3021 consecutive AMI patients was conducted. All patients discharged alive from hospital were followed to monitor their prognosis every year. The primary endpoint of the study was all-cause mortality, and the secondary endpoint was the occurrence of major cardiovascular events. To elucidate the effect of various factors on the long-term prognosis of AMI patients with diabetes, the patients were divided into two groups matched by propensity scores and analyzed retrospectively. Results Diabetes was diagnosed in 1102 patients (36.5%. During the index hospitalization, coronary angioplasty and coronary thrombolysis were performed in 58.1% and 16.3% of patients, respectively. In-hospital mortality of diabetic patients with AMI was comparable to that of non-diabetic AMI patients (9.2% and 9.3%, respectively. In total, 2736 patients (90.6% were discharged alive and followed for a median of 4.2 years (follow-up rate, 96.0%. The long-term survival rate was worse in the diabetic group than in the non-diabetic group, but not significantly different (hazard ratio, 1.20 [0.97-1.49], p = 0.09. On the other hand, AMI patients with diabetes showed a significantly higher incidence of cardiovascular events than the non-diabetic group (1.40 [1.20-1.64], p Conclusions Although diabetic patients with AMI have more frequent adverse events than non-diabetic patients with AMI, the present results suggest that acute revascularization and standard therapy with aspirin and RAS inhibitors may improve their prognosis.

  10. Long-term prognosis of diabetic patients with acute myocardial infarction in the era of acute revascularization.

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    Takara, Ayako; Ogawa, Hiroshi; Endoh, Yasuhiro; Mori, Fumiaki; Yamaguchi, Jun-ichi; Takagi, Atsushi; Koyanagi, Ryo; Shiga, Tsuyoshi; Kasanuki, Hiroshi; Hagiwara, Nobuhisa

    2010-01-04

    The long-term prognosis of diabetic patients with acute myocardial infarction (AMI) treated by acute revascularization is uncertain, and the optimal pharmacotherapy for such cases has not been fully evaluated. To elucidate the long-term prognosis and prognostic factors in diabetic patients with AMI, a prospective, cohort study involving 3021 consecutive AMI patients was conducted. All patients discharged alive from hospital were followed to monitor their prognosis every year. The primary endpoint of the study was all-cause mortality, and the secondary endpoint was the occurrence of major cardiovascular events. To elucidate the effect of various factors on the long-term prognosis of AMI patients with diabetes, the patients were divided into two groups matched by propensity scores and analyzed retrospectively. Diabetes was diagnosed in 1102 patients (36.5%). During the index hospitalization, coronary angioplasty and coronary thrombolysis were performed in 58.1% and 16.3% of patients, respectively. In-hospital mortality of diabetic patients with AMI was comparable to that of non-diabetic AMI patients (9.2% and 9.3%, respectively). In total, 2736 patients (90.6%) were discharged alive and followed for a median of 4.2 years (follow-up rate, 96.0%). The long-term survival rate was worse in the diabetic group than in the non-diabetic group, but not significantly different (hazard ratio, 1.20 [0.97-1.49], p = 0.09). On the other hand, AMI patients with diabetes showed a significantly higher incidence of cardiovascular events than the non-diabetic group (1.40 [1.20-1.64], p < 0.0001). Multivariate analysis revealed that three factors were significantly associated with favorable late outcomes in diabetic AMI patients: acute revascularization (HR, 0.62); prescribing aspirin (HR, 0.27); and prescribing renin-angiotensin system (RAS) inhibitors (HR, 0.53). There was no significant correlation between late outcome and prescription of beta-blockers (HR, 0.97) or calcium channel

  11. The Contemporary Use of Angiography and Revascularization Among Patients With Non-ST-Segment Elevation Myocardial Infarction in the United States Compared With South Korea.

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    Kang, Hyun-Jae; Simon, Dajuanicia; Wang, Tracy Y; Alexander, Karen P; Jeong, Myung Ho; Kim, Hyo-Soo; Bates, Eric R; Henry, Timothy D; Peterson, Eric D; Roe, Matthew T

    2015-12-01

    Practice guidelines recommend an early invasive strategy for high-risk non-ST-segment elevation myocardial infarction (NSTEMI) patients, but international differences in the use of invasive strategies are unknown. Profiling NSTEMI patient management in the United States (U.S.) and South Korea could provide insight into how patients are triaged for an early invasive strategy in different health care environments and geographical regions. We evaluated the use of angiography and revascularization for NSTEMI patients treated at revascularization-capable hospitals (2007-2010) in both the ACTION Registry-GWTG (U.S.: n = 133,835; 433 hospitals) and KAMIR/KorMI Registry (South Korea: n = 7,901; 72 hospitals). Compared with South Korean patients, U.S. NSTEMI patients more commonly had established cardiovascular risk factors, disease, and prior cardiovascular events and procedures. From 2007-2010, the use of angiography for NSTEMI patients rose steadily in both countries, but the use of revascularization only rose in South Korea. Patients from South Korea more commonly underwent angiography and revascularization. Percutaneous coronary intervention was the most common type of revascularization in both countries, but coronary artery bypass grafting was less common in South Korea. The use of both angiography and revascularization was incrementally lower with a higher predicted mortality risk for patients from both countries, but greater differences between low- and high-risk patients occurred in the U.S. The profile, characteristics, and use of angiography and revascularization for NSTEMI patients in the U.S. vs South Korea differed substantially from 2007-2010, underscoring the heterogeneity of NSTEMI patients and treatment selection among different countries. © 2015 Wiley Periodicals, Inc.

  12. Imaging findings of myocardial revascularization at multidetector computed tomography: where are the bypass grafts?: an iconographic essay

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    Ripari, Marcelo Targa; Santaniello, Rogerio; Sasdelli Neto, Roberto; Nomura, Cesar Higa; Chate, Rodrigo Caruso; Passos, Rodrigo Bastos Duarte; Kay, Fernando Uliana; Funari, Marcelo Buarque de Gusmao [Hospital Albert Einstein, Sao Paulo, SP (Brazil). Dept. of Imaging], e-mail: mtripari@uol.com

    2009-09-15

    Multidetector coronary computed tomography angiography is a precise method for evaluating post-coronary revascularization arterial and venous bypass grafts, and is somehow superseding coronary catheterization that is an invasive and more expensive technique. The present iconographic essay is aimed at anatomically demonstrating the bypass grafts most frequently utilized, how to differentiate between arterial and venous grafts and how to find them. The studies were performed in 64-row multidetector computed tomography equipment, with breath hold, controlled heart rate and appropriate protocols with later MPR, MIP and 3D reconstructions according to electrocardiogram. The localization of the bypass grafts and anastomoses at computed tomography studies focused on chest and coronary arteries may represent a difficulty in the images analysis by the radiologist who is not familiar with the matter, so the knowledge of the surgical techniques adopted and possible courses of the saphenous bypass grafts and arterial grafts can aid in the analysis of both studies, avoiding diagnostic errors. (author)

  13. Mortality and Revascularization following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

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    Abrams, Thad E.; Vaughan-Sarrazin, Mary; Kaboli, Peter J.

    2010-01-01

    Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified…

  14. Place of pharmaco-invasive approach for revascularization in acute myocardial infarction: Experience of Kuzbass

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    Tavlueva E.V.

    2015-09-01

    Full Text Available The article describes methods for implementation of pharmaco-invasive approach the treatment of acute myocardial infarction with ST-segment elevation (STEMI in the Kemerovo region, Russian Federation. The result of improving cardiac care was 10-fold increase of pre-hospital thrombolytic therapy in STEMI patients. The number of STEMI patients transferred to the PCI-center in the first day increased by 3 times: 22.5% – 2014y, 66.6% – January-June 2015y (p=0.001. The number of STEMI patients transferred to the PCI-center in the first day after thrombolytic therapy increased 4.5%: 23.8% – 2014y, 28.3% – January-June 2015y (p=0.059.

  15. Quality of life of women submitted to myocardial revascularization surgery in a public hospital - doi:10.5020/18061230.2010.p237

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    Rafaela Melo de Oliveira

    2012-01-01

    Full Text Available Objective: To analyze the sociodemografic profile, risck factors and the quality of life of women submitted to myocardial revascularization surgery. Methods: We conducted a qualitative study by applying a questionnaire on lifestyle and risk factors and an interview with four guiding questions to 15 revascularized inpatients of cardiology units of a referral public hospital and who had no manifestations of depression prior to surgery. Results: The patients profile showed that 9 (60% were Caucasian, 8 (54% had incomplete primary education, 4(27% were housewives, 9 (60% lived in urban area, 10 (67% were married, all had a family income lower than three minimum wages and 4(27% had only two kids. From the content analysis of the interviews, the following categories aroused: religiosity, disruption with everyday life, family and quality of life. Conclusion: We found out that the knowledge about the psychosocial structure of each patient helps in the treatment of the individual submitted to myocardial revascularization. By identifying the lifestyle and risk factors, women promote self-knowledge, which can avoid habits that lead to cardiovascular diseases. We suggest the development of strategies for prevention and health promotion involving the patients and their families so that there is an extension of hospital care at home and a better adaptation to the new condition.

  16. Carbohydrate and lipid metabolism indices dynamic in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity in 6 months and 1 year after myocardial revascularization

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    P. P. Kravchun

    2016-11-01

    Full Text Available Nowadays conservative therapy and reperfusion techniques, which include thrombolytic therapy and percutaneous coronary intervention considered as the main strategies for the acute coronary syndrome treatment. Aim. To assess carbohydrate and lipid metabolism in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity in 6 months and 1 year after myocardial revascularization. Methods and results. 58 patients who underwent thrombolytic therapy and 32 patients who underwent percutaneous coronary intervention were examined. Glucose level was determined by glucose oxidation method, insulin – by ELISA and lipid profile – according to the standard biochemical methods. It was established that in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity positive effect was defined in carbohydrate and lipid metabolism by reducing of serum glucose level, insulin, total cholesterol, low and very low-density lipoproteins, triglycerides and increasing of high density lipoproteins, cholesterol in 6 months and 1 year after reperfusion therapy. Significant differences in carbohydrate and lipid metabolism in the examined patients, depending on the type of reperfusion therapy, have not been detected in 6 months and 1 year after revascularization. Conclusion. Comparative analysis of different methods of myocardial revascularization did not show any advantages of them.

  17. [Coronary angioplasty in the 8th and 9th decades of life: an effective technique for myocardial revascularization?].

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    Sousa, A G; Feres, F; Pinto, I M; Tanajura, L F; Mattos, L A; Maneschi, L A; Cano, M N; Maldonado, G; Fontes, V F; Sousa, J E

    1991-09-01

    To evaluate the efficacy of percutaneous transluminal angioplasty (PTCA), as a revascularization procedure in patients with symptomatic coronary artery disease in the 8th and 9th decades of life. Four hundred and fifty-two elderly patients (mean age 74.7 years) underwent balloon dilation, between April 1982 and June 1990, at the Institute "Dante Pazzanese" of Cardiology. There were 70.4% male, 34.9% with high blood pressure, 18.8% smoked and 10.8% with diabetes. Ninety-four patients (20.7%) had previous myocardial infarction and systemic disorders were diagnosed in 14% (renal failure 5.1%, respiratory insufficiency 3.1%, rheumatic and bone disorders 1.1%, malignancy 4.2%, haematologic disorders 0.4%). One hundred and seventy-three (38.3%) had multivessel coronary artery disease whereas 84 (18.5%) had moderate to severe dysfunction of the left ventricle. PTCA was done according to the method described by Grüntzig, with the use of a "over the wire" (LPS, USCI, Mini Profile USCI, ACX ACS) balloon or a "on the wire" (Probe USCI, Axcel ACS) System. Primary success was achieved in 406 (89.5%) patients where PTCA was done to dilate one vessel in 412, two vessels in 38 and three vessels in 2, accomplishing 494 dilated vessels. Major complications occurred in 14 (3.1%) patients, due to occlusion of the treated coronary artery. Emergency by-pass surgery was necessary in 5 (1.1%) patients, while 8 patients involved to acute myocardial infarction (1.8%), and 5 (1.1%) died. At the end of the late follow-up (mean 24.5 months) of 349 elderly patients (86% of the 406 successful dilated) 246 (70.5%) were asymptomatic, chest pain had recurred in 101 (28.9%) and 2 (0.6%) had myocardial infarction. Twenty-eight patients died during the follow-up, 14 of them (4.0%) due to cardiac causes. Late restenosis developed in 66 patients and 22 had progression of coronary atherosclerosis. Forty patients underwent a late PTCA, and 33 others underwent a late bypass surgery. PTCA in patients in

  18. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

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    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  19. Lifestyle and the importance of health education in the cardiac rehabilitation after myocardial revascularization surgery - doi:10.5020/18061230.2007.p213

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    Denise Gonçaleves Moura Pinheiro

    2012-01-01

    Full Text Available In the treatment of ischemic cardiopathy, the prevention has a main role and the modifications in the lifestyle are indispensable for the good prognosis of the disease. The goal of the study was to describe the lifestyle regarding the prevalence of cardiovascular risk factors, such as smoking, alcohol consumption, dietary habits and sedentary behaviors before myocardial revascularization surgery and during the period of cardiac rehabilitation in a private institution that did not comprise structured health education activities. This was a retrospective, observational study, with a qualitative approach, held with 50 patients submitted to cardiac rehabilitation (36 men and 14 women; age 61±12.74 years. The data were collected from clinical records of the pre-cardiac rehabilitation evaluation which consisted of clinical data and information referring to the patients’ lifestyle. Amongst the most prevalent co-morbidities in the sample, there were: the hypertension (n=24; 48%, the diabetes mellitus (n=18; 36% and dyslipidemias (n=17; 34%. A high rate of smoke cessation (100% and 58% of sedentary behaviors (n=29 was observed after the cardiac surgery. This same number (n=29; 58% referred to have adhered to changes in dietary habits after the myocardial acute infarct. There was also an increase in the prevalence of alcohol consumption (n=21; 42% after myocardial revascularization. We conclude with this research that a cardiac rehabilitation program should provide to their patients, health education actions, for a necessary and real change in lifestyle habits, with the presence of a multidisciplinary team.

  20. Revascularization and cardioprotective drug treatment in myocardial infarction patients: how do they impact on patients' survival when delivered as usual care

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    Courteau Josiane

    2006-05-01

    Full Text Available Abstract Background Randomized clinical trials showed the benefit of pharmacological and revascularization treatments in secondary prevention of myocardial infarction (MI, in selected population with highly controlled interventions. The objective of this study is to measure these treatments' impact on the cardiovascular (CV mortality rate among patients receiving usual care in the province of Quebec. Methods The study population consisted of a "naturalistic" cohort of all patients ≥ 65 years old living in the Quebec province, who survived a MI (ICD-9: 410 in 1998. The studied dependant variable was time to death from a CV disease. Independent variables were revascularization procedure and cardioprotective drugs. Death from a non CV disease was also studied for comparison. Revascularization procedure was defined as percutaneous transluminal coronary angioplasty (PTCA or coronary artery bypass graft (CABG. The exposure to cardioprotective drugs was defined as the number of cardioprotective drug classes (Acetylsalicylic Acid (ASA, Beta-Blockers, Angiotensin-Converting Enzyme (ACE Inhibitors, Statins claimed within the index period (first 30 days after the index hospitalization. Age, gender and a comorbidity index were used as covariates. Kaplan-Meier survival curves, Cox proportional hazard models, logistic regressions and regression trees were used. Results The study population totaled 5596 patients (3206 men; 2390 women. We observed 1128 deaths (20% within two years following index hospitalization, of them 603 from CV disease. The CV survival rate at two years is much greater for patients with revascularization, regardless of pharmacological treatments. For patients without revascularization, the CV survival rate increases with the number of cardioprotective drug classes claimed. Finally, Cox proportional hazard models, regression tree and logistic regression analyses all revealed that the absence of revascularization and, to a lower extent

  1. Voxel Based Analysis of Surgical Revascularization for Moyamoya Disease: Pre- and Postoperative SPECT Studies.

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    Yasutaka Fushimi

    Full Text Available Moyamoya disease (MMD is a chronic, progressive, cerebrovascular occlusive disease that causes abnormal enlargement of collateral pathways (moyamoya vessels in the region of the basal ganglia and thalamus. Cerebral revascularization procedures remain the preferred treatment for patients with MMD, improving the compromised cerebral blood flow (CBF. However, voxel based analysis (VBA of revascularization surgery for MMD based on data from pre- and postoperative data has not been established. The latest algorithm called as Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL has been introduced for VBA as the function of statistical parametric mapping (SPM8, and improved registration has been achieved by SPM8 with DARTEL. In this study, VBA was conducted to evaluate pre- and postoperative single photon emission computed tomography (SPECT images for MMD by SPM8 with DARTEL algorithm, and the results were compared with those from SPM8 without DARTEL (a conventional method. Thirty-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA bypass surgery as the first surgery were included and all patients underwent pre- and postoperative 3D T1-weighted imaging and SPECT. Pre- and postoperative SPECT images were registered to 3D T1-weighted images, then VBA was conducted. Postoperative SPECT showed more statistically increased CBF areas in the bypassed side cerebral hemisphere by using SPM8 with DARTEL (58,989 voxels; P<0.001, and increased ratio of CBF after operation was less than 15%. Meanwhile, postoperative SPECT showed less CBF increased areas by SPM8 without DARTEL. In conclusion, VBA was conducted for patients with MMD, and SPM8 with DARTEL revealed that postoperative SPECT showed statistically significant CBF increases over a relatively large area and with at most 15% increase ratio.

  2. Arterialização seletiva da veia interventricular anterior: opção de revascularização miocárdica Selective arterialization of the anterior interventricular vein: a choice for myocardial revascularization

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    Luiz Fernando Kubrusly

    1992-12-01

    Full Text Available O objetivo deste trabalho é referir dois casos cirúrgicos, onde, após ressecção de aneurisma de ventrículo esquerdo, a revascularização do miocárdio através da artéria interventricular anterior (AIA não foi possível. Utilizando-se a artéria torácica interna (ATI esquerda, optou-se pela anatomose com a veia interventricular anterior (VIA com ligadura próxima, para estabelecimento do fluxo retrógrado e evitar a formação de fístula artenovenosa. Não houve mortalidade e os resultados a curto prazo são encorajadores. Testes de perfusão miocárdica com radioisótopos no pré e no pós-operatório, assim como angiografia do sistema coronário e da artéria torácica interna esquerda pré e pós-operatória são apresentados e discutidos. O objetivo da cirurgia de aneurisma ventricular é a recomposição geométrica do ventrículo esquerdo e revascularização de possíveis áreas isquémicas. Na impossibilidade de revascularização direta da artéria interventricular anterior, a técnica citada demonstra ser facilmente exeqüível e, a curto prazo, com bons resultados.The purpose of this study is to report two surgical cases, whereby after the repair of the left ventricular aneurysm, the myocardial revascularization of the interventricular anterior artery (IAA was not possible. Using the left internal thoracic artery it was decided to perform anastomosis with the interventricular anterior (IAA and its cephalad ligation, in order to obtain a retrograde flow and to avoid an arteriovenous fistula formation. There was no mortality and the results are optimistic in a short follow-up of these two patients. Myocardial perfusion tests and pre and post-operative angiography of the coronary system and the left internal thoracic artery are assessed and discussed. The geometrical reconstruction of the left ventricle and the revascularization of the ischemic areas play major role in the repair of postinfarction ventricular aneurysm. When it

  3. Emprego da nimodipina (oxigen como protetor cerebral na cirurgia de revascularização do miocárdio com circulação extracorpórea em pacientes idosos Use of nimodipine for cerebral injury prophylaxis in surgical myocardial revascularization with extracorporeal circulation in elderly patients

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    Ricardo Manrique

    1996-12-01

    neuropsicological functions the alteration rate achieve 50 to 70%. An independent variable to stroke is age, the frequency in patients older then 75 years is close to 9%. Taking in account that rate of the elderly population grows very fast and that the coronary patient are frequently older than 65 years, we found very important to search for prophylactic ways to reduce this incidence. New drugs promise to achieve the goal of a prophylaxis of the cerebral injury induced by extracorporeal circulation and nimodipine, a neurovascular specific calcium channel blocker, seems to be a great promise for the prevention of cerebral damage. This is a pilot, double blind, randomized and controlling study with 64 patients, 30 in the nimodipine group and 34 in the placebo branch. Demographics and preoperative data were similar, without any significative difference but the incidence of previous transitory ischaemic attack. The nimodipine group shows a reduction in the number of neurological events in comparation with the placebo group, although a most complicated surgical procedure and inter and post-operative evolution. In the nimodipine group 3 patients presented mental confusion but in the placebo branch we found also 3 cases of mental confusion plus 2 cases of drowsy and one ischaemic stroke with sequels. In summary in the nimodipine group were 3 cases in 30 patients (10% against 6 in 34 patients (17.64% in one placebo group. It means a neurological events reduction of 76.4%. Legault reported high mortality in patients using nimodipine in cardiac valve replacement surgery, mainly related to bleeding. We don't found such correlation. The hospital - mortality was similiar in both groups (1 patient in each group and non statistically significant difference in bleeding (1 severe case in the nimodipine group. In the follow up till 41 months there was a higher mortality in the placebo (4 patients than in the nimodipine group (1 case.

  4. Custos comparativos entre a revascularização miocárdica com e sem circulação extracorpórea Comparative costs between myocardial revascularization with or without extracorporeal circulation

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    Priscyla B. M. A. Girardi

    2008-12-01

    Full Text Available FUNDAMENTO: Técnicas cirúrgicas de revascularização miocárdica sem o uso de circulação extracorpórea (CEC projetaram esperanças de resultados operatórios com menor dano sistêmico, menor ocorrência de complicações clínicas e menor tempo de internação hospitalar, gerando expectativas de menor custo hospitalar. OBJETIVO: Avaliar o custo hospitalar em pacientes submetidos à cirurgia de revascularização miocárdica com e sem o uso de CEC, e em portadores de doença multiarterial coronariana estável com função ventricular preservada. MÉTODOS: Os custos hospitalares foram baseados na remuneração governamental vigente. Acrescentaram-se aos custos uso de órteses e próteses, complicações e intercorrências clínicas. Consideraram-se o tempo e os custos de permanência na UTI e de internação hospitalar. RESULTADOS: Entre janeiro de 2002 e agosto de 2006, foram randomizados 131 pacientes para cirurgia com CEC (CCEC e 128 pacientes sem CEC (SCEC. As características basais foram semelhantes para os dois grupos. Os custos das intercorrências cirúrgicas foram significativamente menores (p BACKGROUND: Surgical techniques of myocardial revascularization without the use of extracorporeal circulation (ECC have raised hopes of attaining operative results with less systemic damage, lower occurrence of clinical complications and shorter hospital stay duration, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital costs in patients submitted to myocardial revascularization with and without ECC and in those with stable multiarterial coronary disease with preserved ventricular function. METHODS: The hospital costs were based on the existing governmental reimbursement. The costs included that of ortheses and prostheses and clinical complications. The time and costs of ICU stay and hospital stay duration were considered. RESULTS: Between January 2002 and August 2006, 131 patients were randomized to surgery

  5. OMEGA-3 POLYUNSATURATED FATTY ACIDS IN ATRIAL FIBRILLATION PREVENTION AFTER SURGICAL MYOCARDIAL REVASCULARIZATION

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    A. V. Panov

    2008-01-01

    Full Text Available Aim. To estimate an efficacy of therapy with ω-3 polyunsaturated fatty acids (PUFA in patients with ischemic heart disease (IHD before and after coronary artery bypass graft (CABG.Material and methods. 189 patients (125 men, 64 women; aged 64,2±9,4 y.o. with IHD having indications to CABG were enrolled in the study. Patients of the first group (control had standard pre- and postoperative treatment. Patients of the second group received ω-3 PUFA (ОМАCОR, Solvay Pharma 2 g/daily in addition to standard therapy. Both groups were similar in clinical characteristics. ω-3 PUFA therapy started 7±4 day before CABG, renewed in early postoperative period (24-36 hours after surgery and lasted next 14 days. Efficacy of the therapy was estimated by atrial fibrillation frequency in postoperative period and time before hospital discharge after CABG. An automatic complex for transesophageal electrophysiological cardiac examination was used for the estimation of atrial conduction before and after CABG.Results. Omacor therapy in patients with ICD before CABG and in the early postoperative period reduces atrial fibrillation risk. It results in reduction of hemodynamic disorders and time before hospital discharge. Conclusion. Omacor therapy is safe and can be recommended to all patients going through CABG.

  6. Revascularization Treatment of Emergency Patients with Acute ST-Segment Elevation Myocardial Infarction in Switzerland: Results from a Nationwide, Cross-Sectional Study in Switzerland for 2010-2011.

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    Berlin, Claudia; Jüni, Peter; Endrich, Olga; Zwahlen, Marcel

    2016-01-01

    Cardiovascular diseases are the leading cause of death worldwide and in Switzerland. When applied, treatment guidelines for patients with acute ST-segment elevation myocardial infarction (STEMI) improve the clinical outcome and should eliminate treatment differences by sex and age for patients whose clinical situations are identical. In Switzerland, the rate at which STEMI patients receive revascularization may vary by patient and hospital characteristics. To examine all hospitalizations in Switzerland from 2010-2011 to determine if patient or hospital characteristics affected the rate of revascularization (receiving either a percutaneous coronary intervention or a coronary artery bypass grafting) in acute STEMI patients. We used national data sets on hospital stays, and on hospital infrastructure and operating characteristics, for the years 2010 and 2011, to identify all emergency patients admitted with the main diagnosis of acute STEMI. We then calculated the proportion of patients who were treated with revascularization. We used multivariable multilevel Poisson regression to determine if receipt of revascularization varied by patient and hospital characteristics. Of the 9,696 cases we identified, 71.6% received revascularization. Patients were less likely to receive revascularization if they were female, and 80 years or older. In the multivariable multilevel Poisson regression analysis, there was a trend for small-volume hospitals performing fewer revascularizations but this was not statistically significant while being female (Relative Proportion = 0.91, 95% CI: 0.86 to 0.97) and being older than 80 years was still associated with less frequent revascularization. Female and older patients were less likely to receive revascularization. Further research needs to clarify whether this reflects differential application of treatment guidelines or limitations in this kind of routine data.

  7. Value of a new multiparametric score for prediction of microvascular obstruction lesions in ST-segment elevation myocardial infarction revascularized by percutaneous coronary intervention.

    Science.gov (United States)

    Amabile, Nicolas; Jacquier, Alexis; Gaudart, Jean; Sarran, Anthony; Shuaib, Anes; Panuel, Michel; Moulin, Guy; Bartoli, Jean-Michel; Paganelli, Franck

    2010-10-01

    Despite improvement in revascularization strategies, microvascular obstruction (MO) lesions remain associated with poor outcome after ST-segment elevation myocardial infarction (STEMI). To establish a bedside-available score for predicting MO lesions in STEMI, with cardiac magnetic resonance imaging (CMR) as the reference standard, and to test its prognostic value for clinical outcome. Patients with STEMI of4 accurately identified microcirculatory injuries (sensitivity 84%; specificity 82%) and independently predicted the presence of MO lesions on CMR. MO score>4 predicted adverse cardiovascular events during the first year after STEMI (relative risk 2.60 [1.10-6.60], p=0.03). MO lesions are frequent in PCI-treated STEMI and are associated with larger MIs. MO score accurately predicted MO lesions and identified patients with poor outcome post-STEMI. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  8. Prevention of the Rerupture of Collateral Artery Aneurysms on the Ventricular Wall by Early Surgical Revascularization in Moyamoya Disease: Report of Two Cases and Review of the Literature.

    Science.gov (United States)

    Kanamori, Fumiaki; Takasu, Syuntaro; Ota, Shinji; Seki, Yukio

    2018-01-01

    Collateral artery aneurysms are a source of intracranial hemorrhage in moyamoya disease. Several reports have shown that surgical revascularization leads to the obliteration of collateral artery aneurysms. However, its effect on the prevention of rebleeding has not been established, and the optimal timing of the operation remains unclear. The purpose of the present study is to evaluate the effects of surgical revascularization and to investigate the optimal operation timing in patients with moyamoya disease who have ruptured collateral artery aneurysms on the ventricular wall. Two patients with moyamoya disease who presented with intraventricular hemorrhage caused by rupture of collateral artery aneurysms on the wall of the lateral ventricle are presented here. In both cases, the aneurysms reruptured approximately 1 month after the initial hemorrhage. Both patients successfully underwent superficial temporal artery-middle cerebral artery anastomosis combined with indirect bypass in the subacute stage. The aneurysms decreased with the development of collateral circulation through the direct bypasses, and rebleeding did not occur after the surgery. Because ruptured collateral artery aneurysms on the wall of the lateral ventricle in moyamoya disease are prone to rerupture within 1 month, surgical revascularization may be recommended as soon as the patients are stable and able to withstand the operation. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Reduction in cardiac mortality with bivalirudin in patients with and without major bleeding: The HORIZONS-AMI trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction).

    Science.gov (United States)

    Stone, Gregg W; Clayton, Tim; Deliargyris, Efthymios N; Prats, Jayne; Mehran, Roxana; Pocock, Stuart J

    The purpose of this study was to determine whether, in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), the reduction in cardiac mortality in those taking bivalirudin compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (UFH+GPI) can be fully attributed to reduced bleeding. The association between hemorrhagic complications and mortality may explain the survival benefit with bivalirudin. A total of 3,602 STEMI patients undergoing primary PCI were randomized to bivalirudin versus UFH+GPI. Three-year cardiac mortality was analyzed in patients with and without major bleeding. When compared with UFH+GPI, bivalirudin resulted in lower 3-year rates of major bleeding (6.9% vs. 10.5%, hazard ratio [HR]: 0.64 [95% confidence interval (CI): 0.51 to 0.80], p accounting for major bleeding and other adverse events, bivalirudin was still associated with a 43% reduction in 3-year cardiac mortality (adjusted HR: 0.57 [95% CI: 0.39 to 0.83], p = 0.003). Bivalirudin reduces cardiac mortality in patients with STEMI undergoing primary PCI, an effect that can only partly be attributed to prevention of bleeding. Further studies are required to identify the nonhematologic benefits of bivalirudin. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction; NCT00433966). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. Costs and cost-effectiveness of carotid stenting versus endarterectomy for patients at standard surgical risk: results from the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).

    Science.gov (United States)

    Vilain, Katherine R; Magnuson, Elizabeth A; Li, Haiyan; Clark, Wayne M; Begg, Richard J; Sam, Albert D; Sternbergh, W Charles; Weaver, Fred A; Gray, William A; Voeks, Jenifer H; Brott, Thomas G; Cohen, David J

    2012-09-01

    The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrated similar rates of the primary composite end point between carotid artery stenting (CAS) and carotid endarterectomy (CEA), although the risk of stroke was higher with CAS, and the risk of myocardial infarction was higher with CEA. Given the large number of patients who are candidates for these procedures, an understanding of their relative cost and cost-effectiveness may have important implications for health care policy and treatment guidelines. We performed a formal economic evaluation alongside the CREST trial. Costs were estimated from all trial participants over the first year of follow-up using a combination of resource use data and hospital billing data. Patient-level health use scores were obtained using data from the SF-36. We then used a Markov disease-simulation model calibrated to the CREST results to project 10-year costs and quality-adjusted life expectancy for the 2 treatment groups. Although initial procedural costs were $1025/patient higher with CAS, postprocedure costs and physician costs were lower such that total costs for the index hospitalization were similar for the CAS and CEA groups ($15 055 versus $14 816; mean difference, $239/patient; 95% CI for difference, -$297 to $775). Neither follow-up costs after discharge nor total 1-year costs differed significantly. For the CREST population, model-based projections over a 10-year time horizon demonstrated that CAS would result in a mean incremental cost of $524/patient and a reduction in quality-adjusted life expectancy of 0.008 years compared with CEA. Probabilistic sensitivity analysis demonstrated that CEA was economically attractive at an incremental cost-effectiveness threshold of $50 000/quality-adjusted life-year gained in 54% of samples, whereas CAS was economically attractive in 46%. Despite slightly lower in-trial costs and lower rates of stroke with CEA compared with CAS, projected 10-year outcomes

  11. [BIOCHEMICAL MARKERS OF MYOCARDIAL DAMAGE IN CHILDREN AFTER SURGICAL CORRECTION OF CONGENITAL HEART DISEASE].

    Science.gov (United States)

    Dudnyk, V M; Zborovskaya, O O

    2015-01-01

    The results of observations of 184 children from the CHD after surgical correction on which explored the biochemical markers of myocardial injury in serum--myocardial fraction of creatine kinase and galectin-3. The relationship between increased serum concentrations of these markers, clinical and paraclinical characteristics of examined children.

  12. Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease.

    Science.gov (United States)

    Spitaleri, Giosafat; Tebaldi, Matteo; Biscaglia, Simone; Westra, Jelmer; Brugaletta, Salvatore; Erriquez, Andrea; Passarini, Giulia; Brieda, Alessandro; Leone, Antonio Maria; Picchi, Andrea; Ielasi, Alfonso; Girolamo, Domenico Di; Trani, Carlo; Ferrari, Roberto; Reiber, Johan H C; Valgimigli, Marco; Sabatè, Manel; Campo, Gianluca

    2018-02-01

    The nonculprit lesion (NCL) management in ST-segment-elevation myocardial infarction patients with multivessel disease is debated. We sought to assess whether quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, may be reliable in this scenario. The present proof-of-concept study is based on a 3-step process: (1) identification of the QFR reproducibility in NCLs assessment (cohort A, n=31); (2) prospective validation of QFR diagnostic accuracy in respect to fractional flow reserve (cohort B, n=45); and (3) investigation of long-term clinical outcomes of NCLs stratified according to QFR (cohort C, n=110). A blinded core laboratory computed QFR values for all NCLs. Cohort A showed a good correlation and agreement between QFR values at index (acute) and at staged (subacute, 3-4 days later) procedures ( r =0.98; 95% confidence interval, 0.96-0.99; mean difference, 0.004 [-0.027 to 0.34]). The inter-rater agreement was κ=0.9. In cohort B, fractional flow reserve and QFR identified 16 (33%) and 17 (35%) NCLs potentially flow limiting. Sensitivity, specificity, negative, and positive predictive values were 88%, 97%, 94%, and 94%. The area under the receiver operating characteristics curve was 0.96 (95% confidence interval, 0.89-0.99). Finally, in cohort C, we identified 110 ST-segment-elevation myocardial infarction patients where at least 1 NCL was left untreated. Patients with NCLs showing a QFR value ≤0.80 were at higher risk of adverse events (hazard ratio, 2.3; 95% confidence interval, 1.2-4.5; P =0.01). In a limited and selected study population, our study showed that QFR computation may be a safe and reliable tool to guide coronary revascularization of NCLs in ST-segment-elevation myocardial infarction patients. © 2018 American Heart Association, Inc.

  13. Clinical outcomes after myocardial revascularization according to operator training status: cohort study of 22,697 patients undergoing percutaneous coronary intervention or coronary artery bypass graft surgery.

    Science.gov (United States)

    Jones, Daniel A; Gallagher, Sean; Rathod, Krishnaraj; Jain, Ajay K; Mathur, Anthony; Uppal, Rakesh; Westwood, Mark; Wong, Kit; Rothman, Martin T; Shipolini, Alex; Smith, Elliot J; Mills, Peter G; Timmis, Adam D; Knight, Charles J; Archbold, R Andrew; Wragg, Andrew

    2013-10-01

    Myocardial revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) carries the risk of serious complications. Observational data suggest that outcomes may be improved by experienced operators, but there are few studies that have analysed the relationship between mortality and primary operator grade. The aim of this study was to investigate the effect of operator grade (trainee vs. consultant) upon outcomes of revascularization procedures. This was an observational study at a tertiary cardiology centre with accredited training programmes, between 2003 and 2011. A total of 22 697 consecutive patients undergoing either CABG or PCI were included. Associations between operator grade and mortality were assessed by hazard ratios, estimated by Cox regression analyses; 6689 patients underwent CABG, whereas 16 008 underwent PCI. Trainees performed 1968 (29.4%) CABG procedures and 8502 (53.1%) PCI procedures. The proportion of procedures performed by trainees declined over time for both CABG (30.2% in 2003 vs. 26.0% in 2010) and for PCI (58.1% in 2003 vs. 44.5% in 2010). In the unadjusted Cox analysis, consultant operator grade was associated with an increased 5-year mortality after both CABG [HR: 1.26 (95% CI: 1.07-1.47)] and PCI procedures [HR: 1.34 (95% CI: 1.22-1.47)] compared with a trainee operator. However, following multiple adjustment, consultant grade was no longer associated with mortality after either procedure [CABG: HR: 1.02 (95% CI: 0.87-1.20), PCI: HR: 1.08 (95% CI: 0.98-1.20)]. There was no observed detrimental effect on patient outcomes arising from procedures undertaken by trainees working in a structured training environment compared with consultants.

  14. Cirurgia de revascularização do miocárdio através de minitoracotomia ântero-lateral esquerda Myocardial revascularization surgery through left anterolateral minithoracotomy

    Directory of Open Access Journals (Sweden)

    J. Glauco Lobo Filho

    1996-09-01

    Full Text Available No período de outubro de 1995 a fevereiro de 1996, 16 pacientes selecionados foram submetidos a cirurgia de revascularização do miocárdio através de minitoracotomia ântero-lateral esquerda. Em todos os casos a artéria torácica interna esquerda foi dissecada, para posterior anastomose com o ramo interventricular anterior (RIA sem a utilização de circulação extracorpórea. A idade variou de 43 a 77, com média de 60 anos. Sessenta e dois por cento dos pacientes eram do sexo masculino. Não houve complicações tais como: hemorragias, acidente vascular cerebral, insuficiência renal aguda, mediastinite ou infarto agudo do miocárdio. Não houve mortalidade no grupo em questão. Em 4 (25% pacientes foi realizado estudo hemodinâmico, que demostrou uma normalidade da anastomose da artéria torácica interna para o ramo interventricular anterior. Devido aos excelentes resultados iniciais, acreditamos que este procedimento possa ser empregado com maior freqüência e com a familiarização dos grupos cirúrgicos, e que as artérias diagonais e marginais da circunflexa possam ser beneficiadas com este tipo de procedimento.Between October 1995 and February 1996, sixteen patients were selected to undergo to surgical myocardial revascularization through left anterolateral minithoracotomy. The left internal thoracic artery was dissected in all patients, for consecutive anastomosis with interventricular anterior artery, without using extracorporeal circulation. Patients age ranged from 43 to 77, average 60 years. Sixty-two percent of them were men. There were no complications such as: acute myocardial infarction, mediastinitis, acute renal failure, hemorrhagy or stroke. There were no deaths. Four (25% patients were submitted to cardiac catheterization that showed patency of grafts and grafted native arteries. Due to excellent initial results, the authors believe that this technique can be employed with greater frequency and that its use can be

  15. Whole-brain CT perfusion and CT angiography assessment of Moyamoya disease before and after surgical revascularization: preliminary study with 256-slice CT.

    Directory of Open Access Journals (Sweden)

    Jun Zhang

    Full Text Available BACKGROUND/AIMS: The 256-slice CT enables the entire brain to be scanned in a single examination. We evaluated the application of 256-slice whole-brain CT perfusion (CTP in determining graft patency as well as investigating cerebral hemodynamic changes in Moyamoya disease before and after surgical revascularization. METHODS: Thirty-nine cases of Moyamoya disease were evaluated before and after surgical revascularization with 256-slice CT. Whole-brain perfusion images and dynamic 3D CT angiographic images generated from perfusion source data were obtained in all patients. Cerebral blood flow (CBF, cerebral blood volume (CBV, time to peak (TTP and mean transit time (MTT of one hemisphere in the region of middle cerebral artery (MCA distribution and contralateral mirroring areas were measured. Relative CTP values (rCBF, rCBV, rTTP, rMTT were also obtained. Differences in pre- and post- operation perfusion CT values were assessed with paired t test or matched-pairs signed-ranks test. RESULTS: Preoperative CBF, MTT and TTP of potential surgical side were significantly different from those of contralateral side (P<0.01 for all. All graft patencies were displayed using the 3D-CTA images. Postoperative CBF, rCBF and rCBV values of surgical side in the region of MCA were significantly higher than those before operation (P<0.01 for all. Postoperative MTT, TTP, rMTT and rTTP values of the surgical side in the region of MCA were significantly lower than those before operation (P<0.05 for all. CONCLUSION: The 256-slice whole-brain CTP can be used to evaluate cerebral hemodynamic changes in Moyamoya disease before and after surgery and the 3D-CTA is useful for assessing the abnormalities of intracranial arteries and graft patencies.

  16. Whole-brain CT perfusion and CT angiography assessment of Moyamoya disease before and after surgical revascularization: preliminary study with 256-slice CT.

    Science.gov (United States)

    Zhang, Jun; Wang, Jianhong; Geng, Daoying; Li, Yuxin; Song, Donglei; Gu, Yuxiang

    2013-01-01

    The 256-slice CT enables the entire brain to be scanned in a single examination. We evaluated the application of 256-slice whole-brain CT perfusion (CTP) in determining graft patency as well as investigating cerebral hemodynamic changes in Moyamoya disease before and after surgical revascularization. Thirty-nine cases of Moyamoya disease were evaluated before and after surgical revascularization with 256-slice CT. Whole-brain perfusion images and dynamic 3D CT angiographic images generated from perfusion source data were obtained in all patients. Cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP) and mean transit time (MTT) of one hemisphere in the region of middle cerebral artery (MCA) distribution and contralateral mirroring areas were measured. Relative CTP values (rCBF, rCBV, rTTP, rMTT) were also obtained. Differences in pre- and post- operation perfusion CT values were assessed with paired t test or matched-pairs signed-ranks test. Preoperative CBF, MTT and TTP of potential surgical side were significantly different from those of contralateral side (P<0.01 for all). All graft patencies were displayed using the 3D-CTA images. Postoperative CBF, rCBF and rCBV values of surgical side in the region of MCA were significantly higher than those before operation (P<0.01 for all). Postoperative MTT, TTP, rMTT and rTTP values of the surgical side in the region of MCA were significantly lower than those before operation (P<0.05 for all). The 256-slice whole-brain CTP can be used to evaluate cerebral hemodynamic changes in Moyamoya disease before and after surgery and the 3D-CTA is useful for assessing the abnormalities of intracranial arteries and graft patencies.

  17. Influence of multivessel disease with or without additional revascularization on mortality in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Terkelsen, Christian Juhl; Horváth-Puhó, Erzsébet

    2015-01-01

    BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), timely reperfusion with primary percutaneous coronary intervention (PCI) is the preferred treatment. In primary PCI patients with multivessel disease, it is unclear whether culprit vessel PCI only is the preferred...... consisted of 8,822 patients: 4,770 (54.1%) had single-vessel disease and 4,052 (45.9%) had multivessel disease. Overall, 1-year cumulative mortality was 7.6%, and 7-year cumulative mortality was 24.0%. Multivessel disease was associated with higher 7-year mortality (adjusted HR 1.45 [95% CI 1.30-1.62], P...... 7-year mortality (adjusted HR 1.50 [95% CI 1.25-1.80], P 7-year mortality...

  18. Off-pump myocardial revascularization safety aspects in combined operations on patients with ischemic heart disease complicated by ischemic mitral regurgitation

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    A. S. Zavologhin

    2017-11-01

    Full Text Available Aim. The issues of safety of off-pump myocardial revascularization in patients with severe ischemic mitral regurgitation remain insufficiently studied. Control of transport and oxygen consumption allows one to assess some of the safety aspects of this technique. The study was designed to evaluate the safety of myocardial revascularization without cardiopulmonary bypass in a combined operation for patients with ischemic mitral regurgitation and a similar operation under cardiopulmonary bypass and cardioplegia by assessment of the main parameters of transport and oxygen consumption.Methods. Forty-two adult patients scheduled for elective coronary artery bypass grafting in combination with mitral annuloplasty were randomized into two groups: off-pump (22 patients and on-pump (20 patients. In the off-pump group, coronary artery bypass grafting was performed on a beating heart without cardiopulmonary bypass, whereas in the on-pump group it was conventional coronary artery bypass grafting on a cardiopulmonary bypass with cardiac arrest. The coronary artery bypass grafting stage was performed before intervention on the mitral valve.Results. On completion of the coronary artery bypass grafting stage, the cardiac index, the oxygen delivery index and the blood lactate level in the off-pump group were lower than those in the on-pump group by 20%, 17% and 100% (p = 0.01, 0.02, 0.003, respectively, while the consumption index and oxygen extraction were higher by 17% and 94% (p = 0.016 and 0.0001, respectively. In the off-pump group, the oxygen consumption index remained stable at all stages of the operation and the C-reactive protein level tended to decrease between 10–14 days after surgery (p = 0.13.Conclusion. Implementation of off-pump coronary surgery in a combined operation for patients with ischemic mitral regurgitation does not lead to disruption of transport and oxygen consumption, does not exacerbate the systemic inflammatory response and can be

  19. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization

    DEFF Research Database (Denmark)

    Roe, Matthew T; Armstrong, Paul W; Fox, Keith A A

    2012-01-01

    The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated.......The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated....

  20. Influence of ischemic preconditioning in myocardial protection in patients undergoing myocardial revascularization with intermittent crossclamping of the aorta. Analysis of ions and blood gases

    Directory of Open Access Journals (Sweden)

    Fernandes Paulo Manuel Pêgo

    2001-01-01

    Full Text Available OBJECTIVE: To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. METHODS: In the control group (18 patients, surgery was performed with systemic hypothermia at 32ºC and intermittent crossclamping of the aorta. Extracorporeal circulation was used. In the preconditioning group (17 patients, 2 crossclampings of the aorta lasting 3min each were added prior to the intermittent crossclamping of the conventional technique with an interval of 2min of reperfusion between them. Blood samples for analyses of pH, pCO2, pO2, sodium, potassium, calcium, and magnesium were obtained from the coronary sinus at the beginning of extracorporeal circulation (time 1, at the end of the first anastomosis (time 2, and at the end of extracorporeal circulation (time 3. RESULTS: No difference was observed in the results of the 2 groups, except for a variation in the ionic values in the different times of blood withdrawal; sodium values, however, remained stable. All patients had a good clinical outcome. CONCLUSION: The results of intermittent crossclamping of the aorta with moderate hypothermia were not altered by the use of ischemic preconditioning.

  1. Cirurgia de revascularização do miocárdio associada a endarterectomia de carótida Combined operation for myocardial revascularization and carotid endarterectomy

    Directory of Open Access Journals (Sweden)

    Januário M Souza

    1995-03-01

    RM, sendo a outra carótida operada em segundo tempo (em torno de uma semana. Considerando que nenhum dos pacientes apresentou AVC transoperatório, achamos ser a conduta adequada para essa associação de lesões.There are still controversies about the treatment of associated coronary artery disease and carotid artery obstruction. Between 1979 and 1994, 10940 patients were operated on for myocardial revascularization. Combined operations (myocardial revascularization and carotid endarterectomy were done in 46 (0.43% patients, during the same period. Patients age ranged from 48 to 76 years with an average of 65.2 yrs; 80.4% were male; 23 had had previous myocardial infarction. Associated diseases were diabetes mellitus in 10 patients, chronic renal insufficiency in 5; 29 were in functional class 111 or IV for angina; 4 patients had congestive cardiac insufficiency: left main carotid obstruction, and in 4 of them one carotid artery was completaly obstructed; 23 patients had had transient cerebral ischemic attack and 2 had had stroke with sequelae. Hospital mortality was 8.6% (4/46. Permanent stroke did not occur in the operative period; 3 of the 4 deaths occurred in patients 70 years or older. Carotid endarterectomy was done just before cardiopulmonary bypass in 42 patients and in 4 patients with one of the carotid arteries occluded, done after cardiopulmonary bypass was established and the patient temperature was 25ºC. Considering that no patient had perioperative stroke, we think that this strategy is adequate for this association of diseases.

  2. Surgical Repair of Post-Infarct True Posterobasal Ventricular Aneurysm with Mitral Valve Replacement and Coronary Revascularization: a Case Report

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    Dasarathan Charumathi

    2012-03-01

    Full Text Available Post-infarction ventricular aneurysm is a complication of myocardial infarction. While the involvement of the anterior wall is quite common, posterobasal left ventricular aneurysm is a rare clinical complication in this setting. In this case report, we report a post-infarction posterobasal left ventricular aneurysm combined with ischemic mitral regurgitation due to coronary artery disease, for which we successfully performed triple coronary artery bypass and ventricular geometry restitution via a modified Dor’s procedure with mitral valve replacement through an extracardiac approach.1

  3. Current state and future direction of hybrid coronary revascularization

    NARCIS (Netherlands)

    Harskamp, Ralf E.

    2015-01-01

    The most optimal revascularization strategy in patients with multivessel coronary artery disease is a subject of ongoing debate. Hybrid coronary revascularization (HCR) aims to combine the advantages of both percutaneous and surgical revascularization in a single strategy. This review provides a

  4. Papillary muscle rupture following acute myocardial infarction: Anatomic, echocardiographic, and surgical insights.

    Science.gov (United States)

    Harari, Rafael; Bansal, Priya; Yatskar, Leonid; Rubinstein, David; Silbiger, Jeffrey J

    2017-11-01

    Papillary muscle (PM) rupture is a rare complication of acute myocardial infarction which carries an excessive mortality rate. Optimal outcomes require rapid diagnosis and prompt surgical referral, and in this regard, echocardiography plays a crucial role. Comprehensive echocardiographic examination of the patient with PM rupture consists of identification of the ruptured PM segment, visualization of flail mitral valve segment(s), evaluation of mitral regurgitation severity, and assessment of left ventricular systolic function. This article discusses anatomic and echocardiographic features as well as the surgical management of PM rupture. © 2017, Wiley Periodicals, Inc.

  5. Revascularization strategy in patients with multivessel disease and a major vessel chronically occluded; data from the CABRI trial.

    Science.gov (United States)

    Martuscelli, Eugenio; Clementi, Fabrizio; Gallagher, Mark M; D'Eliseo, Alessia; Chiricolo, Gaetano; Nigri, Antonio; Marino, Benedetto; Romeo, Francesco

    2008-01-01

    In patients with multivessel coronary artery disease and total occlusion of major epicardial vessel, completeness of revascularization has not been investigated in specific trials comparing the surgical and the percutaneous revascularization strategy. Analyzing the database of the CABRI study, which randomized a substantial number of these patients, we investigated the long-term effects of a successful or unsuccessful revascularization of the occluded vessel and completeness of the revascularization. The CABRI study randomized 1054 patients with multivessel coronary disease to coronary bypass or to coronary angioplasty. From the database of this trial, we selected patients with a major vessel chronically occluded (103 in the bypass group and 120 in the angioplasty group). At a median follow-up of 30 months, the incidence of death or Q-wave myocardial infarction (combined end point) was significantly lower in the bypass group than in the angioplasty group (6.8% vs 17.5%, respectively; hazard ratio [HR], 0.42 [95% CI 0.17-0.98]; p=0.047). On univariate analysis, age, proximal occlusion, complete revascularization, revascularization of the occluded vessel and revascularization procedure were identified as significant predictors of combined end points. On multivariate analysis, independent predictors of combined end points resulted in completeness of revascularization (HR 0.26; 95% CI 0.09-0.76; p=0.01) and age (HR 1.07; 95% CI 1.02-1.12; p<0.01). In patients with multivessel coronary disease and chronic occlusion of a major epicardial vessel, achieving of a complete revascularization by reopening or bypassing the occluded vessel is associated with a significantly better long-term prognosis.

  6. Is there evidence supporting coronary revascularization in patients with left ventricular systolic dysfunction?

    International Nuclear Information System (INIS)

    Ammirati, E.; Camici, P.G.; Rimoldi, O.E.

    2010-01-01

    The mid- and long-term outcomes of revascularization procedures in patients with chronic left ventricular (LV) systolic dysfunction due to coronary artery disease (CAD) in the presence or absence of heart failure (HF) symptoms are still uncertain. The identification of dysfunctional myocardial segments with residual viability that can improve after revascularization is pivotal for further patient management. Hibernating myocardium (id est (ie), chronically dysfunctional but still viable tissue) can be identified by positron emission tomography (PET) and cardiac magnetic resonance (CMR) and its presence and extent can predict functional recovery after revascularization. Before β-blockers were introduced as routine care for HF, surgical revascularization appeared to improve survival in these patients. Nowadays, novel medical treatments and devices, such as cardiac-resynchronization therapy and implantable cardioverter-defibrillators, have improved the prognosis of HF patients and their use is supported by a number of clinical trials. To adequately address the unresolved issue of the prognostic benefits of coronary revascularization in CAD patients with chronic LV dysfunction on optimal medical therapy with/without devices a randomized trial is warranted. In such a trial the presence of viability will be assessed by either PET or CMR. This is an overview of the pathophysiological mechanisms, as well as of the main clinical studies and meta-analyses that have addressed this issue in the past 4 decades. (author)

  7. Complete versus incomplete revascularization with drug-eluting stents for multi-vessel disease in stable, unstable angina or non-ST-segment elevation myocardial infarction: A meta-analysis.

    Science.gov (United States)

    Ando, Tomo; Takagi, Hisato; Grines, Cindy L

    2017-08-01

    To determine whether drug-eluting stent (DES) coronary complete revascularization (CR) confers clinical benefit over incomplete revascularization (IR) in patients with multivessel coronary artery disease (MVD). Clinical benefit of CR over IR in patients with MVD with angina (both stable and unstable) and non-ST-segment elevation myocardial infarction (NSTEMI) in DES has not been well studied. We conducted a systematic online literature search of PUBMED and EMBASE. Literatures that compared the clinical outcomes between CR and IR with exclusively or majority (>80%) using DES in patients without or included only small portion (meta-analysis. CR was associated with lower incident of all-cause mortality (HR 0.71, P = 0.001), major adverse events (HR 0.75, P Meta-regression analysis showed that CR significantly reduced the risk of all-cause mortality in advanced age, triple vessel disease and male sub-groups. CR with DES conferred favorable outcomes compared to IR in MVD patients with stable, unstable angina or NTEMI. Further research to achieve higher CR in MVD patients may lead to improvement in prognosis in these cohorts. © 2017, Wiley Periodicals, Inc.

  8. Fatores prognósticos da revascularização na fase aguda do infarto agudo do miocárdio Prognostic factors of myocardial revascularization in acute myocardial infaction

    Directory of Open Access Journals (Sweden)

    Fabio B. JATENE

    2001-09-01

    Full Text Available OBJETIVO: Determinar os fatores preditores de má evolução nos pacientes submetidos a revascularização do miocárdio (RM na fase aguda do infarto do miocárdio (IAM. CASUÍSTICA E MÉTODOS: No período de março de 1998 a novembro de 1999, 49 pacientes foram submetidos a RM na fase aguda do IAM. Foram excluídos pacientes portadores de complicações mecânicas do IAM e submetidos a procedimentos associados a RM. Os pacientes foram divididos em: Grupo I - 29 casos que não apresentaram complicações decorrentes do IAM e Grupo II - 20 casos com uma ou mais complicações. As complicações consideradas foram: isquemia recorrente (18 pacientes, insuficiência cardíaca congestiva (11, choque cardiogênico (9, hipotensão (7, reinfarto (4, taquicardia ventricular sustentada (4 e fibrilação ventricular (3. Os grupos foram considerados comparáveis em relação às características pré-operatórias, exceto pela idade mais avançada no grupo II. No intuito de identificar os fatores determinantes de pior prognóstico pós-operatório, foram correlacionadas e analisadas as características dos pacientes e as complicações do IAM, estudados pelo teste de variância e análise multivariada. RESULTADOS: A mortalidade global foi de 6,12% (3 pacientes, sendo somente no grupo II. A análise multivariada identificou como fatores preditores de mortalidade hospitalar a hipotensão arterial (p=0,045, o choque cardiogênico (p=0,001 e a fibrilação ventricular (p=0,012. CONCLUSÕES: A RM na fase aguda do IAM é um procedimento seguro em pacientes sem complicações, sem mortalidade operatória. A presença de complicações pré-operatórias como choque cardiogênico, fibrilação ventricular e hipotensão são considerados fatores de mau prognóstico nesta condição.OBJECTIVES: To determine the predictors of bad evolution in patients submitted to myocardial revascularization (MR in the acute myocardial infarction (AMI. MATERIAL E METHODS: Between March

  9. Coronary angiography and myocardial revascularization following the first acute myocardial infarction in Norway during 2001-2009: Analyzing time trends and educational inequalities using data from the CVDNOR project.

    Science.gov (United States)

    Sulo, Enxhela; Nygård, Ottar; Vollset, Stein Emil; Igland, Jannicke; Sulo, Gerhard; Ebbing, Marta; Egeland, Grace M; Hawkins, Nathaniel M; Tell, Grethe S

    2016-06-01

    We analyzed trends in the utilization of coronary angiography and revascularization - including percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) - related to the first AMI and explored potential educational inequalities in such procedures. All first AMI patients aged 35-89, hospitalized during 2001-2009 were retrieved from 'The Cardiovascular Disease in Norway' project. Information on education was obtained from The Norwegian Education Database. Gender and age group-specific trends in coronary procedures were analyzed using Joinpoint regression. Educational inequalities were explored using multivariable Poisson regression and reported as incidence rate ratios (IRR). A total of 104 836 patients (37.3% women) were included. Revascularization rates increased on average 9.0% and 15.4% per year among younger (35-64years) and older (65-89years) men. Corresponding increases among women were 5.6% and 16.6%. Compared to patients with primary education only, those with secondary and tertiary education had 8% (IRR=1.08, 95% CI; 1.06-1.10) and 12% (IRR=1.12, 95% CI; 1.09-1.14) higher revascularization rates. Educational inequalities were entirely driven by educational differences in receiving coronary angiography (IRR=1.10, 95% CI; 1.08-1.11 for secondary versus primary and IRR=1.14, 95% CI; 1.12-1.16 for tertiary versus primary education level.) Among diagnosed patients, no educational differences were observed in coronary revascularization rates. Revascularization rates increased whereas educational differences in revascularization decreased among AMI patients in Norway during 2001-2009. Lower coronary revascularization rates among patients with low education were explained by educational differences in receiving coronary angiography. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Multi-center randomized trial on the impact of “CONFIDENCE” communication program aimed at evaluating therapy adherence of patients with registered myocardial infarction who underwent successful revascularization by stenting or thrombolysis after discharg

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    А. Р. Таркова

    2017-04-01

    Full Text Available Aim. The article looks at the effect of the program "Confidence" to increase the proportion of patients’ therapy in patients with coronary heart disease for two years after successful revascularization using thrombolytic or stenting of the coronary arteries on the myocardial infarction.Methods. This is a prospective, randomized, controlled, parallel-group trial including 4.000 patients. They will be divided into two groups: patients receiving standard outpatient observation (n=2000 and those enrolled for the program "Confidence" (n=2000. The total duration is 24 months. The trial will take place in two stages. In the first stage (0-12 months the impact of the program "Confidence" on therapy adherence and outcomes of cardiovascular diseases will be assessed. In the second stage (after the change of groups in 12 months, 12-24 months the effect of changing the way to remind patients of therapy adherence will be evaluated.Conclusion. The trial was designed in such a way as to show that the proposed program "Confidence" increases the proportion of patients who adhere to therapy in the cohort of those with coronary heart disease for two years after successful revascularization by using thrombolytic or stenting of the coronary arteries against the background of myocardial infarction.Received 13 February 2017. Accepted 9 March 2017.Financing: KRKA company’s grant. Sponsorship had no effect on data acquisition, analysis and interpretation.Conflict of interest: Kretov E.I. served as executive editor of “Endovascular surgery” section. All other authors declare no conflict of interest.Author contributionsStudy conception and design: Kretov E.I., Grazhdankin I.O., Baystrukov V.I., Zubarev D.D. Statistical data processing: Krestyaninov O.V., Kozyr K.V., Obedinskiy A.A., Prokhorikhin A.A.Drafting the article: Tarkova A.R., Anisimova V.D.Critical revision: Tarkova A.R., Anisimova V.D., Kretov E.I.

  11. B-type natriuretic peptide as predictor of heart failure in patients with acute ST elevation myocardial infarction, single-vessel disease, and complete revascularization: follow-up study.

    LENUS (Irish Health Repository)

    Manola, Sime

    2012-01-31

    AIM: To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization. METHODS: Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or near-normal left ventricular ejection fraction (> or =50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year. RESULTS: Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (> or =80 pg\\/mL) at 24 hours (P=0.001) and 7 days (P=0.020) after STEMI and successful reperfusion. Patients who had BNP levels > or =80 pg\\/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P=0.008). CONCLUSION: BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission.

  12. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

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    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  13. Infecções do esterno pós revascularização do miocárdio: tratamento com retalhos miocutâneos e musculares Sternal infections after myocardial revascularization: treatment by myocutaneous and muscle flaps

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    Rubens T. de Barros

    1989-08-01

    Full Text Available No período de outubro de 1986 a janeiro de 1989, realizamos 445 esternotomias, sendo 158 para revascularização do miocárdio; em 92 pacientes, a artéria mamária interna esquerda (AMIE foi utilizada. Dos 445 casos, sete pacientes tiveram infecção do esterno no período pós-operatório imediato. O tempo médio de aparecimento foi de 8,7 dias (4-15 dias, sendo que seis pacientes eram do sexo masculino e a idade média foi de 48,8 anos (35-60 anos. Em todos os casos, os pacientes estavam sendo submetidos à primeira cirurgia, tendo como possíveis fatores associados diabete (um caso, embolia pulmonar com insuficiência respiratória (um caso, síndrome de baixo débito (três casos, cirurgia prolongada (um caso e dissecção da AMIE (seis casos. Na correção desta complicação, a associação de técnicas de cirurgia plástica, com a utilização de retalhos miocutâneos ou musculares, permitiu mais rápida recuperação dos pacientes, sem que tivéssemos óbitos nesta série. Os resultados estético e funcional foram considerados excelentes, com três pequenas deiscências tratadas ambulatorialmente. A identificação do germe através de cultura e a orientação do tratamento pelo antibiograma também se mostraram de grande importância, ao lado das técnicas cirúrgicas empregadas. Concluindo, julgamos que a intervenção precoce e agressiva nas infecções do esterno contribuiu, efetivamente, na queda da morbi-mortalidade desta complicação.During the period of October 1986 to January 1989 we executed 445 sternotomies; 158 of these were for myocardial revascularization. In 92 cases the left internal mammary artery (LIMA was used. Of 445 cases, 7 patients developed sternal infection in the immediate post operative period. The average time for the infection to appear was 8.7 days (4-15 days. Of these, 6 patients were male with an average age of 48.8 years (35-60 years. All cases were first operations; complicating factors were diabetes

  14. Variabilidade da frequência cardíaca e infecções pulmonares pós revascularização miocárdica Variabilidad de la frecuencia cardíaca e infecciones pulmonares post revascularización miocárdica Heart rate variability and pulmonary infections after myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Paulo Rogério Corrêa

    2010-10-01

    ón. El análisis de la VFC por métodos de dinámica no lineal en el período pre-operatorio de la cirugía de revascularización del miocardio podría ser predictora de morbilidad en el post-operatorio, como por ejemplo, infecciones pulmonares. OBJETIVO: Evaluar el comportamiento de la VFC por la dinámica no lineal, en el período pre-operatorio de la cirugía de revascularización del miocardio y su relación con la ocurrencia de infecciones pulmonares en el período post-operatorio intrahospitalario. MÉTODOS: Fueron evaluados 69 pacientes (media de edad de 58,6 ± 10,4 años con enfermedad arterial coronaria e indicación electiva de cirugía de revascularización del miocardio. Para cuantificar la dinámica no lineal de la VFC, fueron realizados: análisis de las fluctuaciones depuradas de tendencias (DFA, sus componentes de corto (α1 y largo (α2 plazos, entropía aproximada (-ApEn, exponente de Lyapunov (LE, y exponente de Hurst (HE de series tiemporales de los intervalos RR del ECG, captados con equipamiento Polar S810i, en la víspera de la operación. RESULTADOS: En los niveles de corte estipulado por la curva ROC, hubo diferencia significativa entre los grupos con y sin infecciones pulmonares en el post-operatorio de revascularización del miocardio para la DFA total, entropía aproximada y exponente Lyapunov con p = 0, 0309, p = 0,0307 y p = 0,0006, respectivamente. CONCLUSIÓN: Los métodos de dinámica no lineal, en sus respectivos niveles de corte, permitieron diferenciar los casos que evolucionaron con infección pulmonar en el post-operatorio de cirugía de revascularización del miocardio, sugiriendo que, en ese grupo de pacientes, estos métodos pueden tener carácter pronóstico.BACKGROUND: Heart rate variability (HRV is a noninvasive diagnostic method used in the assessment of the autonomic modulation of the heart. The assessment of HRV using nonlinear dynamics methods in the preoperative period of surgical myocardial revascularization could be

  15. CONDUCCIÓN ANESTÉSICA DE LA REVASCULARIZACIÓN MIOCÁRDICA VIDEO-ASISTIDA. INFORME DE CINCO CASOS / Anesthetic conduction of video-assisted myocardial revascularization. Report of five cases

    Directory of Open Access Journals (Sweden)

    Elizabeth Rodríguez Rosales

    2011-06-01

    Full Text Available The advantages of video-assisted cardiac surgery are very necessary for high-risk patients, but subjecting them to possible complications is a big responsibility and a challenge for the cardiovascular anesthesiologist. This article presents the first five cases of video-assisted coronary artery bypass grafting in the country, and describes the anesthetic techniques and results. Also, the advantages of this surgical technique are discussed: less invasive, less postoperative pain, less duration of postoperative intubation and ventilation, minimal risk of infection and bleeding, reduced need for transfusions, and better healing and aesthetics of the wound. It was concluded that although this series is small, we consider it a good option for patients with ischemic heart disease and a single-vessel (anterior descending artery revascularization criterion, not accessible to intervention.

  16. PREVENTION OF COMPLICATIONS CAUSED BY MYOCARDIAL ISCHEMIA-REPERFUSION IN NONCARDIAC SURGICAL PROCEDURES

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    I. A. Kozlov

    2016-01-01

    Full Text Available In the next 20 years, the aging population will be a major factor affecting the characteristics of perioperative anesthesia tactics. Domestic researchers have reported that the incidence of cardiac complications after general surgical procedures in patients with middle and old age is 9.1%, and mortality in these complications reached 45.5%. Analyzed current data on myocardial ischemia-reperfusion, the etiopathogenesis of perioperative cardiac complications, recurrence of their development and the possible consequences. It is concluded that prevention and timely treatment of complications resulting from ischemia-reperfusion of the myocardium, with noncardiac surgical interventions is an important tactical (prevention of perioperative myocardial infarction, arrhythmias, cardiac death and policy (prevention of cardiac remodeling and post-hospital disability of patients anaesthesiological tasks. Research carried out in the Nrgovsky Research Institute of General Reanimatology showed that in the real practice Detsky index, Lee index and echocardiographic left ventricular ejection fraction did not provide high accuracy prediction of cardiac events. More informative proved preoperative determination of blood N-terminal part of the pro-brain natriuretic peptide (NT-proBNP. In assessing the predictive ability of NT-proBNP area under the ROC-curve achieved 0.86. NT-proBNP value 358 pg/ml and above provided 77% sensitivity and 85% specificity. The comparative assessment and recommendations on the use to reduce the risk of cardiac complications of β-blockers, statins, calcium channel blockers, nitrates, clonidine, dexmedetomidine, levosimendan and phosphocreatine. Phosphocreatine, introduced in practice domestic cardiac surgery and transplantology more than 20 years ago, continues to be studied and used at the moment. Recently demonstrated that perioperative phosphocreatine usage appointment in older oncological patients with a high risk of cardiac

  17. Long-term treatment with a platelet glycoprotein-receptor antagonist after percutaneous coronary revascularization. EXCITE Trial Investigators. Evaluation of Oral Xemilofiban in Controlling Thrombotic Events.

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M. Knudtson; G.A. van Es (Gerrit Anne); G.C. Timmis; C. van der Zwaan (Coen); J. Kleiman; J. Gong (Jianjian); E.B. Roecker; R. Dreiling; J.C. Alexander (John); R.J. Anders (Robert); W.W. O'Neill (William)

    2000-01-01

    textabstractBACKGROUND: When administered intravenously at the time of percutaneous coronary revascularization, glycoprotein IIb/IIIa receptor antagonists decrease the incidence of death and nonfatal myocardial infarction and the need for urgent revascularization. We hypothesized that long-term

  18. Persistent socio-economic differences in revascularization after acute myocardial infarction despite a universal health care system-a Danish study

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe Nørgaard; Rasmussen, Søren; Gislason, Gunnar H

    2007-01-01

    , but not for acute PCI, for which no gradient was seen. No educational gradient was found for CABG, and that for non-acute and acute PCI decreased during the period; by the end of the period, more patients with low than high education received acute PCI. CONCLUSION: In the universal health care system of Denmark...... AND METHODS: All patients aged 30-74 years in hospital for a first AMI in Denmark between 1996 and 2004 were included. Cox proportional hazard models were used to estimate the association between individual income (tertiles) and education (>12, 10-12 and ... months. Revascularization was stratified into CABG, acute PCI (within 2 days of admission) and non-acute PCI (after the third day). RESULTS: A total of 38,803 patients were included. In 1996-1998, 6.8% received CABG, 9.3% non-acute PCI and 2.4% acute PCI; in 2002-2004, these numbers were 11.8, 36...

  19. Educational manual for the care of patients in the post-operative period of myocardial revascularization: a tool for patients and families

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    Luana Llagostera Sillano Gentil

    2017-11-01

    Full Text Available An educational manual for the self-care of revascularized patients after hospital discharge was created. It is a methodological study whose data collection occurred between February and April, 2012, with eight cardiology experts and 35 patients/families. Content and face validation were conducted with eight patients/families and eight experts. Of the proposed 46 items, patients/families rated 26 items (57% as very important (agreement between 91.4% and 100% and experts rated 29 items (63% as very important (agreement equal to or over 75%. Thirty-six items, distributed in 26 categories, were selected for the final manual. There was 100% agreement between patients/families regarding content, language, and illustrations. The tool presented semantic validity and content adequacy for the population, because it was able to reduce complications resulting from lack of training for self-care, thus reducing the number of readmissions and hospital costs, in addition to systematizing post-operative teaching.

  20. Prevalence and prognostic implications of non-sustained ventricular tachycardia in ST-segment elevation myocardial infarction after revascularization with either fibrinolysis or primary angioplasty

    DEFF Research Database (Denmark)

    Høfsten, Dan Eik; Wachtell, Kristian; Lund, Birgit

    2007-01-01

    AIMS: We compared the prevalence and prognostic implications of non-sustained ventricular tachycardia (nsVT) detected early after ST-segment elevation myocardial infarction (STEMI) in patients randomized to either fibrinolysis or primary angioplasty in the DANAMI-2 trial. METHODS AND RESULTS...... for STEMI does not affect the subsequent prevalence of nsVT when compared with fibrinolysis. After adjustment for other relevant risk factors, the prognostic value of nsVT detected early after STEMI is limited, regardless of the chosen reperfusion strategy....

  1. Primeros resultados comparativos de dos vías de abordajes de cirugía de revascularización coronaria mínimamente invasiva First comparative results from two-ways surgical approaches of minimally-invasive coronary revascularization

    Directory of Open Access Journals (Sweden)

    Alejandro Villar Inclán

    2010-12-01

    menores por esta vía que por la habitual, e igualmente son significativos los resultados en cuanto a estadía hospitalaria y uso de hemoderivados, por lo cual proponemos continuar trabajando en la estabilización de esta nueva vía de cirugía coronaria en nuestro servicio.INTRODUCTION. The objective of present paper was to expose and to compare the results from two-ways different approaches (left anterior thoracotomy and longitudinal medium sternotomy for myocardial revascularization with the heart beating carried out in the "Hermanos Ameijeiras" Clinical Surgical Hospital between September, 2007 (when this technique was introduced by thoracotomy and January, 2008. METHODS. A longitudinal, descriptive and prospective study was conducted to compare the results depending on the surgical approach for minimally invasive myocardial revascularization: usual route, by longitudinal medium sternotomy (29 operated on, 65,9% and the new rout and unusual by left anterior thoracotomy (15 operated on, 34,1%. RESULTS. The average of shunts carried out was of 3,31 by sternotomy and of 3 by thoracotomy. The 96,6^ and the 26,7% of operated on sternotomy and thoracotomy, respectively need blood transfusions which was statistically significant. The use of inotropic drugs and of intra-aortic balloon counterpulsation hasn't statistical significance. The usual surgical time in both techniques was of 5 to 7 h, whereas the intubation was greater in patients operated on using sternotomy (11-14 h versus 3-6 h in the thoracotomy. The hospital stay was greater in the cases of sternotomy ( 3-4 days versus 1-2 days in those of sternotomy. There weren't statistical difference when complications and mortality were compared. CONCLUSIONS. The approach route using thoratocomy for myocardial revascularization is a alternative, effective and safe technique. It is possible to carry out a complete myocardial revascularization without compromising the procedure safe and he anastomoses quality. The costs are

  2. Análise prospectiva de risco em pacientes submetidos à cirurgia de revascularização miocárdica Prospective risk analysis in patients submitted to myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Mugayar Bianco

    2005-10-01

    Full Text Available OBJETIVO: Análise estratificada de risco em Cirurgia de Revascularização Miocárdica (CRVM. MÉTODOS: Estudou-se, de forma prospectiva, 814 pacientes, aplicando-se dois índices prognósticos (IP: Parsonnet e Higgins Modificado. O IP Higgins foi Modificado por substituição da variável "valor do índice cardíaco" por "síndrome de baixo débito cardíaco", na admissão à Unidade de Terapia Intensiva (UTI. A capacidade discriminatória para morbimortalidade de ambos foi analisada através de curva ROC (receiver operating characteristic. Identificou-se, através de regressão logística, os fatores associados, de forma independente aos eventos. RESULTADOS: A taxa de mortalidade foi de 5,9% e a de morbidade, 35,5%. O IP Higgins Modificado, que analisa variáveis pré, intra-operatórias e variáveis fisiológicas na admissão à UTI, demonstrou áreas sob a curva ROC de 77% para mortalidade e de 67%, para morbidade. Por sua vez, o IP Parsonnet, que analisa somente variáveis pré-operatórias, demonstrou áreas de 62,2% e 62,4%, respectivamente. Doze variáveis caracterizaram-se como fatores prognósticos independentes: idade, diabete melito, baixa superfície corpórea, creatinina (>1,5 mg/dl, hipoalbuminemia, cirurgia não-eletiva, tempo prolongado de circulação extracorpórea (CEC, necessidade de balão intra-aórtico pós-CEC, síndrome de baixo débito cardíaco na admissão do paciente à UTI, freqüência cardíaca elevada, queda do bicarbonato sérico e alargamento do gradiente alvéolo-arterial de oxigênio nesse período. CONCLUSÃO: O IP Higgins Modificado mostrou-se superior ao IP Parsonnet na estratificação de risco cirúrgico, salientando a importância da análise de eventos intra-operatórios e variáveis fisiológicas na admissão do paciente à UTI, quando da definição prognóstica.OBJECTIVE: To perform a stratified risk analysis in Myocardial Revascularization Surgery (MRS. METHODS: 814 patients were prospectively

  3. The contrast media and nephrotoxicity following coronary revascularization by primary angioplasty for acute myocardial infarction study: design and rationale of the CONTRAST-AMI study.

    Science.gov (United States)

    Bolognese, Leonardo; Falsini, Giovanni; Grotti, Simone; Limbruno, Ugo; Liistro, Francesco; Carrera, Arcangelo; Angioli, Paolo; Picchi, Andrea; Ducci, Kenneth; Pierli, Carlo

    2010-03-01

    Contrast-induced acute kidney injury (CI-AKI) is a complex syndrome of acute renal failure occurring after the administration of contrast media and contributing to prolonged hospital stay and mortality. The risk of CI-AKI is higher among patients undergoing primary percutaneous coronary interventions for acute myocardial infarction (AMI), but its clinical relevance in such setting has only been evaluated by small sample size single-center studies and retrospective or observational analyses. Furthermore, whereas high-osmolar contrast media was shown to have direct nephrotoxicity, the role of low-osmolar and iso-osmolar agents is still debated. The CONTRAST-AMI study is a prospective, multicenter, controlled, randomized, single-blind, parallel-group trial, designed to show the noninferiority of the effects of iopromide (low-osmolar) compared with iodixanol (iso-osmolar) contrast media on the incidence of CI-AKI and tissue-level perfusion in patients with AMI. All consecutive patients admitted to participating centers for ST-segment elevation AMI undergoing primary percutaneous coronary intervention will be enrolled. All patients will be treated with high-dose N-acetylcysteine (1200 mg intravenously during the procedure and 1200 mg orally two times daily for the next 48 h after percutaneous coronary intervention) and hydration according to a standardized protocol. The primary endpoint is the proportion of patients with a relative increase in serum creatinine (sCr) of at least 25% from baseline to 72 h after agent administration. The secondary endpoints are absolute and relative increases in sCr of at least 50%, thrombolysis in myocardial infarction (TIMI) perfusion grade, and major adverse cardiac events at 1, 6, and 12 months. The CONTRAST-AMI study will provide information on the effects of iodixanol and iopromide on the incidence of CI-AKI and tissue-level perfusion in patients with AMI.

  4. [Diagnostic and therapeutic alternatives in perioperative acute myocardial ischemia in heart surgery].

    Science.gov (United States)

    Bueno-González, A M; Pérez-Vela, J L; Hernández, F; Renes, E; Arribas, P; Corres, M A; Gutiérrez, J; Perales, N

    2010-01-01

    Ischemia and infarct after surgical revascularization are a relatively frequent complication, with high morbidity and mortality. Early diagnosis is essential. However, this is less standardized and more complicated to diagnose than in patients who have not undergone surgery since there is no specific biomarker that allows the clinician to differentiate between myocardial ischemia due to the procedure itself and myocardial damage due to perioperative infarct. Once detected, perioperative ischemia should be treated immediately in order to limit myocardial damage. The objectives of this study have been 1. To show the diagnostic criteria for perioperative infarct and ischemia. 2. to show the different therapeutic options available. 3. to propose a treatment algorithm that includes the differential diagnosis, how to control vasospasm, implantation of balloon counterpulsation, and the possible revascularization strategies (percutaneous coronary intervention vs reoperation). Copyright 2008 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  5. [Postero'inferior aneurysm of the left ventricle following myocardial infarction. Diagnosis and surgical treatment].

    Science.gov (United States)

    Flores Covarrubias, S E; Acoltzin Vidal, C; Nava Lopez, G; Palacios Macedo, X

    1979-01-01

    This is a report of the first four cases of left ventricle aneurysm of the posterior and inferior segments successfully treated surgically in the Hospital de Cardiología y Neumología del Centro Médico Nacional, México D. F., and represent the twelve per cent of all realized aneurysmectomies. The patients were all men with 57 years mean age, and a previous history of posteroinferior myocardial infarction, complicated in three of them with angor and severe ventricle arrythmias; chest X ray in lateral view showed a bump of the posteroinferior border of the cardiac silhouette; the echocardiography increase in the ventricular diameter below the mitral valve; the ventriculography made evident a diastolic bulging with systolic expansion of posterior and inferior segments of the left ventricle and no mitral regurgitation; selective coronary arteriography showed a dominant right pattern with 100 per cent proximal occlusion. Aneurysmectomy was done in all four cases and aortocoronary by-pass in two. The posteromedial papilar muscle was found respected in all cases and in two cases a mural thrombus was detected.

  6. [Surgical Treatment of Left Main Trunk Coronary Artery Aneurysm with Asymptomatic Myocardial Ischemia;Report of a Case].

    Science.gov (United States)

    Okugi, Satoshi; Saito, Hiroyuki; Umeda, Etsuji; Takiguchi, Yoji

    2017-05-01

    Coronary artery aneurysm is rare, and there is no established protocol for surgical indication. On preoperative examination of orthopedic surgery, a 76-year-old male was found with asymptomatic myocardial ischemia. Radiological examinations revealed triple vessel disease and a coronary artery aneurysm, 10 mm in size, at the bifurcation of the left main trunk. Combined with quintuple coronary artery bypass grafting, surgical repair of the aneurysm was peformed under cardiopulmonary bypass on beating heart. Epicardial echocardiography was used to detect the site and the blood flow on the aneurysm. Postoperative course was uneventful. Epicardial echocardiography was useful for detecting the coronary artery aneurysm in the myocardium and the residual aneurysmal blood flow.

  7. Fisioterapia respiratória no pré e pós-operatório de cirurgia de revascularização do miocárdio Respiratory physiotherapy in the pre and postoperative myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    Simone Cavenaghi

    2011-09-01

    respiratória é parte integrante na gestão dos cuidados do paciente cardiopata, tanto no pré quanto no pós-operatório, pois contribui significativamente para um melhor prognóstico desses pacientes por meio de técnicas específicas.The cardiovascular diseases are among the main death causes in the developed world. They have been increasing epidemically in the developing countries. In spite of several alternatives for the treatment of the coronary artery disease; the surgery of the myocardial revascularization is an option with proper indications of medium and long-term with good results. It provides the remission of the angina symptoms contributing to the increase of the expectation and improvement of the life quality. Most of patients undergoing myocardial revascularization surgery develop postoperative lung dysfunction with important reduction of the lung volumes, damages in the respiratory mechanism, decrease in the lung indulgence and increase of the respiratory work. The reduction of volumes and lung capacities can contribute to alterations in the gas exchanges, resulting in hypoxemia and decrease in the diffusion capacity. Taking this into account, the Physiotherapy has been requested more and more to perform in the pre as well as in the postoperative period of this surgery. This study aimed at updating the knowledge regarding the respiratory physiotherapy performance in the pre and postoperative period of the myocardial revascularization surgery enhancing the prevention of lung complications. The Physiotherapy uses several techniques in the preoperative period; such as: the incentive spirometry, exercises of deep breathing, cough, inspiratory muscle training, earlier ambulation and physiotherapeutic orientations. While in the postoperative period, the objective is the treatment after lung complications took place, performed by means of physiotherapeutic maneuvers and noninvasive respiratory devices, aiming at improving the respiratory mechanism, the lung

  8. Similar effect of revascularization on technetium-99 m sestamibi and 15-(p-iodophenyl)pentadecanoic acid uptake in myocardial infarction patients

    International Nuclear Information System (INIS)

    Bendel, S.; Kettunen, R.; Hartikainen, J.; Remes, J.; Vanninen, E.; Yang, J.; Kuikka, J.; Huikuri, H.

    1999-01-01

    To study its usefulness as a tracer for assessment of the perfusion and viability of myocardium, 15-(p-iodophenyl)pentadecanoic acid (IPPA) was compared with technetium-99m sestamibi (MIBI). Dual-tracer single-photon emission tomography rest imaging was performed no more than 2 months before and 3 months after coronary artery bypass grafting in 28 patients with previous anterior (n=13) or inferior (n=15) infarction. The size of MIBI and IPPA defects decreased from 14%±12% and 13%±9% to 10%±11% and 9%±7%, respectively (P<0.001 for both). The MIBI uptake increased in the infarct zones from 35%±11% to 43%±8% (P<0.001), and in the peri-infarct zones from 50%±11% to 55%±10% (P<0.05). The IPPA uptake increased in the infarct zones from 37%±11% to 44%±13% (P<0.001), and in the peri-infarct zones from 51%±11% to 57%±12% (P<0.05). In nine patients with improved regional echocardiographic wall motion score after bypass surgery, the pre-operative uptake values of both MIBI and IPPA in the infarct and peri-infarct zones were on average slightly but not significantly higher than in 19 patients with no observed improvement in regional wall motion score. In patients with improved regional wall motion, the MIBI scans and the IPPA scans showed (non-significant) decreases in defect size and increases in infarct and peri-infarct zone uptake after bypass surgery. Similar (in some cases significant) changes were observed in the patients without improvement in wall motion. Thus IPPA and MIBI provided similar information about perfusion and viability in pre- and postoperative evaluation of patients with clinically evident myocardial infarction and with normal global ejection fraction. Regardless of the tracer used, the resolution capability of the dual-tracer method with a rest imaging protocol was not sufficient to differentiate viable from non-viable infarction defects in unselected individual patients with a normal ejection fraction. (orig.)

  9. A cirurgia de revascularização do miocárdio sem circulação extracorpórea minimiza o sangramento pós-operatório e a necessidade transfusional Myocardial revascularization surgery without extracorporeal circulation minimizes postoperative bleeding and the need for transfusion

    Directory of Open Access Journals (Sweden)

    Fernando Antibas Atik

    2004-10-01

    2001 to February 2002, 186 patients undergoing myocardial revascularization were assessed, excluding those who underwent associated procedures. The patients were divided into 2 groups as follows: group A - comprising 116 patients undergoing MR with ECC; and group B - comprising 69 patients undergoing MR without ECC. Both groups were comparable in regard to pre- and intraoperative characteristics, except for the greater number of distal anastomoses (P=0.0004 in group A, and greater prothrombin activity (P=0.04 and INR (P=0.03 in group B. To avoid discrepancies between the groups, 140 patients with statistically similar characteristics were selected. RESULTS: Studying the paired groups, both the total bleeding volume in 24 hours (P=0.001 and the bleeding volume indexed for body surface (P=0.004 were greater in group A (609.6 ± 395.8 mL; 331.8 ± 225.8 mL/m², respectively than in group B (437.2 ± 315 mL; 241 ± 173.9 mL/m², respectively. Although the need for transfusion was not significantly different between the groups (P=0.1, the amount of erythrocyte concentrate transfused was greater in group A (P=0.01. No statistical difference was observed in regard to transfusion of other hemocomponents and the need for surgical review of hemostasis. CONCLUSION: Myocardial revascularization without ECC was more advantageous than MR with ECC in regard to smaller postoperative blood loss and a lesser need for transfusion of erythrocyte concentrate. The repercussions of this finding may be innumerable, particularly in regard to minimization of morbid factors and hospital costs.

  10. Resultados de la revascularización coronaria en el cardiocentro del Hospital «Hermanos Ameijeiras», en un período de 20 años Results of coronary revascularization in the Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital over 20 years

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    Manuel Nafeh Abi-Rezk

    2011-03-01

    ón coronaria tuvo una tendencia ascendente en estos 20 años, sobre todo en pacientes de la tercera edad y del sexo masculino, en los que el tabaquismo y la hipertensión arterial fueron los factores de riesgo mayormente asociados. Predominó la revascularización con tres puentes y el uso de la safena, pero con tendencia al uso ascendente de la arteria mamaria interna. La mortalidad tuvo un comportamiento decreciente.INTRODUCTION. In Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital cardiovascular surgery is done from more twenty years ago introducing and developing different techniques of myocardial revascularization. The objective of present research was to describe the results of coronary revascularization over that period. METHODS. A retrospective, longitudinal and descriptive research with five-year cross-sectional cuts was conducted comparing each five-year period with the following one. From the total of 763 patients underwent coronary revascularization from January,1985 to December, 2004, 17 patients were excluded due to missing medical records or with incomplete data and 15 patients operated on without extracorporeal circulation, thus, the universe included 731 patients operated on with this technique. RESULTS. There was predominance the patients aged between 51 and 60years and male sex where smoking and high blood pressure were the more frequent risk factors. The predominant clinical stages were the chronic stable angina and the unstable angina as well as revascularization with three bridges and a trend to rise, as well as the saphenous vein use but with an ascending evolution as the only duct. The time of extracorporeal circulation and anoxic arrest showed a trend to decrease. The more frequent complications were the urinary and respiratory sepsis. There was a decrease of deaths from cardiac causes among which the multiorgan failure and the low cardiac output were the major ones. The low transoperative output decreased but there was a trend to

  11. Revascularização do miocárdio no idoso: fatores de risco para morbidade e mortalidade hospitalar Myocardial revascularization: risck factors of nosocomial morbidity and mortality in elderly

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    José Carlos R Iglézias

    1991-12-01

    Full Text Available Com a finalidade de determinar os principais fatores de risco para a morbidade e mortalidade hospitalar de pacientes coronarianos idosos (idade > 65 anos, submetidos a revascularização isolada, eletiva do miocárdio, estudamos prospectivamente 72 pacientes consecutivos, que possuíam observações completas no InCór, no período compreendido entre janeiro e dezembro de 1988. No roteiro do protocolo foram incluídos fatores clínicos, radiológicos, hemodinâmicos, operatórios e de pós-operatórios (Tabela 1. Os resultados foram analisados utilizando-se o teste do Qui quadrado de Pearson e a Prova Exata de Fisher, através do SPSS (Statistical Package for Social Science. Dentre os fatores analisados, apresentaram significância estatística: o tabagismo, o número de vasos coronários acometidos, o tempo de duração da circulação extracorpórea, o tempo de pinçamento da aorta, o número total de enxertos realizados, a presença de anastomose mamária coronária e o índice de movimentação da parede ventricular esquerda.Seventy-two consecutive patients with complete observations were studied at the Heart Institute (InCór between January and December 1988, to determine the main risk factors of nosocomial morbidity and mortality of elderly coronary patients (>65 years submitted to elective isolated myocardial revascularization. Clinical, radiologic, hemodynamic, operative and post-operative factors were included in the protocol. The results were analysed through Pearson's X² test and Fisher's Exact Test using the SPSS (Statistical Package for Social Science. Among the analyzed factors, smoking habit, number of impaired coronary vessels, duration of extracorporeal circulation, time of aortic clamping, total number of performed grafts, presence of the coronary-mammary anastomisis and index of the left ventricular wall movement present statistical significance.

  12. Myocardial Bridging

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    Shi-Min Yuan

    2016-02-01

    Full Text Available Abstract Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.

  13. Carotid revascularization: risks and benefits

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    O'Brien M

    2014-07-01

    Full Text Available Marlene O'Brien, Ankur Chandra Department of Surgery, Division of Vascular Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Abstract: Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%–30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS or carotid endarterectomy (CEA is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment

  14. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    Science.gov (United States)

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease.

  15. Revascularização direta do miocárdio sem circulação extracorpórea: estudo crítico dos resultados em 391 pacientes Direct myocardial revascularization without extra-corporeal circulation: results in 391 patients

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    Ênio Buffolo

    1986-08-01

    dois grupos. Concluem os autores que a revascularização do miocárdio sem utilização da extracorpórea se consolidou, ao longo destes 4 anos de experiência, como tática de eleição em lesões da coronária direita, descendente anterior, ou ambas, face às vantagens que apresenta.The authors analyse the results of 391 consecutive non-selected patients who underwent direct myocardial revascularization (MR without cardiopulmonary bypass (CPB from September 1981 to February 1985. In the same period we performed a total of 1568 revascularization procedures; thus 24.9% were MR without CPB. Out of the 391 patients, 318 (81.3% were male and the ages varied from 35 to 76, with a median of 56 y/o. The surgical procedure was performed due to: chronic coronary insufficiency 286 (73.1%, after coronary thrombolysis 42 (10.7%, evolving acute myocardial infarction 18 (4.6%, ill-succeeded angioplasty 18 (4.6%, redos 14 (3.6%, intermediate syndrome 12 (3.1 % and chronic aortic dissection 1. Single bypass was performed in 175 (44.7% patients, double in 192 (49.1% and triple in 24 (6.1% with an average of 1.6 grafts/patient. The mammary artery was utilized 10Q times, bovine heterologous mammary 2 and all remaining cases received saphenous vein grafts. The hospital mortality was 2.5% (10/391 which is significantly different from our 5% hospital mortality in 1177 patients operated on the same period with CPB. We prospectively compared the postoperative complications in 378 patients without CPB against 689 patients with CPB concerning arrhythmias, perioperative myocardial infarction, neurologic, infectious, pulmonary and hemorrhagic complications.

  16. Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Cardiology (SIC), Italian Association of Interventional Cardiology (SICI-GISE) and Italian Society of Cardiac Surgery (SICCH): clinical approach to pharmacologic pre-treatment for patients undergoing myocardial revascularization procedures

    Science.gov (United States)

    Geraci, Giovanna; Gulizia, Michele Massimo; Borzi, Mauro; Colivicchi, Furio; Menozzi, A.; Musumeci, Giuseppe; Scherillo, Marino; Ledda, Antonietta; Tarantini, Giuseppe; Gerometta, Piersilvio; Casolo, Giancarlo; Formigli, Dario; Romeo, Francesco; Di Bartolomeo, Roberto

    2017-01-01

    Abstract The wide availability of effective drugs in reducing cardiovascular events together with the use of myocardial revascularization has greatly improved the prognosis of patients with coronary artery disease. The combination of antithrombotic drugs to be administered before the knowledge of the coronary anatomy and before the consequent therapeutic strategies, can allow to anticipate optimal treatment, but can also expose the patients at risk of bleeding that, especially in acute coronary syndromes, can significantly weigh on their prognosis, even more than the expected theoretical benefit. In non ST-elevation acute coronary syndromes patients in particular, we propose a ‘selective pre-treatment’ with P2Y12 inhibitors, based on the ischaemic risk, on the bleeding risk and on the time scheduled for the execution of coronary angiography. Much of the problems concerning this issue would be resolved by an early access to coronary angiography, particularly for patients at higher ischaemic and bleeding risk. PMID:28751841

  17. Influencia del uso de una técnica menos invasiva que disminuye la aparición de complicaciones de la safenectomía en la cirugía de revascularización miocárdica Influence of the use of a less invasive technique that reduces the appearance of complications of safenectomy in myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    José L Ramírez

    2007-12-01

    Full Text Available Introducción: a pesar de sus limitaciones, la vena safena interna aún es el conducto más utilizado en cirugía de revascularización miocárdica. Sin embargo, las complicaciones del procedimiento de extracción de la vena constituyen un problema de gran magnitud en cuanto a morbilidad, estancia hospitalaria y costos de atención. Material y métodos: se presenta un ensayo clínico controlado, en el cual se evalúa una técnica menos invasiva para la extracción de la vena safena interna, en comparación con la técnica estándar de nuestra institución, para lo cual se tomaron 200 pacientes en el grupo de intervención y 400 pacientes en el grupo control. Resultados: la tasa de infección intrahospitalaria de la safenectomía en el grupo de intervención, fue del 0,5% en comparación con el 4% en el grupo control, lo que produce un valor de RR=0,125 con un intervalo de confianza del 95% de 0,016-0,916 sustancialmente menor en el grupo de estudio; el valor de RRA fue de 3,5% y el de NNT fue de 28, lo que indica que con esta técnica se evita una infección en cada 28 pacientes que van a cirugía. Además, se halló que los pacientes del grupo de intervención tienen una estancia hospitalaria significativamente menor que los controles; las medias fueron 7,39 ± 5,882 días para el grupo de intervención y 8,64 ± 8,55 días para el grupo control. Conclusiones: se puede concluir que la técnica de safenectomía menos invasiva es segura, y fácil de aprender, y ofrece una gran ventaja desde el punto de vista de la morbilidad asociada a la herida quirúrgica en las piernas.Background: The internal saphenous vein, despite all its limitations, remains the most used duct for myocardial revascularization. However, the complications regarding the extraction of the vein are a big problem in terms of morbidity, length of hospital stay and costs. Material and methods: We present a controlled clinical assay, evaluating a less invasive technique for

  18. Surgical revascularization techniques for diabetic foot

    OpenAIRE

    Kota, Siva Krishna; Kota, Sunil Kumar; Meher, Lalit Kumar; Sahoo, Satyajit; Mohapatra, Sudeep; Modi, Kirtikumar Dharmsibhai

    2013-01-01

    Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5–10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15–20% higher in diabetic populations than in the general population. The University of Texas classification is the reference class...

  19. Quantification of reversible perfusion abnormality using exercise-stress thallium SPECT before and after coronary revascularization

    International Nuclear Information System (INIS)

    Nagao, Kazuhiko; Nakata, Tomoaki; Tsuchihashi, Kazufumi

    1994-01-01

    Reversible myocardial perfusion abnormality was quantified by bull's eye and unfolded surface mapping methods in exercise thallium SPECT before and after coronary revascularization in 47 patients with angina pectoris, including 34 patients with previous myocardial infarction (PMI) and 13 with effort angina (AP). There was no difference in the incidence or extent of myocardial ischemia between the 2 groups before revascularization. However, the ischemic scores were significantly smaller in PMI group preoperatively than the reductions of the ischemic scores after revascularization. The ischemic scores, preoperatively estimated reversible perfusion abnormality was 32%, 69% and 48% of the improvement of the ischemic score (extent score, severity score, and ischemic area, respectively). Using the 3 ischemic scores, the improvement of perfusion abnormality was well predicted in 70-89% of AP patients but 35-57% of PMI patients. Thus, quantitative analysis in stress thallium SPECT is useful for detecting myocardial ischemia and evaluating the effect of coronary revascularization. However, about a half of myocardial viability was underestimated in one third of PMI patients by the conventional exercise-stress thallium SPECT study. (author)

  20. A comparison of the efficacy of surgical renal denervation and pharmacologic therapies in post-myocardial infarction heart failure.

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    Jialu Hu

    Full Text Available OBJECTIVE: Although renal denervation (RD has been shown to be effective in treating post- myocardial Infarction (MI heart failure (HF in animal models and clinical trials, its utility as a standalone treatment without traditional drug treatment for post-MI HF still needs to be investigated. METHODS: Rats were randomly assigned into seven experimental groups: N group (control group with no MI and no RD, n = 10, MI group (MI, n = 20, RD group (renal denervation, n = 10, RD-3d+MI group (RD performed three days before MI, n = 15, β-blocker-3d+MI group (Metoprolol treated three days before MI, n = 15, ACEI-3d+MI group (Perindopril treated three days before MI, n = 15, and ARB-3d+MI group (Losartan treated three days before MI, n = 15. Cardiac function, autonomic nervous system parameters, and neuroendocrine activities were evaluated 8 weeks post MI. RESULTS: Compared to β-blockers, ACEIs, and ARBs, RD alone provided significantly better cardiac remodeling and function, enhanced water and sodium excretion, and improved autonomic modulation. CONCLUSIONS: In this post-MI HF animal model, surgical RD provides effective autonomic modulation, inhibition of the RAAS, improved cardiac remodeling, and preserved renal function, without affecting normal circulation and cardiopulmonary function in normal rats. Compared to β-blocker, ACEI, and ARB single-drug therapies, RD alone is more efficacious. These results suggest that RD may be an effective treatment option for HF, especially in patients who have contraindications to drug therapy.

  1. Assessment of myocardial viability using PET

    International Nuclear Information System (INIS)

    Yoon, Seok Nam

    2005-01-01

    The potential for recovery of left ventricular dysfunction after myocardial revascularization represents a practical clinical definition for myocardial viability. The evaluation of viable myocardium in patients with severe global left ventricular dysfunction due to coronary artery disease and with regional dysfunction after acute myocardial infarction is an important issue whether left ventricular dysfunction may be reversible or irreversible after therapy. If the dysfunction is due to stunning or hibernation, functional improvement is observed. But stunned myocardium may recover of dysfunction with no revascularization. Hibernation is chronic process due to chronic reduction in the resting myocardial blood flow. There are two types of myocardial hibernation; 'functional hibernation' with preserved contractile reserve and 'structural hibernation' without contractile reserve in segments with preserved glucose metabolism. This review focus on the application of F-18 FDG and other radionuclides to evaluate myocardial viability. In addition the factors influencing predictive value of FDG imaging for evaluating viability and the different criteria for viability are also reviewed

  2. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization.

    Science.gov (United States)

    El Demerdash, Salah; Khorshid, Hazem; Salah, Iman; Abdel-Rahman, Mohamed A; Salem, Alaa M

    2015-01-01

    Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient's symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3months after the end of the study. The mean age was 56.8±3.1years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3months after completion of CRP, there was a significant decrease in BMI (30.3±2.9 vs. 31.2±1.9, pstress and at rest (SDS) was significantly lower after CRP (4.4±3 vs. 7.2±3, pischemic burden in patients with IHD who are unfit or not suitable for conventional cardiac revascularization. In addition the decreased ischemic burden, functional capacity, hemodynamic and metabolic profiles also improve for this group of patients and thus, cardiac rehabilitation should be implemented for routine management of those patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year

    DEFF Research Database (Denmark)

    Iversen, Allan Zeeberg; Galatius, Soeren; Abildgaard, Ulrik

    2011-01-01

    Objectives: Administration of the glycoprotein IIb/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) improves outcome. Data have suggested that an intracoronary (IC) bolus might be superior...... similar with regard to baseline characteristics. Mortality was reduced from 10% in the IV group to 2.7% in the IC group (p = 0.004). TVR and MI were also reduced with IC administration (TVR: 14.1 vs. 7.6%, p = 0.04; MI: 11.8 vs. 5.4%, p = 0.03). Consequently, patients in the IC treatment arm had...

  4. Mortality in type 1 vs. type 2 myocardial infarction

    DEFF Research Database (Denmark)

    Thygesen, Kristian; Gerke, Oke; Saaby, Lotte

    2013-01-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly.......Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly....

  5. Análise de 1071 reoperações para revascularização do miocárdio: resultados obtidos e conduta sugerida com base nessa experiência Evaluation of 1071 reoperations for myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Luís Alberto Dallan

    1992-06-01

    first and second operations varied from the same day to 22 years after (mean 9,3%, the second and third from one to 11 years (mean 8.0 and between the third and fourth seven to nine years (mean 7.7. During the surgical procedures: one mammary artery in 610 (56.9% cases, both mammary arteries in 192 (17.9%, gastroepiploic arteries in six (0.6% and epigastric arteries in five (0.5% were used. In 813 (75.9% of the 1071 reoperations at least one arterial graft was employed in the coronary bypass grafts. There were 87 (8.1% hospital deaths in this period, of which 39 (44.8% were directly related to ventricle dysfunction, and 48 (55.2% caused by other complications: pulmonary 22, sepsis 8, coagulation 7, neurologic 6 and mesenteric ischemia 5. The principal factors associated to mortality were: I preoperative risk factors were: diabetes, hypertension, high colesterol, obesity, smoking, hereditary history, etc.; 731 patients presented up to two risk factors with 35 deaths (4.8%; 299 presented three or four with 38 (12.7% deaths and in 4 patients there were five or more risk factors, with 14 (34.1 % deaths; 2 preoperative functional class: 317 were in class I or II, 11 (3.5% of which died; 449 were in class III, 39 (8.7% having died; and 305 in class IV with 46 (15.1% deaths. Triarterial vessels compromised associated or not to main trunk lesion: 788 presented this complication, of which 74 (9.4% died. Among 283 characterized by uni or biarterial lesions, 13 (4.3% having died; 3 surgery status: 110 emergency operations with 35 deaths (31.8%, 961 elective surgeries 52 (5.4% having died. In the last two years, however, 379 coronary bypass graft reoperations were performed with only 13 deaths (3.5%. This decreased in mortality in relation to the preceding years was attributed, among other factors, to the improved methods of myocardial protection, especially in patients with worse ventricle condition. It was also emphasized in the last two years the arterial graft usage in the

  6. Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.

    Science.gov (United States)

    Damman, Peter; van Geloven, Nan; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Clayton, Tim; Pocock, Stuart J; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2012-02-01

    This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate. Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting. Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models. In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN

  7. Paraplegia após revascularização cirúrgica do miocárdio: relato de caso Paraplejia después de la revascularización quirúrgica del miocardio: relato de caso Paraplegia after myocardial revascularization: case report

    Directory of Open Access Journals (Sweden)

    Caetano Nigro Neto

    2010-04-01

    décadas, los avances que se han dado en anestesiología resultaron en una reducción de los indicadores de morbilidad y mortalidad. En ese contexto, varias técnicas y agentes anestésicos han sido utilizados para controlar la respuesta hemodinámica y minimizar los efectos perjudiciales provenientes del estimulo quirúrgico en pacientes sometidos a procedimientos cardíacos. En cirugía cardíaca, la asociación de la anestesia regional a la anestesia general, ha sido motivo de muchas controversias entre los anestesistas, además de haber promovido muchos estudios en los últimos años. El surgimiento de las complicaciones neurológicas, es una situación devastadora que puede ocurrir después de una cirugía cardiovascular. En este artículo, relatamos un caso de paraplejia ocurrida en un paciente de 70 años, del sexo masculino, y después de una cirugía de revascularización del miocardio añadiéndosele opioide subaracnoideo a la anestesia general.BACKGROUND AND OBJECTIVES: Developments in anesthesiology have improved safety indices. Several techniques and agents are used to control the hemodynamic response and minimize adverse effects triggered by surgical stimuli in patients undergoing cardiac procedures. CASE REPORT: This is a 70 years old male patient, 1.74 m, 75 kg, ASA III, and NYHA II. The patient had controlled dyslipedemia, type II diabetes mellitus, and hypertension; history of smoking, peripheral vascular disease, and myocardial infarction 20 years ago. The patient underwent revascularization with the left internal mammary artery and saphenous grafts with extracorporeal circulation with intermittent clamping of the aorta. During the first 24 hours in the ICU, the patient developed hemodynamic instability, sudden hypotension, and atrial fibrillation. Twenty-six hours after the end of the surgery, the patient was awake, hemodynamically stable, and with good respiratory dynamics, being extubated. The patient was talkative and oriented, but immobile

  8. Thallium-201 myocardial imaging in anomalous left coronary artery arising from the pulmonary artery. Applications before and after medical and surgical treatment.

    Science.gov (United States)

    Finley, J P; Howman-Giles, R; Gilday, D L; Olley, P M; Rowe, R D

    1978-10-01

    Thallium-201 myocardial imaging was performed on six patients with an anomalous left coronary artery arising from the pulmonary artery. Initial images in three children (aged 4 months, 12 months and 2 1/2 years, respectively) demonstrated anterolateral perfusion defects in agreement with the electrocardiographic localization of infarction. Repeat imaging in two patients 2 to 3 months later, after clinical improvement with anticongestive therapy, demonstrated a reduction in the perfusion defect. In 3 other patients (aged 16, 16 and 20 years, respectively) thallium-201 scans performed during exercise stress demonstrated normal myocardial perfusion 7 to 15 years after operation (ligation of anomalous left coronary in two, ligation plus bypass graft in one). Thallium-201 imaging appears to be helpful in monitoring changes in myocardial perfusion before and after medical or surgical treatment of an anomalous left coronary artery, and may shed light on the pathophysiology of the defect. A possible practical limitation of thallium-201 imaging in this condition is the difficulty of imaging subendocardial infarction.

  9. CONDUCCIÓN ANESTÉSICA DE LA REVASCULARIZACIÓN MIOCÁRDICA VIDEO-ASISTIDA. INFORME DE CINCO CASOS / Anesthetic conduction of video-assisted myocardial revascularization. Report of five cases

    OpenAIRE

    Elizabeth Rodríguez Rosales; Osvaldo Valdés Dupeirón; Miguel Ángel Carrasco Molina; Fausto Leonel Rodríguez Salgueiro; Antonio de Arazoza Hernández

    2011-01-01

    The advantages of video-assisted cardiac surgery are very necessary for high-risk patients, but subjecting them to possible complications is a big responsibility and a challenge for the cardiovascular anesthesiologist. This article presents the first five cases of video-assisted coronary artery bypass grafting in the country, and describes the anesthetic techniques and results. Also, the advantages of this surgical technique are discussed: less invasive, less postoperative pain, less duration...

  10. Intracoronary Compared to Intravenous Bolus Abciximab during Primary Percutaneous Coronary Intervention in ST-segment Elevation Myocardial Infarction (STEMI) Patients Reduces 30-day Mortality and Target Vessel Revascularization: A Randomized Trial

    DEFF Research Database (Denmark)

    Iversen, Allan; Abildgaard, Ulrik; Galloe, Anders

    2011-01-01

    Background: Abciximab is beneficial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). However, the optimal administration route of the initial bolus of abciximab, that is, intravenous (IV) versus intracoronary (IC), has.......03). No significant difference in MI rates was seen (IV 4.7% vs. IC 2.7%; P = 0.32). We found a significant reduction in the composite end-point (IV 19.4% vs. IC 7.6%; P = 0.001) in favor of IC use. Major bleeding complications were similar (IV 2.4% vs. IC 1.6%; P = 0.62). Neither difference was observed in minor...... bleedings (IV 14.1% vs. IC 9.7%; P = 0.20). Conclusion: IC administration of bolus abciximab in STEMI patients undergoing pPCI reduces 30-day mortality and TVR and tends to reduce MI, compared to IV-bolus. (J Interven Cardiol 2011;24:105-111)....

  11. Avaliação do EuroSCORE como preditor de mortalidade em cirurgia de revascularização miocárdica no Instituto do Coração de Pernambuco Assessment of the EuroSCORE as a predictor for mortality in myocardial revascularization surgery at the Heart Institute of Pernambuco

    Directory of Open Access Journals (Sweden)

    Fernando Moraes

    2006-03-01

    Full Text Available OBJETIVO: Avaliar a aplicabilidade do Sistema Europeu de Risco em Operações Cardíacas (EuroSCORE em pacientes submetidos à revascularização miocárdica no Instituto do Coração de Pernambuco. MÉTODO: Durante os anos de 2003 e 2004, 759 pacientes foram submetidos à revascularização miocárdica. Desse total, sete doentes foram excluídos por ausência de informações relativas a algum dos fatores envolvidos na obtenção do EuroSCORE. Para avaliar a aplicabilidade do EuroSCORE, foi realizado o ajuste de um modelo de regressão logística da mortalidade operatória (variável resposta sobre o EuroSCORE (variável explanatória. A calibração do modelo foi mensurada comparando-se a mortalidade observada com a esperada, utilizando o teste de bondade de ajuste de Hosmer-Lemeshow. A acurácia do modelo foi avaliada através da estatística-c. RESULTADOS: Foram satisfatórias a acurácia do modelo, estimada em 69,9%, e a calibração (valor p do teste de Hosmer-Lemeshow igual a 0,663. A mortalidade total prevista foi praticamente idêntica à observada, 1,7%. O grupo de baixo risco (EuroSCORE: 0-2 tinha 231 pacientes e ocorreram 2 (0,87% óbitos. O grupo de médio risco (EuroSCORE: 3-5 tinha 268 pacientes e ocorreu 1 (0,37% óbito. O grupo de alto risco (EuroSCORE: > 6 apresentava 253 pacientes e houve 10 (3,95% óbitos. As discrepâncias entre as porcentagens de óbitos observadas nesses grupos e aquelas previstas pelo modelo não foram estatisticamente significantes, de acordo com o resultado do teste qui-quadrado (p = 0,624. CONCLUSÃO: O EuroSCORE, um índice simples e objetivo, mostrou-se como um preditor satisfatório de mortalidade operatória, em pacientes submetidos à revascularização miocárdica no Instituto do Coração de Pernambuco.OBJECTIVE: To assess the applicability of the European Risk System in Cardiac Operations (EuroSCORE in patients undergoing myocardial revascularization at the Heart Institute of Pernambuco. METHOD

  12. Variable Myocardial Response to Load Stresses in Infants with Single Left Ventricular Anatomy: Influence of Initial Physiology and Surgical Palliative Strategy.

    Science.gov (United States)

    Horriat, Narges L; Deatsman, Sara L; Stelter, Jessica; Frommelt, Peter C; Hill, Garick D

    2016-12-01

    Initial surgical strategies in neonates with single left ventricular (LV) anatomy vary based on adequacy of pulmonary and systemic blood flow. Differing myocardial responses to these strategies, as reflected in indices of systolic function, ventricular size, and mass have not been well defined. We sought to evaluate single LV myocardial response to varied physiology and initial palliation and determine whether the response is consistent and predictable. Infants with single LV physiology were divided based on neonatal palliation: no palliation/PA band (NO); BT shunt only (BT); or Norwood procedure (NP). Echo measures were obtained at presentation, early post-bidirectional Glenn (BDG), late post-BDG follow-up, and post-Fontan procedure. Measures included ejection fraction, LV mass indexed to height 2.7 and end diastolic volume indexed to body surface area, and mass/volume ratio. The cohort included 38 children (13 NO, 13 BT, 12 NP). Ejection fraction was similar but depressed in all groups at all stages. LV mass was higher in the NP group than the BT group at early post-BDG (p = 0.03) and higher than both BT and NO groups (p < 0.01) at late post-BDG, but the difference was resolved by post-Fontan follow-up. The NP group had the most remarkable remodeling in LV size from BDG to Fontan, suggesting that volume unloading is most valuable in this subgroup. Ventricular remodeling can be identified by echocardiography in children with single LV physiology, despite variable initial surgical palliative strategies. Importantly, these initial surgical strategies do not result in significant differences after Fontan palliation during early childhood.

  13. Fluxômetro hidrodinámico em cirurgia de revascularização do miocárdio Hidro-dynamic flowmeter in myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    Fábio Biscegli Jatene

    1986-08-01

    Full Text Available A avaliação do fluxo pelas pontes de veia safena na cirurgia de revascularização do miocárdio fornece uma informação segura do aporte sangüíneo ao miocárdio, bem como da perspectiva de perviabilidade destas anastomoses a longo prazo. Contudo, em nosso meio, a disponibilidade de fluxômetros eletrônicos, habitualmente utilizados, é, por vezes, difícil, sobretudo em função de seu custo e manutenção. O sistema desenvolvido consta de um conector para a linha arterial, com saída lateral, ligado a um tubo de Y. Uma das extremidades é conectada a um manómetro e a outra, à veia safena, ao término da anastomose distal. Como a saída lateral tem diâmetro conhecido, a queda da pressão, quando se liga o sistema para aveia safena, é proporcional ao fluxo. Uma tabela obtida por calibração prévia, permite conhecer, instantaneamente, o fluxo para a artéria tratada. Outra vantagem do sistema é a irrigação seletiva para a área tratada antes da realização da anastomose proximal, situação favorável quando existem áreas severamente isquémicas. Este sistema, em uso corrente em nosso Serviço, vem provando a sua eficiência, aliada à sua praticidade e ao custo irrelevante.Evaluation of blood flow in saphenous vein grafts during coronary surgery gives valuable information about myocardial perfusion and long-term by- pass patency as well. However, electronic flowmeter availability is a limiting factor because of costs and maintenance. A system was developed consisting of a connection to the arterial line, with a Y tube; one branch of the Y tube is connected to a manometer and the other one to the vein graft. Since the connection to the arterial line has a know diameter, pressure drop in the system is proportional to the flow in the graft. With previous calibration, a chart was constructed that allows instantaneous evaluation of the flow. Another advantage of the system is the selective perfusion of the area to be treated before

  14. Prognostic relevance of PCI-related myocardial infarction

    NARCIS (Netherlands)

    Woudstra, Pier; Grundeken, Maik J.; van de Hoef, Tim P.; Wallentin, Lars; Fox, Keith A.; de Winter, Robbert J.; Damman, Peter

    2013-01-01

    Procedure-related myocardial infarction (pMI) is directly associated with a coronary revascularization procedure, such as percutaneous coronary intervention (PCI) or CABG surgery. In contrast to spontaneous myocardial infarction (MI), the prognostic relevance of pMI is the subject of ongoing debate.

  15. Assessment of myocardial viability.

    Science.gov (United States)

    Travin, Mark I; Bergmann, Steven R

    2005-01-01

    The prevalence of left ventricular (LV) dysfunction and resultant congestive heart failure is increasing. Patients with this condition are at high risk for cardiac death and usually have significant limitations in their lifestyles. Although there have been advances in medical therapy resulting in improved survival and well being, the best and most definitive therapy, when appropriate, is revascularization. In the setting of coronary artery disease, accounting for approximately two thirds of cases of congestive heart failure, LV dysfunction often is not the result of irreversible scar but rather caused by impairment in function and energy use of still viable-myocytes, with the opportunity for improved function if coronary blood flow is restored. Patients with LV dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy, whether using thallium-201, Tc-99m sestamibi, or Tc-99m tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic imaging with positron emission tomography radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization, including some patients referred instead for cardiac transplantation. Other noninvasive modalities, such as stress echocardiography, also facilitate the assessment of myocardial viability, but there are advantages and disadvantages compared with the nuclear techniques. Nuclear imaging appears to require fewer viable cells for detection, resulting in a higher sensitivity but a lower specificity than stress

  16. Statins and perioperative myocardial infarction. | Levin | Southern ...

    African Journals Online (AJOL)

    The growing prevalence of atherosclerosis means that perioperative myocardial infarction (PMI) is of significant concern to anesthesiologists. Perioperative revascularization (if indicated medically), beta blockade (in high risk patients) and statin therapy are therapeutic modalities that are currently employed to reduce PMI.

  17. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

    NARCIS (Netherlands)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J.; Noc, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan J M; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Voskuil, M

    2017-01-01

    BACKGROUND: In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether

  18. The success of microsurgical penile revascularization in treating arteriogenic impotence.

    Science.gov (United States)

    Melman, A; Riccardi, R

    1993-03-01

    The treatment of arteriogenic erectile dysfunction with revascularization techniques has been controversial both in terms of its use and the type of surgical repair. Success rates reported in the literature are based almost exclusively on patient testimonial, without the use of objective post-operative criteria. At our institution from 7/88 through 8/91, 18 patients were treated for arteriogenic impotence using microsurgical penile revascularization. The patient population ranged in age from 23 to 64 years, and each patient underwent a complete history and physical examination, serum hormone testing, psychological evaluation of patient and partner, biothesiometry, penile plethysmography, nocturnal penile tumescence/rigidity testing with a Rigiscan device, and selective pudendal arteriography. One patient was status post a pelvic fracture, 2 lacked identifiable risk factors, 2 had diabetes, 6 were heavy smokers, and 7 had hypertension. Pre-operatively each patient had a suspicious medical history, abnormal plethysmography, abnormal Rigiscan testing, and a hemodynamically significant lesion on angiography. Revascularization was done by anastomosing the inferior epigastric artery to the deep dorsal veing and dorsal artery, or the deep dorsal vein alone if both arteries were atretic. Postoperatively, all 18 patients underwent a personal interview, repeat penile plethysmography, and repeat Rigiscan testing. Six patients reports successful coitus and an additional four were having coitus with the aid of intracavernous pharmacotherapy. Seventy-eight percent (14/18) had improved tracings on penile plethysmography, and 56% (10/18) had normal erectile capability by Rigiscan testing.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Avaliação hemodinâmica intra-operatória na cirurgia de revascularização miocárdica sem auxílio da circulação extracorpórea Intraoperative hemodynamic evaluation of myocardial revascularization without extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Ricardo Carvalho LIMA

    2000-09-01

    .002 and right circumflex (p=0.0006 artery and its branches. The cardiac index was shown to be diminished throughout the procedure (p=0.0011. CONCLUSIONS: A The present technique allows for maximum mobilization of the heart without inducing hemodynamic instability. B The improvement of a number of hemodynamic parameters at the end of the procedure may be accounted for by: (1 the response to the myocardial revascularization; (2 the release of catecholamines following manipulation of the heart in the different positions and (3 the release of vasoactive mediators following prolonged traction of the pericardium.

  20. O uso do balão intra-aórtico no pré-operatório de cirurgia de revascularização miocárdica, associada à disfunção ventricular grave The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Marcelo Kern

    2006-02-01

    Full Text Available OBJETIVO: Avaliar a efetividade do Balão Intra-Aórtico (BIAo profilático em cirurgia de revascularização miocárdica (CRM eletiva, para prevenir o infarto trans ou pós-operatório e para reduzir a mortalidade intra-hospitalar nos pacientes com baixa fração de ejeção ventricular esquerda. MÉTODOS: Em modelo de estudo de coorte, foram analisados 239 pacientes com fração de ejeção do ventrículo esquerdo inferior ou igual a 40%, submetidos à CRM eletiva com circulação extracorpórea (CEC, no período compreendido entre março de 1995 a fevereiro de 2001. RESULTADOS: Destes, 58 pacientes receberam BIAo pré-operatório e os demais foram operados sem assistência circulatória (grupo controle. Os dois grupos de pacientes tinham características semelhantes quanto a fatores associados aos desfechos em questão. Ocorreram 5 (8,6% óbitos no grupo com BIAo e 21 (11,6%, no grupo controle (diferença não-signifícativa. Ocorreram 2 (3,4% infartos no grupo com BIAo e 28 (15,5%, no grupo controle BIAo (p OBJECTIVE: To evaluate the effectiveness of prophylactic intra-aortic balloon (IAB in elective myocardial revascularization surgery (MRS, to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction. METHODS: Using a cohort study model, 239 patients with left ventricular ejection fraction <40%, submitted to elective MRS with extracorporeal circulation (ECC were evaluated from March 1995 to February 2001. RESULTS: Of these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group. The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were five demises (8.6% in the group with IAB and 21 (11.6% in the control group (non-significant difference. There were 2 (3.4% infarctions in the IAB group and 28 (15.5% in the control group (p< 0

  1. Transmyocardial laser revascularization - first experiences of imaging in MRT

    International Nuclear Information System (INIS)

    Weber, C.; Maas, R.; Steiner, P.; Beese, M.; Hvalic, M.; Buecheler, E.; Stubbe, M.

    1998-01-01

    Purpose: Imaging of myocardial signal alteration and perfusion differences after transmyocardial laser revascularization (TMLR). Methods and Material: 5 patients suffering from coronary vessel disease underwent MRI (0.5 T) pre- and 4-7 d post-TMLR. T 1 -weighted spin echo sequences were acquired ECG-triggered native and after injection of gadolinium. Qualitative analysis was performed on both native and contrast-enhanced images. Myocardial signal alterations and wall changes were evaluated. Qualitative and quantitative analyses of contrast-enhanced images were performed with regard of post therapeutic perfusion differences. Analysis was based on contrast-to-noise (C/N) data obtained from operator defined 'regions of interest'. Results: Visualization of laser-induced channels was not possible. Native scans obtained before and after TMLR revealed no significant change with regard to the qualitative analysis. Both qualitative and quantitative analyses demonstrated a posttherapeutic increase of C/N in both the left ventricular myocardium (64.4 pre-TMLR; 89.1 post-TMLR; p=0.06) and the septum in the majority of cases. No significant difference between laser-treated left myocardium and untreated septum was observed (p>0.05). Discussion: Single myocardial laser channels could not be visualized with a 0.5-T MRI. However, visualization of increased myocardial contrast enhancement in laser-treated left ventricular myocardium was evident in the majority of cases on the basis of qualitative and quantitative analyses. Conclusions: The MRI technique used enabled a first, limited depiction of TMLR-induced myocardial changes. The clinical value and impact still have to be defined. (orig.) [de

  2. Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia.

    Science.gov (United States)

    Kim, Tackeun; Oh, Chang Wan; Kwon, O-Ki; Hwang, Gyojun; Kim, Jeong Eun; Kang, Hyun-Seung; Cho, Won-Sang; Bang, Jae Seung

    2016-06-01

    OBJECT Moyamoya disease (MMD) is a progressive disease that can cause recurrent stroke. The authors undertook this retrospective case-control study with a large sample size in an attempt to assess the efficacy of direct or combined revascularization surgery for ischemia in adults with MMD. METHODS The authors investigated cases involving patients with moyamoya disease presenting with ischemia who visited Seoul National University Bundang Hospital and Seoul National University Hospital between 2000 and 2014. Among 441 eligible patients, 301 underwent revascularization surgery and 140 were treated conservatively. Variables evaluated included age at diagnosis, sex, surgical record, Suzuki stage, and occurrence of stroke. Patients were stratified into 2 groups based on whether or not they had undergone revascularization surgery. Actuarial 1-, 5-, and 10-year stroke rates were calculated using the life table method. Risk factor analysis for 5-year stroke occurrence was conducted with multivariate regression. RESULTS Of the 441 patients, 301 had been surgically treated (revascularization group) and 140 had not (control group). The mean follow-up durations were 45 and 77 months, respectively. The actuarial 10-year cumulative incidence rate for any kind of stroke was significantly lower in the revascularization group (9.4%) than in the control group (19.6%) (p = 0.041); the relative risk reduction (RRR) was also superior (52.0%) in the revascularization group, and the number needed to treat was 10. The 10-year rate of ischemic stroke was greater (13.3%) in the control group than in the revascularization group (3.9%) (p = 0.019). The RRR for ischemic stroke in the revascularization group was 70.7%, and the number needed to treat was 11. However, the actuarial 1- and 5-year rates of ischemic stroke did not significantly differently between the groups. Overall, revascularization surgery was shown to be an independent protective factor, as revealed by multivariate analysis

  3. Myocardial Bridge

    Science.gov (United States)

    ... Center > Myocardial Bridge Menu Topics Topics FAQs Myocardial Bridge Article Info En español Your heart is made ... surface of the heart. What is a myocardial bridge? A myocardial bridge is a band of heart ...

  4. The daily life of adults and elderly after myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Claudia Regina Maldaner

    2014-01-01

    Full Text Available Objetivo: descrever as evidências sobre as necessidades de cuidado e fatores que influenciam no cotidiano dos pacientes após a cirurgia de revascularização miocárdica. Métodos: Revisão integrativa da literatura, com coleta dos dados nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde e Medical Literature Analysis and Retrieval Sistem Online utilizando os descritores “revascularização miocárdica” and “alta do paciente” or “atividades cotidianas” or “reabilitação” or “ajustamento social”, em janeiro de 2013. Foram analisados 12 artigos que constituíram o corpus do estudo. Resultados: Os resultados apontam que o dia-a-dia após cirurgia inclui a necessidade de mudanças no estilo de vida. As repercussões negativas da revascularização miocárdica incluem a ansiedade, depressão e acompanhamento médico e os fatores positivos a diminuição dos sintomas anginosos. Conclusão: Conclui-se que há carência de intervenções dos profissionais de enfermagem que contribuam na qualidade de vida dos indivíduos revascularizados, incentivando a autonomia na reconstrução da identidade.

  5. Rat experimental model of myocardial ischemia/reperfusion injury: an ethical approach to set up the analgesic management of acute post-surgical pain.

    Directory of Open Access Journals (Sweden)

    Maria Chiara Ciuffreda

    Full Text Available RATIONALE: During the past 30 years, myocardial ischemia/reperfusion injury in rodents became one of the most commonly used model in cardiovascular research. Appropriate pain-prevention appears critical since it may influence the outcome and the results obtained with this model. However, there are no proper guidelines for pain management in rats undergoing thoracic surgery. Accordingly, we evaluated three analgesic regimens in cardiac ischemia/reperfusion injury. This study was strongly focused on 3R's ethic principles, in particular the principle of Reduction. METHODS: Rats undergoing surgery were treated with pre-surgical tramadol (45 mg/kg intra-peritoneal, or carprofen (5 mg/kg sub-cutaneous, or with pre-surgical administration of carprofen followed by 2 post-surgery tramadol injections (multi-modal group. We assessed behavioral signs of pain and made a subjective evaluation of stress and suffering one and two hours after surgery. RESULTS: Multi-modal treatment significantly reduced the number of signs of pain compared to carprofen alone at both the first hour (61±42 vs 123±47; p<0.05 and the second hour (43±21 vs 74±24; p<0.05 post-surgery. Tramadol alone appeared as effective as multi-modal treatment during the first hour, but signs of pain significantly increased one hour later (from 66±72 to 151±86, p<0.05. Carprofen alone was more effective at the second hour post-surgery when signs of pain reduced to 74±24 from 113±40 in the first hour (p<0.05. Stress behaviors during the second hour were observed in only 20% of rats in the multimodal group compared to 75% and 86% in the carprofen and tramadol groups, respectively (p<0.05. CONCLUSIONS: Multi-modal treatment with carprofen and tramadol was more effective in preventing pain during the second hour after surgery compared with both tramadol or carprofen. Our results suggest that the combination of carprofen and tramadol represent the best therapy to prevent animal pain after

  6. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

    Energy Technology Data Exchange (ETDEWEB)

    El Demerdash, Salah [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Khorshid, Hazem, E-mail: hazemkhorshid@yahoo.com [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salah, Iman; Abdel-Rahman, Mohamed A. [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salem, Alaa M. [Department of Internal Medicine, Medical Division, National Research Centre, Cairo (Egypt)

    2015-07-15

    Background: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. Aim: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. Methods: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study. Results: The mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT

  7. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

    International Nuclear Information System (INIS)

    El Demerdash, Salah; Khorshid, Hazem; Salah, Iman; Abdel-Rahman, Mohamed A.; Salem, Alaa M.

    2015-01-01

    Background: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. Aim: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. Methods: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study. Results: The mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT

  8. TYPES OF SURGICAL TREATMENT FOR POSTINFARCTION LEFT VENTRICULAR ANEURYSMS

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    A. V. Pavlov

    2015-01-01

    Full Text Available Surgical treatment of postinfarction left ventricular aneurysms in ischemic heart disease patients allows for a significant improvement of outcomes and clinical endpoints, an increase in quality of life and survival. The article deals with historical periods in surgical treatment of left ventricular aneurysms and chronologically describes the history of methods for reconstruction of the left ventricle.Despite the fact that within the last 50 years, mainly due to improvements in surgical techniques, in-hospital mortality decreased two-fold, it still remains high. The choice of technique for any kind of ventricular reparation depends on localization of the lesion that defines which sites of left ventricular asynergia should be repaired and how its form should be restored. At present, it is not possible to reliably assess benefits of any type of reparative surgery over another. Risk factors of inhospital mortality are: age, incomplete myocardial revascularization, high grade heart failure, female gender, immediate surgery, ejection fraction below 30%. To improve clinical outcomes one should strive to approximate to the physiological form of the left ventricle, to minimize negative influence of surgery on myocardial contractility.

  9. [CARDIOREABILITATION PECULIARITIES AND CORRECTION OF VIOLATIONS OF SISTOLIC, DIASOLIC FUNCTION AND HEART RATE VARIABILITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND CORONARY ARTERY REVASCULARIZATION].

    Science.gov (United States)

    Shved, M; Tsuglevych, L; Kyrychok, I; Levytska, L; Boiko, T; Kitsak, Ya

    2017-04-01

    In patients with acute coronary syndrome (ACS) who underwent coronary arteries revascularization, violations of hemodynamics, metabolism and heart rate variability often develop in the postoperative period, therefore, the goal of the study was to establish the features of disturbances and the effectiveness of correction of left ventricular systolic and diastolic dysfunction and heart rate variability in stages of cardiorehabilitation in patients with acute coronary syndrome who underwent coronary arteries revascularization. The experimental group included 40 patients with ACS in the postoperative period who underwent balloon angioplasty and stenting of the coronary arteries (25 patients with ST-segment elevation ACS and 15 patients without ST-segment elevation ACS). The age of examined patients was 37 to 74 years, an average of 52.6±6.7 years. The control group consisted of 20 patients, comparable in age and clinico-laboratory manifestations of ACS, who underwent drug treatment with direct anticoagulants, double antiplatelet therapy, β-blockers, ACE inhibitors and statins. Clinical efficacy of cardiorespiratory process in patients of both groups was assessed by the dynamics of general clinical symptoms and parameters of natriuretic propeptide, systolic and diastolic function of the left ventricle and heart rate variability. In the initial state, clinical and laboratory-instrumental signs of myocardial ischemia disappear in patients with ACS undergoing surgical revascularization of the coronary arteries, but clinical and subclinical manifestations of heart failure were diagnosed. The use of the accelerated program of cardiac rehabilitation already during the first month of studies leads to a decreasement of the signs of systolic and diastolic dysfunction, the level of NT-proBNP and improve in the variability of the heart rhythm wich significantly improves the life quality of patients with ACS. To monitor the effectiveness and safety of cardiac rehabilitation in

  10. Revascularização do miocárdio sem circulação extracorpórea em idosos: análise da morbidade e mortalidade Off-pump myocardial revascularization in the elderly: analysis of morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Ana Maria Rocha Pinto e Silva

    2008-03-01

    Full Text Available OBJETIVO: Analisar a evolução intra-hospitalar de doentes com 70 anos de idade ou mais, submetidos a revascularização do miocárdio sem circulação extracorpórea, com uso de shunt intracoronário, operados na urgência, emergência e eletivamente. MÉTODOS: Foram submetidos à cirurgia 87 doentes com idade entre 70 e 92 anos de julho de 1989 a julho de 2005. Dos 87 doentes, 50 (57,5% eram portadores de angina instável, sendo três (3,4% na vigência de infarto agudo do miocárdio. Foram operados em caráter de emergência e urgência 31 (35,6% doentes. De todo o grupo, havia 13 (14,9% doentes com infarto ocorrido em até 30 dias e 34 (39,1% com infarto ocorrido há mais de 30 dias. RESULTADOS: As complicações mais freqüentes foram: fibrilação atrial (32,2%, insuficiência cardíaca congestiva (12,6%, broncopneumonia (10,3%, sepse (3,4%, infarto agudo do miocárdio peri-operatório (2,3%, mediastinite (1,1%, acidente isquêmico transitório (1,1%, pneumotórax (1,1%. O tempo médio de intubação foi de 18,50±19,09 horas; permanência em UTI, 2,92±2,03 dias, e hospitalar, 10,55±7,16 dias. Apenas nove (10,3% doentes receberam concentrado de hemácias no pós-operatório e nenhum foi reoperado por sangramento. A mortalidade hospitalar foi de 4,6%. CONCLUSÃO: Em doentes acima de 70 anos, operados na emergência, urgência e eletivamente, a revascularização do miocárdio sem extracorpórea com shunt intracoronário apresentou adequada evolução pós-operatória e baixos índices de complicações e mortalidade em relação à população estudada.OBJECTIVE: To analyze the in-hospital outcome of elderly patients aged 70 years and older who underwent off-pump coronary artery bypass graft surgery with an intraluminal shunt in urgent, emergent, and elective coronary revascularizations. METHODS: From July 1989 to July 2005, we analyzed 87 patients ranging in age from 70 to 92 years. Of the 87 patients enrolled, 50 (57.5% patients had

  11. Bailout revascularization of chronic femoral artery occlusions with the new outback catheter following failed conventional endovascular intervention.

    Science.gov (United States)

    Husmann, Marc; Federer, Jonas; Keo, Hak Hong; Schmidli, Jürg; Kickuth, Ralph; Baumgartner, Iris; Do, Dai-Do

    2009-04-01

    To report the application of a true lumen re-entry device in the bailout treatment of chronic total occlusions (CTO) of the superficial femoral artery (SFA) after failed angioplasty. Nineteen patients (12 men; mean age 81 years, range 61-97) with 20 SFA CTOs and Rutherford category 2 to 5 ischemia were prospectively evaluated. All CTOs had unsuccessful recanalization using conventional techniques and were subsequently treated with the Outback LTD catheter. Follow-up at 3, 6, and 12 months included ankle/toe pressure measurement and pulse volume recordings. Endpoints were revascularization rate, target lesion revascularization, and limb salvage. Revascularization was achieved in 95% of the cases. There were 2 (10%) periprocedural complications unrelated to the re-entry device, which were resolved by endovascular or surgical treatment. The target lesion revascularization rate was 10%, with the 2 events occurring at 3 and 6 months, respectively, in patients with Rutherford category 4-5 ischemia. There was one below-the-knee amputation in the patient with failed revascularization. The acute failure of endovascular treatment of SFA CTOs is most often due to an inability to re-enter the true lumen after the occlusion is crossed in a subintimal plane. Bailout revascularization with the Outback LTD catheter is highly successful and shows a low device-related complication rate. This needle- and fluoroscopic-based re-entry device increases the endovascular success rate and is therefore expanding the minimally invasive treatment options for surgically unfit patients.

  12. Artéria radial versus veia safena para revascularização do miocárdio: metanálise (não houve diferença estatisticamente significante Radial artery versus saphenous vein to myocardial revascularization: meta-analysis (there is no statistically significant difference

    Directory of Open Access Journals (Sweden)

    Rafael Fagionato Locali

    2006-09-01

    Full Text Available OBJETIVO: Comparar a efetividade do enxerto de artéria radial com o enxerto de veia safena para revascularização do miocárdio, em associação com a artéria torácica interna. MÉTODO: Realizou-se uma revisão sistemática da literatura, utilizando uma estratégia de busca de artigos aplicada às bases de dados da MEDLINE e LILACS. Dois pesquisadores independentes realizaram a seleção dos artigos identificados, avaliando criteriosamente a metodologia dos artigos considerados relevantes para o tema. Somente os ensaios clínicos controlados e randomizados com adequado sistema de aleatorização foram incluídos. Em todas as situações em que ocorreu discordância entre os pesquisadores, foi realizada uma reunião de consenso. Não foi estipulada restrição quanto ao período pós-operatório para avaliação angiográfica do enxerto, o vaso tratado cirurgicamente e as características dos pacientes incluídos. Os resultados são expressos como Risco Relativo (RR, com 95% de Intervalo de Confiança (CI, da comparação da efetividade entre a artéria radial e a veia safena. RESULTADOS: Com base nesses critérios foram incluídos três estudos. Não foi detectada diferença estatística entre a perviabilidade dos enxertos estudados (RR 0,53 [95% IC 0,13 - 2,18]. CONCLUSÃO: Apesar dos estudos serem de boa qualidade metodológica, não houve resultado estatisticamente significativo beneficiando um dos enxertos. O poder estatístico da metanálise é baixo. Portanto, são necessários novos ensaios clínicos controlados e randomizados, com tamanho de amostra adequado para detectar possíveis diferenças entre os tratamentos propostos.OBJECTIVE: To compare the effectiveness of radial artery graft with saphenous vein graft to myocardial revascularization, in association with the internal thoracic artery. METHODS: We made a systematic review of literature, using a strategy to search articles applied to MEDLINE and LILACS databases. Two

  13. Prognosis in patients having the diagnosis of myocardial infarction made during admission to a non-cardiology department

    DEFF Research Database (Denmark)

    Thygesen, Kristian; Saaby, Lotte; Poulsen, Tina Svenstrup

    2013-01-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly.......Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly....

  14. Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Kärkkäinen, Jussi M., E-mail: jkarkkai@gmail.com [Kuopio University Hospital, Heart Center (Finland); Lehtimäki, Tiina T., E-mail: tiina.lehtimaki@kuh.fi; Saari, Petri, E-mail: petri.saari@kuh.fi [Kuopio University Hospital, Department of Clinical Radiology (Finland); Hartikainen, Juha, E-mail: juha.hartikainen@kuh.fi [Kuopio University Hospital, Heart Center (Finland); Rantanen, Tuomo, E-mail: tuomo.rantanen@kuh.fi; Paajanen, Hannu, E-mail: hannu.paajanen@kuh.fi [Kuopio University Hospital, Department of Gastrointestinal Surgery (Finland); Manninen, Hannu, E-mail: hannu.manninen@kuh.fi [Kuopio University Hospital, Department of Clinical Radiology (Finland)

    2015-10-15

    PurposeTo evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI).MethodsA retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded.ResultsFifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival.ConclusionsEVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate.

  15. Endovascular Therapy as a Primary Revascularization Modality in Acute Mesenteric Ischemia

    International Nuclear Information System (INIS)

    Kärkkäinen, Jussi M.; Lehtimäki, Tiina T.; Saari, Petri; Hartikainen, Juha; Rantanen, Tuomo; Paajanen, Hannu; Manninen, Hannu

    2015-01-01

    PurposeTo evaluate endovascular therapy (EVT) as the primary revascularization method for acute mesenteric ischemia (AMI).MethodsA retrospective review was performed on all consecutive patients treated for AMI during a 5-year period (January 2009 to December 2013). EVT was attempted in all patients referred for emergent revascularization. Surgical revascularization was performed selectively after failure of EVT. Patient characteristics, clinical presentation, and outcomes were studied. Failures and complications of EVT were recorded.ResultsFifty patients, aged 79 ± 9 years (mean ± SD), out of 66 consecutive patients with AMI secondary to embolic or thrombotic obstruction of the superior mesenteric artery were referred for revascularization. The etiology of AMI was embolism in 18 (36 %) and thrombosis in 32 (64 %) patients. EVT was technically successful in 44 (88 %) patients. Mortality after successful or failed EVT was 32 %. The rates of emergency laparotomy, bowel resection, and EVT-related complication were 40, 34, and 10 %, respectively. Three out of six patients with failure of EVT were treated with surgical bypass. EVT failure did not significantly affect survival.ConclusionsEVT is feasible in most cases of AMI, with favorable patient outcome and acceptable complication rate

  16. Nursing consultation protocol for patients after myocardial revascularization: influence on anxiety and depression Protocolo de consultas de enfermería al paciente después de la revascularización del miocardio: influencia en la ansiedad y depresión Protocolo de consultas de enfermagem ao paciente após a revascularização do miocárdio: influência na ansiedade e depressão

    Directory of Open Access Journals (Sweden)

    Francisca Elisângela Teixeira Lima

    2010-06-01

    Full Text Available The objective was to evaluate the influence of the Nursing Consultation Protocol in aspects of anxiety and depression in patients after myocardial revascularization using the Hospital Anxiety and Depression scale (HAD. A randomized clinical trial developed in the outpatient clinic of a public hospital in Fortaleza-Ceará. One hundred and forty six patients, who underwent myocardial revascularization, composed the population, providing the sample of 39 patients in the control group (CG and 39 in the intervention group (IG. The results were presented in tables. Anxiety had a mean of 5.41 in the CG and a median of 5 and a mean in the IG of 5.21 and a median of 4. Depression predominated in the CG, with a mean 4.82 and a median of 4, while the IG had a mean of 3.79 and a median of 3. It was found that people monitored in accordance with the Nursing Consultation Protocol had a lower percentage of anxiety and depression after six months.El objetivo fue verificar la influencia del protocolo de consultas de enfermería sobre aspectos relacionados a ansiedad y depresión en pacientes después de la revascularización del miocardio, utilizando la escala de HAD (Hospital Ansiety and Depresion. Se trata de un ensayo clínico, aleatorio, desarrollado en el ambulatorio de un hospital público en Fortaleza, estado de Ceará. La población fue compuesta 146 pacientes en los cuales fue realizada la revascularización del miocardio, constituyendo la muestra 39 pacientes del grupo de control (GC y 39 del grupo de intervención (GI. Los resultados fueron presentados en tablas. La ansiedad tuvo promedio en el GC de 5,41 y mediana de 5 y, en el GI, tuvo promedio de 5,21 y mediana de 4. La depresión predominó en el GC, con promedio 4,82 y mediana de 4; en cuanto el GI tuvo promedio de 3,79 y mediana de 3. Se constató que las personas acompañadas de acuerdo con el protocolo de consultas de enfermería tuvieron un porcentaje menor de ansiedad y depresión, despu

  17. Revascularization experience and results in ischaemic cerebrovascular disease: Moyamoya disease and carotid occlusion.

    Science.gov (United States)

    Arikan, Fuat; Rubiera, Marta; Serena, Joaquín; Rodríguez-Hernández, Ana; Gándara, Darío; Lorenzo-Bosquet, Carles; Tomasello, Alejandro; Chocrón, Ivette; Quintana-Corvalan, Maximiliano; Sahuquillo, Juan

    2018-03-14

    Cerebral revascularization techniques are an indispensable tool in the current armamentarium of vascular neurosurgeons. We present revascularization surgery experience and results in both moyamoya disease and occlusive cerebral ischaemia. Patients with ischaemic occlusive disease and moyamoya disease who underwent microsurgical revascularization between October 2014 and September 2017 were analysed. In the study period, 23 patients with occlusive ischaemic disease underwent microsurgical revascularization. Three patients presented with serious postoperative complications (2 intraparenchymal haemorrhages in the immediate postoperative period and one thrombosis of the femoral artery). All patients, except one, achieved normalization of the cerebral hemodynamic reserve (CHR) in the SPECT study. Twenty patients had a good neurological result, with no ischaemic recurrence of the revascularized territory. Among patients with moyamoya, 20 had moyamoya disease and 5 had moyamoya syndrome with unilateral involvement. Five patients were treated at paediatric age. Haemorrhagic onset occurred in 2 patients. The CHR study showed hemodynamic compromise in all patients. Cerebral SPECT at one year showed resolution of the hemodynamic failure in all patients. There have been 4 postoperative complications (acute subdural hematoma, two subdural collections and one dehiscence of the surgical wound). No patient presented with neurological worsening at 6 and 12months of follow-up. Cerebral revascularization through end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery is an indisputable technique in the treatment of moyamoya disease and possibly in a subgroup of patients with symptomatic occlusive ischaemic cerebrovascular disease. Copyright © 2018 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. DETECTION OF MYOCARDIAL VIABILITY IN ISСHAEMIC DAMAGE USING MAGNETIC RESONANCE AND EMISSION TOMOGRAPHY

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    V. Yu. Ussov

    2013-01-01

    Full Text Available A review of modern methods of magnetic resonance imaging (MRI and emission tomography (singlephoton emission and positron emission computer tomography – SPECT and PET as toos for diagnosis and prognosis of myocardial ischaemic damage, in particular in coronary revascularization. The definition of term “myocardial viability” is discussed. It has been shown that the integrity of blood-tissue barrier between myocardium and microcirculatory vessels is the most sensitive marker of tissue viability and of functional integrity of myocardium. It’s evaluation by means of contrast-enhanced MRI of myocardium is the most available and most precise technique of diagnosis and prognosis both in patients with postinfarction myocardiosclerosis and in patients with coronary disease without myocardial infarction. It is proposed that in the nearest future the combination of MR-coronarography and contrast-enhanced MRI of myocardium will provide a possibility to obtain the full set of data necessary for planning of endovascular and surgical treatment of various forms of coronary heart disease. PET and SPECT techniques currently are of some essential interest for pathophysiologic research of coronary ishaemia in clinical and experimental studies as well as for qualitative visual studies of pharmacokinetics.

  19. Outcome of patients with significant coronary stenosis but without ischemic evidence on exercise myocardial perfusion scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Kawaguchi, Ren; Toyama, Takuji; Sekiguchi, Makoto; Takama, Noriaki; Adachi, Hitoshi; Naito, Shigeto; Hoshizaki, Hiroshi; Oshima, Shigeru; Taniguchi, Koichi [Gunma Prefectural Cardiovascular Center, Maebashi (Japan)

    2001-03-01

    The rates of cardiac events and coronary revascularization were evaluated in patients with significant coronary stenosis of more than 75% by the American Heart Association (AHA) classification but no ischemic evidence by exercise myocardial perfusion scintigraphy. Subjects were 171 patients (113 males, 58 females, mean age 66{+-}9 years) undergoing coronary angiography and without scintigraphic evidence of myocardial ishemia. They were divided into two groups according to the severity of coronary artery stenosis based on AHA classification. Group A was composed of 139 patients with more than 75% stenosis (101 patients with 75% stenosis and 38 patients with more than 90% stenosis), and Group B was composed of 32 patients with 50% stenosis. Cardiac events including angina pectoris (n=63), myocardial infarction (n=1), heart failure (n=2) and cardiac death (n=0), coronary revascularization and predictive factors were evaluated during follow-up of 34{+-}21 months. Furthermore, the interval between coronary revascularization and exercise myocardial perfusion scintigraphy was estimated. The rates of cardiac events (45%) and coronary revascularization (29%) in Group A were significantly higher than the rate of cardiac events (9%, p<0.05) and coronary revascularization (6%, p<0.05) in Group B. Only percentage stenosis and the number of diseased vessels affected the rates of cardiac event and coronary revascularization. Patients with significant coronary stenosis, but without ischemic evidence by exercise myocardial perfusion scintigraphy, have a relatively high rate of cardiac event and coronary revascularization, especially in patients with severe stenosis or multivessel disease. However, coronary revascularization should not be performed in all patients with significant coronary stenosis. (author)

  20. Situaciones que requieren cuidado de enfermería en el paciente en posoperatorio temprano de una revascularización miocárdica Situações que requerem cuidado inicial de enfermagem em pós-operatório de uma revascularização miocárdica Situations that require nursing care for the patient in an early post-operative stage following a myocardial revascularization

    Directory of Open Access Journals (Sweden)

    CLAUDIA ARIZA OLARTE

    2010-06-01

    (POPI de uma revascularização miocárdica (48 a 96 horas. Essas situações constituem os dados qualitativos da tese de doutorado intitulada "Cuidado de enfermagem ao paciente em pós-operatório inicial de uma revascularização miocárdica", visando desenhar uma proposta de cuidado de enfermagem para um paciente em pós-operatório inicial de uma revascularização miocárdica com base nos problemas identificados a partir da interpretação dos eventos clínicos e das situações que requerem cuidado de enfermagem. Quarenta pacientes na fase pós-operatoria inicial responderam uma entrevista (semi-estruturada focada em seus sentimentos, emoções e preocupações. A informação coletada a partir da entrevista foi depurada. Utilizaram-se frases textuais dos pacientes e estabeleceram-se códigos descritivos que foram interpretados no intuito de determinar códigos nominais ou substantivos. Em último lugar, agruparam-se os códigos sob um mesmo termo, formando categorias que correspondem às situacoes que requerem cuidado de enfermagem: bem-estar, conquistas, razoamento, benefício, complacência, creenças e valores, sofrimento, agonia e pesadume. A proposta coloca que o diálogo, o encontro e o chamado-resposta terão melhores efeitos sobre o bem-estar e estar melhor do paciente quando mudarmos o ambiente frio e impessoal do hospital por um ambiente de cuidado que fortalece condições como a presença familiar, a disponibilidade afetiva das enfermeiras, fornecendo informação sobre o processo do paciente, mediante uma linguagem que possibilite seu entendimento e contribua para diminur a angústia e ansiedade gerada pelo contexto circundante.Situations that require nursing care (SRCE take place and are typical of a patient in an early post-operative stage (POPT of myocardial revascularization (48 to 96 hours. Said situations constitute the qualitative data of the doctoral thesis titled "Nursing care to the patient in early post-operative stage following a

  1. Transcutaneous oxygen tension monitoring after successful revascularization in diabetic patients with ischaemic foot ulcers.

    Science.gov (United States)

    Caselli, A; Latini, V; Lapenna, A; Di Carlo, S; Pirozzi, F; Benvenuto, A; Uccioli, L

    2005-04-01

    To monitor transcutaneous oxygen tension (TcPO2) after percutaneous transluminal angioplasty (PTA) in diabetic patients with ischaemic foot ulcers. Twenty-three diabetic patients with ischaemic foot ulcers who underwent successful revascularization by PTA (SR group) were retrospectively selected. Twenty diabetic patients who underwent unsuccessful revascularization (UR group) were also included. Transcutaneous oxygen tension was measured at the dorsum of the foot before and 1 (+/- 1), 7 (+/- 1), 14 (+/- 1), 21 (+/- 1) and 28 (+/- 1) days after the surgical procedure. After PTA, TcPO2 progressively improved in the SR group, reaching its peak 4 weeks after angioplasty. A concomitant decrease of cutaneous carbon dioxide tension (TcPCO2) was also observed immediately after PTA which reached the lowest levels 3 weeks later. In the UR group, TcPO2 showed a slight improvement immediately after PTA but remained stable throughout the observation, while TcPCO2 levels did not change. Finally, the percentage of SR patients with a TcPO2 > or = 30 mmHg was 38.5% 1 week after PTA, while it increased to 75% 3 weeks later. Transcutaneous oxygen tension monitoring showed that after successful revascularization it takes 3-4 weeks for cutaneous oxygenation to improve and reach the optimal levels for wound healing. Transcutaneous carbon dioxide tension monitoring may be more useful to identify the negative outcome of a revascularization procedure. Our findings suggest that, when the surgical approach can be delayed, the best timing to perform a more aggressive debridement or minor amputations is 3-4 weeks after successful revascularization.

  2. Os efeitos da pressão positiva intermitente e do incentivador respiratório no pós-operatório de revascularização miocárdica The effects of intermittent positive pressure and incentive spirometry in the postoperative of myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Walmir Romanini

    2007-08-01

    spirometry (IS in patients submitted to myocardial revascularization surgery. METHODS: Forty patients were divided in two groups: one was submitted to IPPB (n=20 and the other to IS (n=20. The patients were evaluated at the preoperative period and 24, 48 and 72 hours postoperatively, with the resources being applied in the postoperative period. The following parameters were analyzed: oxygen saturation (SpO2, respiratory frequency (RF, minute volume (MV, current volume (CV, maximum inspiratory pressure (Ip max and maximum expiratory pressure (Ep max. RESULTS: The groups were considered homogeneous regarding the demographic and clinical variables. In the group submitted to IPPB, an increase in SpO2 was observed 48 (p=0.007 and 72 h (p=0.0001 after surgery, when compared to the IS group. As for the RF, MV and CV variables, there were no statistically significant differences between the groups. The group submitted to IS showed a significant increase in the Epmax 24 (p=0.02 and 48 (p=0.01 h after surgery. CONCLUSION: Aiming at reversing hypoxemia earlier, IPPB showed to be more efficient when compared to IS; however, IS was more effective in improving respiratory muscle strength.

  3. Papel del tejido perivascular en la regulación del tono vascular: repercusión en el uso de puentes aorto-coronarios para revascularización miocárdica Role of perivascular tissue in vascular tone regulation: repercussion in the use of aortocoronary bypass for myocardial revascularization

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    Patricio López-Jaramillo

    patients with severe coronary disease. The lifespan of these grafts has shown to be longer with arterial tissue even though its use is limited by its restricted availability. This is why the saphenous vein bypasses, although having a greater risk of presenting occlusion, are the most used in these procedures of myocardial reperfusion. The reasons by which the venous grafts are occluded after its insertion in the arterial site are still not clear; nevertheless, it has been proposed that it could be due to different factors such as: surgical mechanical trauma, increment of arterial pressure and diminished friction stress. In 1996 the «no-touch» preparation technique of venous grafts was described, in which the venous bypasses were implanted in the coronary site along with the surrounding perivascular tissue and demonstrated to improve the lifespan of this type of grafts. Recently it has been proposed that the perivascular fat tissue could play a role in the vascular tone regulation and it has been even described the existence of an adipose cell derived relaxing factor (ADRF, whose nature has not been completely cleared yet. The objective of this article is to review the different factors related to the aortocoronary grafts’ occlusion, the possible physiopathologic channels that form this phenomenon, the new surgical alternatives used for vein grafts preparation and the advances in the description of ADRF and its role in vascular tone regulation.

  4. Value of covered stents to improve patency of long-segment SFA revascularization.

    Science.gov (United States)

    Beschorner, U; Zeller, T

    2014-08-01

    Endovascular treatment has become first-line approach for revascularization of long and complex femoropopliteal lesions in many centers. This development urges the need for endovascular approaches with a sustainable success in terms of patency. In several recently published trials the Viabahn® endoprosthesis by Gore (W.L. Gore Inc, Flagstaff, AZ, USA) has shown promising patency rates comparable or even better than traditional surgical bypass procedures with prosthetic material.

  5. Role of 2D speckle tracking echocardiography in predicting acute coronary occlusion in patients with non ST-segment elevation myocardial infarction

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    Viola William Keddeas

    2017-06-01

    Conclusion: Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.

  6. Long-term mortality in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: a real world clinical scenario

    DEFF Research Database (Denmark)

    Thygesen, Kristian; Saaby, Lotte; Poulsen, Tina Svenstrup

    2013-01-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly.......Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly....

  7. LONG-TERM RESULTS OF TRANSMYOCARDIAL LASER REVASCULARIZATION COMBINED WITH IMPLANTATION OF AUTOLOGOUS BONE MARROW MONONUCLEAR FRACTION IN THE TREATMENT OF CHRONIC ISCHEMIC HEART DISEAS

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    A. M. Chernyavsky

    2016-01-01

    Full Text Available Aim. Clinical and instrumental assessment of long-term results of autologous bone marrow cells (BMC implantation in laser channels in surgery of ischemic heart disease with diffuse and distal coronary disease.Materials and Methods. In the period of 2007–2008 35 CHD patients with diffuse and distal coronary disease underwent BMC implantation in laser channels during coronary artery bypass grafting (CABG. The control group consisted of 29 patients. All patients in this group underwent only direct myocardial revascularization (DMR. In the long-term period we examined only 30 patients of the first group. Clinical and instrumental assessment of the method efficacy was carried out in 2 weeks, 6 months and 6 years after surgery.Results. FC (NYHA mean value in indirect revascularization group significantly decreased from 2.57 ± 0.61 preoperatively to 1.77 ±0.66 in6 months after surgery (p = 0.043. After 6 years FC (NYHA was not significantly changed – 1.84 ± 0.42 (p = 0.053. Perfusion scintigraphy revealed a slight decrease of stable perfusion defect (SPD in the immediate postoperative period, a more pronounced reduction of SPD in 6 months after surgery. The average value of SPD before surgery was 20.46 ± 10.75%, in 2 weeks after the operation – 19.07 ± 9.69%, in 6 months after surgery – 15.22 ± 9.49%. In the long-term period (6 years SPD was 14.8 ± 8.43% (p = 0.047. A similar pattern was observed in the analysis of transient perfusion defect: baseline – 30 ± 2.2%, in 6 months – 15 ± 1.3%, in the long term period – 20 ± 6.1% (p = 0.047. The average value of left ventricular ejection fraction (LVEF before surgery was 55 ± 10.4%, in 2 weeks after the operation – 55.7 ± 9.3%, in 6 months – 56.7 ± 10%, after 6 years – 54 ± 12%. The dynamics is unauthentic (p = 0.068.Conclusion. BMC implantation in laser channels in addition to CABG is a safe and effective method of surgical treatment in case of CABG inability. The effect of

  8. Coronary revascularization does not decrease cardiac events in patients with stable ischemic heart disease but might do in those who showed moderate to severe ischemia.

    Science.gov (United States)

    Moroi, Masao; Yamashina, Akira; Tsukamoto, Kazumasa; Nishimura, Tsunehiko

    2012-07-12

    As an initial management strategy for stable ischemic heart disease (IHD), coronary revascularization therapy is thought to be equal to optimal medical therapy alone regarding prognosis. Whether or not the effects of revascularization on the prognosis of patients with stable IHD are associated with the amount of ischemic myocardium detected by nuclear stress imaging was evaluated. This retrospective study analyzed data from 4629 patients with suspected or known IHD who underwent gated stress myocardial-perfusion SPECT at 117 hospitals in Japan. The follow-up periods were three years and the combined endpoints consisted of cardiac death, nonfatal myocardial infarction, and congestive heart failure requiring hospitalization. After matching propensity scores between patients who underwent early revascularization and those who did not (n=316 per group), we compared cardiac event rates in relation to the amount of ischemic myocardium. Cardiac event rates did not significantly differ between patients who underwent early revascularization and those who did not (5.4% vs. 6.4%). Among patients with ≤ 5%, 6-10%, and >10% ischemic myocardium, cardiac event rates were 8%, 3% and 0% respectively, who underwent early revascularization compared with 4.5%, 6.1%, and 12.3%, respectively, among those who did not. Cardiac event rates were significantly lower among patients with >10% ischemic myocardium who underwent early revascularization compared with those who did not (0% vs. 12.3%, p=0.0062). Coronary revascularization for stable IHD does not decrease major cardiac events in all patients but might do in patients with moderate to severe ischemia. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  9. Present trends in the detection of myocardial viability using nuclear cardiology tests

    International Nuclear Information System (INIS)

    Peix Gonzalez, Amalia; Garcia Barreto, David

    1999-01-01

    The myocardial viability diagnosis is important for those who will undergo myocardial revascularization whether by surgery or coronary angioplasty. Our purpose is to present some of the present trends in the detection of myocardial viability using nuclear cardiology tests. Emphasis is made on the estimation of radiopharmaceutical uptake and the use of vasodilators in perfusion scintigraphy mainly with technetium-labeled compounds. Also, the current possibilities for a myocardial metabolism study using single-photon emission-computed tomography as well as some clinical implications of myocardial viability are set forth

  10. Comparison of Early Outcomes with Three Approaches for Combined Coronary Revascularization and Carotid Endarterectomy

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    Arzu Antal Dönmez

    Full Text Available Abstract Objective: This study aims to compare three different surgical approaches for combined coronary and carotid artery stenosis as a single stage procedure and to assess effect of operative strategy on mortality and neurological complications. Methods: This retrospective study involves 136 patients who had synchronous coronary artery revascularization and carotid endarterectomy in our institution, between January 2002 and December 2012. Patients were divided into 3 groups according to the surgical technique used. Group I included 70 patients who had carotid endarterectomy, followed by coronary revascularization with on-pump technique, group II included 29 patients who had carotid endarterectomy, followed by coronary revascularization with off-pump technique, group III included 37 patients who had coronary revascularization with on-pump technique followed by carotid endarterectomy under aortic cross-clamp and systemic hypothermia (22-27ºC. Postoperative outcomes were evaluated. Results: Overall early mortality and stroke rate was 5.1% for both. There were 3 (4.3% deaths in group I, 2 (6.9% deaths in group II and 2 (5.4% deaths in group III. Stroke was observed in 5 (7.1% patients in group I and 2 (6.9% in group II. Stroke was not observed in group III. No statistically significant difference was observed for mortality and stroke rates among the groups. Conclusion: We identified no significant difference in mortality or neurologic complications among three approaches for synchronous surgery for coronary and carotid disease. Therefore it is impossible to conclude that a single principle might be adapted into standard practice. Patient specific risk factors and clinical conditions might be important in determining the surgical tecnnique.

  11. Clinical outcomes following target lesion revascularization for bioresorbable scaffold failure.

    Science.gov (United States)

    Tanaka, Akihito; Ruparelia, Neil; Kawamoto, Hiroyoshi; Sticchi, Alessandro; Figini, Filippo; Carlino, Mauro; Chieffo, Alaide; Montorfano, Matteo; Latib, Azeem; Colombo, Antonio

    2016-04-01

    To investigate clinical outcomes following target lesion revascularization (TLR) for bioresorbable scaffold (BRS) failure in a real world population. BRS has become a new option in percutaneous coronary intervention, and may be potentially advantages because of the absence of a permanent metallic cage and the possibility for restoration of vasomotion and endothelial function. However, the requirement for TLR following BRS has been reported, but data on outcomes following reintervention are currently lacking. Eighteen patients (20 lesions) who underwent TLR for BRS failure were identified at two high-volume centers in Milan, Italy. Clinical outcomes including all cause death, myocardial infarction, and repeat TLR after TLR for BRS failure were examined. The type of scaffold failure at TLR was classified into focal pattern in 15 lesions, diffuse pattern in two lesions, restenosis at side branch ostium in one lesion and scaffold thrombosis in two lesions. TLR was treated with plain old balloon angioplasty (POBA) in two lesions, with drug-coating balloon in three lesions, drug eluting stent implantation in 11 lesions, further BRS implantation in four lesions. During the followup (median: 345 days after TLR), one sudden death and three repeat TLRs were observed. In our series, we observed an adverse event rate of 20% of during the followup period following TLR for BRS failure. The optimal treatment option for these patients remains to be determined. © 2015 Wiley Periodicals, Inc.

  12. Situaciones que requieren cuidado de enfermería en el paciente en posoperatorio temprano de una revascularización miocárdica Situations that require nursing care for the patient in an early post-operative stage following a myocardial revascularization Situações que requerem cuidado inicial de enfermagem em pós-operatório de uma revascularização miocárdica

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    ARIZA OLARTE CLAUDIA

    2010-04-01

    myocardial revascularization (48 to 96 hours. Said situations constitute the qualitative data of the doctoral thesis titled “Nursing care to the patient in early post-operative stage following a myocardial revascularization”, whose general objective was to design the nursing care proposal for the patient in early post-operative stage following a myocardial revascularization based on problems identified from the interpretation of the clinical events and the situations that require nursing care. Interviews (semi-structured were taken of 40 patients during their early post-operative stage; questions were asked about their feelings, emotions and concerns. The collected information was refined. Literal phrases of the patients were used and descriptive codes were established, which were interpreted in order to determine the nominal and substantive codes to then be grouped under one same term forming the categories, which are the situations that require nursing care: wellbeing, achievements, reasoning, benefit, satisfaction, beliefs and values, suffering, anxiety and affliction. The proposal states that dialogue, gathering and the call-answer scenario will have better effects on the wellbeing of the patient, if the cold and impersonal atmosphere of the hospital is changed into a caring surrounding where conditions such as presence of family and affective availability of nurses are strengthened, providing information on the process the patient goes through, using a language that allows his/hers being understood and that contributes to reducing the distress and the anxiety that the surrounding context may generate.Este estudo apresenta as situações que requerem cuidado de enfermagem (SRCE características do paciente em pós-operatorio inicial (POPI de uma revascularização miocárdica (48 a 96 horas. Essas situações constituem os dados qualitativos da tese de doutorado intitulada “Cuidado de enfermagem ao paciente em pós-operatório inicial de uma revasculariza

  13. Myocardial contusion

    Science.gov (United States)

    ... 000202.htm Myocardial contusion To use the sharing features on this page, please enable JavaScript. Myocardial contusion ... Wear a seat belt when driving. Choose a car with air bags. Take steps to ensure safety when working at heights. Alternative Names Blunt myocardial ...

  14. Revascularization of an impacted, immature dilacerated permanent maxillary central incisor associated with odontoma and a supernumerary tooth

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    Priya Subramaniam

    2013-01-01

    Full Text Available To intentionally replant an impacted immature permanent maxillary central incisor in the mixed dentition period followed by revascularization in order to achieve apical root closure. A 9-year-old boy presented with retained maxillary left primary incisors. Radiographic evaluation revealed the presence of a supernumerary tooth and an odontoma associated with an impacted permanent maxillary left central incisor, having root dilaceration. Treatment included surgical removal of mesiodens and odontoma. The impacted dilacerated permanent central incisor was removed and intentionally replanted, followed by revascularization of pulp. During the follow-up, root end closure with narrowing of canal space was observed, patient has been asymptomatic and the tooth remains vital. Revascularization of the immature reimplanted tooth showed continued root development and thickening of the lateral dentinal walls through deposition of new hard tissue and narrowing of the canal space.

  15. Population-level differences in revascularization treatment and outcomes among various United States subpopulations.

    Science.gov (United States)

    Graham, Garth; Xiao, Yang-Yu Karen; Rappoport, Dan; Siddiqi, Saima

    2016-01-26

    Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to

  16. Left main disease management strategy: indications and revascularization methods in particular groups of subjects.

    Science.gov (United States)

    Krzych, Łukasz J; Bochenek-Klimczyk, Krystyna; Wasiak, Michał; Białek, Krzysztof; Bolkowski, Maciej; Gierek, Danuta; Bochenek, Andrzej

    2012-01-01

    Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease.

  17. Severe acute myocardial infarction and peripheral thrombosis in patient with bladder cancer

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    Ahmet Seyfeddin Gürbüz

    2017-12-01

    Full Text Available Cancer-associated thrombosis worsens the lives of patients substantially. Venous manifestations of cancer-associated thrombosis include deep vein thrombosis and pulmonary embolism. Arterial events include stroke and myocardial infarction. In this patient, myocardial infarction and cardiogenic shock are associated with diffuse coronary thrombosis together with peripheral thrombosis. He had surgery because of bladder carcinoma. Severe hypercoagulable condition probably facilitated by cancer itself and surgery caused multivessel coronary and peripheral intense thrombus burden. Intracoronary 10 mcg/kg tirofiban bolus and 15 mg tissue plasminogen activator (tPA were administered respectively before revascularization and thrombectomy operation was performed. Complete revascularization was achieved.

  18. Hipercapnia acentuada durante circulação extracorpórea em cirurgia para revascularização do miocárdio: relato de caso Hipercapnia acentuada durante circulación extracorpórea en cirugía para revascularización del miocárdio: relato de caso Marked hypercapnia during cardiopulmonary bypass for myocardial revascularization: case report

    Directory of Open Access Journals (Sweden)

    Maurício Serrano Nascimento

    2002-04-01

    ía estar conectado al cilindro de aire comprimido. CONCLUSIONES: Fallas mecánicas de los componentes del circuito de extracorpórea pueden ocurrir en el per-operatorio y exigen correcciones rápidas. Los avanzos tecnológicos en los equipamientos de anestesia, monitorización y normatizaciones de seguridad atenuaron la posibilidad de que casos como ese se repitan, más jamás substituirán la presencia vigilante del anestesiólogo.BACKGROUND AND OBJECTIVES: Bypassing heart blood and returning it oxygenated to systemic circulation is achieved at the expenses of major cardiopulmonary physiologic changes. The aim of this report was to present an anesthetic complication during CPB and to warn for the need of interaction of the whole anesthetic-surgical team to prevent adverse perioperative events. CASE REPORT: A brown female patient, 56 years old, 95 kg, height 1.65 m, physical status ASA IV, with chronic renal failure under hemodialysis was admitted for myocardial revascularization. Monitoring consisted of ECG, invasive blood pressure, pulse oximetry, capnography, esophageal temperature, central venous pressure and anesthetic gases analysis. Patient was premedicated with intravenous midazolam (0.05 mg.kg-1. Anesthesia was induced with fentanyl (16 µg.kg-1, etomidate (0.3 mg.kg-1 and pancuronium (0.1 mg.kg-1, and was maintained with O2, isoflurane (0.5 - 1 MAC and fentanyl continuous infusion. Blood gas analysis after induction has shown: pH: 7.41; PaO2: 288 mmHg; PaCO2: 38 mmHg; HCO3: 24 mmol.L-1; BE: 0 mmol.L-1; SatO2 100%. A second blood gases analysis, sampled soon after CPB, returned in 30 minutes, showing: pH 7.15; PaO2: 86 mmHg; PaCO2 224 mmHg; HCO3: 29 mmol.L-1; BE: -3 mmol.L-1; SatO2 99%. Thorough and urgent checking of anesthetic and perfusion equipment was performed and revealed that the gas blender was connected to the O2 line and to a CO2 cylinder, when it should be connected to the compressed air cylinder. CONCLUSIONS: Bypass circuit mechanical problems may

  19. Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization

    NARCIS (Netherlands)

    Loef, BG; Epema, AH; Navis, G; Ebels, T; van Oeveren, W; Henning, RH

    Study objectives: Cardiopulmonary bypass (CPB) represents a specific risk factor for renal damage during coronary, revascularization. The purpose of this study, was to compare the perioperative renal damage in patients undergoing on-pump and off-pump Coronary, surgery.. Design and patients: The

  20. Assessment of myocardial variability in chronic ischemic heart disease: current status

    International Nuclear Information System (INIS)

    Rizzello, V.; Poldermans, D.; Bax, J.J.

    2005-01-01

    Assessment of myocardial variability is clinically important in the work-up of patients with ischemic cardiomyopathy. Numerous studies in the past 2 decades demonstrated that revascularization improves left ventricular ejection fraction (LVEF), heart failure symptoms and prognosis in patients with viable myocardium. Conversely patients without viable tissue do not benefit from revascularization. Also, a substantial amount of viable myocardium (at least 25% of the left ventricle) is needed to result in improvement of LVEF. Hence, both identification and quantification on the extent of viable myocardium are required for a careful selection of candidates for revascularization. Indeed, the presence of a substantial amount of viable myocardium decreases the risk of surgery in patients with reduced LVEV. Several diagnostic techniques are available to identify myocardial viability. Positron emission tomography (PET), myocardial perfusion imaging, and stress echocardiography are considered the traditional techniques to evaluate myocardial viability. Recently, newer techniques including cardiac magnetic resonance (CMR), myocardial contrast echography (MCE) and electro-mechanical mapping have been introduced. In this manuscript the status of the currently available techniques to assess viability was reviewed. Also the relative merits of each techniques for prediction of functional recovery and prognosis was addressed. The available retrospective data support the clinical use of viability assessment. Patients with ischemic cardiomyopathy should undergo viability testing to determine therapeutic strategy. In the presence of substantial amount of viable myocardium, patients should undergo revascularization since benefits in terms of left ventricular function, remodelling, symptoms and prognosis may be anticipated. However, prospective randomized trial are needed to confirm these data

  1. Assessment of myocardial variability in chronic ischemic heart disease: current status

    Energy Technology Data Exchange (ETDEWEB)

    Rizzello, V.; Poldermans, D. [Thoraxcenter Erasmus MC, Rotterdam (Netherlands). Department of Cardiology; Bax, J.J. [Leiden Univ. Medical College, Leiden (Netherlands). Department of Cardiology

    2005-03-01

    Assessment of myocardial variability is clinically important in the work-up of patients with ischemic cardiomyopathy. Numerous studies in the past 2 decades demonstrated that revascularization improves left ventricular ejection fraction (LVEF), heart failure symptoms and prognosis in patients with viable myocardium. Conversely patients without viable tissue do not benefit from revascularization. Also, a substantial amount of viable myocardium (at least 25% of the left ventricle) is needed to result in improvement of LVEF. Hence, both identification and quantification on the extent of viable myocardium are required for a careful selection of candidates for revascularization. Indeed, the presence of a substantial amount of viable myocardium decreases the risk of surgery in patients with reduced LVEV. Several diagnostic techniques are available to identify myocardial viability. Positron emission tomography (PET), myocardial perfusion imaging, and stress echocardiography are considered the traditional techniques to evaluate myocardial viability. Recently, newer techniques including cardiac magnetic resonance (CMR), myocardial contrast echography (MCE) and electro-mechanical mapping have been introduced. In this manuscript the status of the currently available techniques to assess viability was reviewed. Also the relative merits of each techniques for prediction of functional recovery and prognosis was addressed. The available retrospective data support the clinical use of viability assessment. Patients with ischemic cardiomyopathy should undergo viability testing to determine therapeutic strategy. In the presence of substantial amount of viable myocardium, patients should undergo revascularization since benefits in terms of left ventricular function, remodelling, symptoms and prognosis may be anticipated. However, prospective randomized trial are needed to confirm these data.

  2. Advances in peripheral arterial disease endovascular revascularization.

    Science.gov (United States)

    Panico, Ambrose; Jafferani, Asif; Shah, Falak; Dieter, Robert S

    2015-02-01

    Significant advances have been made in the endovascular treatment of lower extremity arterial occlusive disease. Since the 2011 update, technologies has developed and allowed for the revascularization of complex vascular lesions. Although this technical success is encouraging, these technologies must provide measurable long-term clinical success at a reasonable cost. Large, randomized, controlled trials need to be designed to focus on clinical outcomes and success rates for treatment. These future studies will serve as the guide by which clinicians can provide the most successful clinical and cost effect care in treating patients with lower-extremity peripheral artery disease. Published by Elsevier Inc.

  3. Detecting culprit vessel of coronary artery disease with SPECT 99Tcm-MIBI myocardial imaging

    International Nuclear Information System (INIS)

    Luan Zhaosheng; Zhou Wen; Peng Yong; Su Yuwen; Tian Jianhe; Gai lue; Sun Zhijun

    2002-01-01

    Objective: To assess the value of detecting culprit vessel of coronary artery disease (CAD) with SPECT 99 Tc m -MIBI myocardial imaging. Methods: Forty-six patients with CAD were studied. Every patients had multiple-vessel lesion showed by coronary arteriography and was treated by revascularization as percutaneous transluminal angioplasty (PTCA), coronary artery bypass graft (CABG) or laser holing. Exercise (EX), rest (RE) and intravenous infusion of nitroglycerine (NTG) SPECT 99 Tc m -MIBI myocardial imagings were performed before revascularization. Exercise and rest images revealed the myocardial ischemia. NTG images revealed myocardial viability. Culprit vessels were detected according to the defects showed by above mentioned images. The veracity of detected culprit vessels was tested with the outcome of the reperfusion therapy. Results: In this group, the coronary arteriography revealed 107 lesioned coronary arteries. Myocardial imaging detected 46 culprit vessels including 23 left anterior descending (LAD), 19 left circumflex coronary artery (LCX) and 4 right coronary artery (RCA). All 46 culprit vessels underwent revascularization and had nice outcome. The veracity of 99 Tc m -MIBI myocardial imaging detected culprit vessels was high according to patients' outcome. Conclusion: Exercise, rest and NTG 99 Tc m -MIBI myocardial imaging is a great method for detecting culprit vessels in multivessel coronary disease

  4. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation.

    Science.gov (United States)

    Jang, Woo Jin; Yang, Jeong Hoon; Choi, Seung-Hyuk; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Kim, Wook Sung; Lee, Young Tak; Gwon, Hyeon-Cheol

    2015-02-01

    The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Effect of intravenous TRO40303 as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Atar, Dan; Arheden, Håkan; Berdeaux, Alain

    2015-01-01

    AIM: The MITOCARE study evaluated the efficacy and safety of TRO40303 for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). METHODS: Patients presenting with STEMI within 6 h of the onset of pain randomly received TRO40303...... with contemporary mechanical revascularization principles did not show any effect of TRO40303 in limiting reperfusion injury of the ischaemic myocardium....

  6. Transmyocardial laser revascularization. Early clinical experience

    Directory of Open Access Journals (Sweden)

    Oliveira Sérgio Almeida de

    1999-01-01

    Full Text Available OBJECTIVE: To analyze the initial clinical experience of transmyocardial laser revascularization (TMLR in patients with severe diffuse coronary artery disease. METHODS: Between February, 1998 and February, 1999, 20 patients were submitted to TMLR at the Heart Institute (InCor, University of São Paulo Medical School, Brazil, isolated or in association with conventional coronary artery bypass graft (CABG. All patients had severe diffuse coronary artery disease, with angina functional class III/IV (Canadian Cardiovascular Society score unresponsive to medical therapy. Fourteen patients were submitted to TMLR as the sole therapy, whereas 6 underwent concomitant CABG. Fifty per cent of the patients had either been previously submitted to a CABG or to a percutaneous transluminal coronary angioplasty (PTCA. Mean age was 60 years, ranging from 45 to 74 years. RESULTS: All patients had three-vessel disease, with normal or mildly impaired left ventricular global function. Follow-up ranged from 1 to 13 months (mean 6.6 months, with no postoperative short or long term mortality. There was significant symptom improvement after the procedure, with 85% of the patients free of angina, and the remaining 15 % of the patients showing improvement in functional class, as well as in exercise tolerance. CONCLUSION: This novel technique can be considered a low risk alternative for a highly selected group of patients not suitable for conventional revascularization procedures.

  7. Replantation and revascularization vs. amputation in injured digits

    NARCIS (Netherlands)

    Mulders, Marjolein A. M.; Neuhaus, Valentin; Becker, Stéphanie J. E.; Lee, Sang-Gil; Ring, David C.

    2013-01-01

    The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization. We reviewed 315 complete and subtotal amputations at or proximal to the

  8. The Influence of findings of coronary artery on myocardial salvage in acute myocardial infarction

    International Nuclear Information System (INIS)

    Itano, Midoriko; Naruse, Hitoshi; Morita, Masato; Kawamoto, Hideo; Yamamoto, Juro; Fukutake, Naoshige; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru

    1992-01-01

    201 Tl stress myocardial scintigraphy was performed in convalescent patients with acute myocardial infarction, to evaluate the influence of stenosis and collateral circulation of coronary artery in acute phase, on myocardial salvage in chronic phase. In 14 cases of unsuccessful coronary revascularization (complete occlusion), a complete defect of thallium imaging in chronic phase was seen in only one case of four cases with good collateral circulation, while eight of 10 cases with poor collateral circulation. In 16 cases with collateral circulation, six cases showed a complete defect, although the target vessel had improved to less than 75% of stenosis. However, in cases of good collateral circulation, no case showed a complete defect when the target vessel had improved to less than 75% of stenosis. The myocardial salvage is quite possible (p<0.05), when the coronary angiography in acute phase showed the forward flow (99% or 90% of stenosis) before coronary revascularization and/or good collateral circulation (Rentrop 2deg or 3deg). (author)

  9. Non-invasive imaging in detecting myocardial viability: Myocardial function versus perfusion

    Directory of Open Access Journals (Sweden)

    Iqbal A. Elfigih

    2014-12-01

    Full Text Available Coronary artery disease (CAD is the most prevalent and single most common cause of morbidity and mortality [1] with the resulting left ventricular (LV dysfunction an important complication. The distinction between viable and non-viable myocardium in patients with LV dysfunction is a clinically important issue among possible candidates for myocardial revascularization. Several available non-invasive techniques are used to detect and assess ischemia and myocardial viability. These techniques include echocardiography, radionuclide images, cardiac magnetic resonance imaging and recently myocardial computed tomography perfusion imaging. This review aims to distinguish between the available non-invasive imaging techniques in detecting signs of functional and perfusion viability and identify those which have the most clinical relevance in detecting myocardial viability in patients with CAD and chronic ischemic LV dysfunction. The most current available studies showed that both myocardial perfusion and function based on non-invasive imaging have high sensitivity with however wide range of specificity for detecting myocardial viability. Both perfusion and function imaging modalities provide complementary information about myocardial viability and no optimum single imaging technique exists that can provide very accurate diagnostic and prognostic viability assessment. The weight of the body of evidence suggested that non-invasive imaging can help in guiding therapeutic decision making in patients with LV dysfunction.

  10. [The impact of renal function on clinical outcomes of patients without chronic kidney disease undergoing coronary revascularization].

    Science.gov (United States)

    Zhang, Qiang; Ma, Chang-Sheng; Nie, Shao-Ping

    2008-09-01

    This study determined the profile of renal insufficiency in patients without chronic kidney disease (CKD) undergoing coronary revascularization and elucidated the effect of renal insufficiency of different degrees on clinical outcomes after revascularization and examined whether the reasonable choice of the mode of revascularization could favourably influence prognosis. Patients undergoing coronary revascularization were grouped by estimated creatinine clearance (CrCl) (Group I, CrCl > or = 90 ml/min; Group II, 60 relationship between the CrCl and the clinical outcomes of all of the patients. The mean Scr level of 2896 patients was (80.0 +/- 35.4) micromol/L. There were 1035 patients (35.7%) in Group I, 1337 patients (46.2%) in Group II, 524 patients (18.1%) in Group III and no patient in Group IV. During hospitalization, significant difference was found among Group I-III on mortality (1.0%, 2.5% and 2.9%, P = 0.009) and major adverse cardiac cerebra events (MACCE) (1.4%, 3.5% and 4.6%, P = 0.001). Compared with the normal renal function group, there were significantly higher rate of mortality (2.5% vs. 1.0%, P = 0.007), new-onset myocardial infarction (1.0% vs. 0.2%, P = 0.018) and MACCE (3.5% vs. 1.4%, P = 0.002) in mild renal insufficiency (Grou II). During follow-up, there were significant difference among Group I-III on mortality (2.0%, 3.0% and 5.7%, P = 0.002), stroke (1.0%, 1.8% and 3.1%, P = 0.023) and MACCE (9.9%, 10.3% and 16.6%, P = 0.001). The independent risk factors for all-cause death in patients after revascularization were the mode of revascularization (OR 8.332, 95%CI 2.386 - 22.869, P = 0.001), age (OR 1.184, 95%CI 1.020 - 1.246, P = 0.001), and the level of CrCl (OR 0.503, 95%CI 0.186 - 0.988, P = 0.045). In patients with normal renal function and mild renal insufficiency, the all-cause mortality after PCI was significantly lower that than after CABG (both P function or mild renal insufficiency, the mode of revascularization might lead to a

  11. Laser plant "Iguana" for transmyocardial revascularization based on kW-level waveguide CO2 laser

    Science.gov (United States)

    Panchenko, Vladislav Y.; Bockeria, L. A.; Berishvili, I. I.; Vasiltsov, Victor V.; Golubev, Vladimir S.; Ul'yanov, Valery A.

    2001-05-01

    For many years the Institute on Laser and Information Technologies RAN has been developing a concept of high-power industrial CO2 lasers with diffusion cooling of the working medium. The paper gives a description of the laser medical system Iguana for transmyocardial laser revascularization (TMLR) as an example of various applications of high-power waveguide CO2 lasers. The clinical results of the TMLR method application in surgical treatment are presented. The methods of determination of the time, when the laser beam passes through the demarcation line between myocardium tissue and blood, are discussed.

  12. Padronização da dose de heparina sódica utilizada na cirurgia de revascularização do miocárdio sem circulação extracorpórea Standardization of the sodium heparin dose used in off-pump myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    José Glauco Lobo Filho

    2005-09-01

    Full Text Available OBJETIVO: Propor uma metodologia de anticoagulação com heparina sódica monitorizada pelo Tempo de Coagulação Ativada (TCA nos pacientes submetidos à cirurgia de revascularização miocárdica (RM sem circulação extracorpórea (CEC, que promova uma anticoagulação segura (TCA >200 segundos, utilizando uma dose inicial de 1mg heparina sódica/kg de peso. MÉTODO: Quarenta pacientes (30 homens e 10 mulheres, entre 41 e 85 anos, foram submetidos à cirurgia de RM sem CEC, utilizando uma dose inicial de 1mg heparina sódica/kg de peso. Dez minutos após a administração da droga, quando TCA > 200 segundos, iniciava-se a confecção das anastomoses coronarianas. Caso contrário, administrava-se 0,5mg/kg de heparina suplementar. Durante a cirurgia, a cada 30 minutos, novos valores de TCA foram obtidos. Concluídas as anastomoses coronarianas, a heparina foi revertida na proporção de 1:1 utilizando cloridrato de protamina. RESULTADOS: O valor médio de TCA dez minutos pós-heparinização foi de 372,2(+/-104,31 segundos, sem variação estatisticamente significante entre os sexos ou grupos etários (p>0,05. Os valores de TCA, 30 e 60 minutos pós-heparinização, mantiveram-se acima de 200 segundos. Aos 30 minutos, verificou-se diferença estatisticamente significante dos valores do TCA entre os sexos e diferentes idades (pOBJECTIVE: To evaluate a methodology of anticoagulation during off pump coronary artery bypass surgery (CABS that promotes safe anticoagulation during the procedure (Activated Coagulation Time >200 seconds, using an initial dose of 1 mg of sodium heparin/kg weight. METHOD: 40 patients (30 men and 10 women, ages ranging from 41 to 85 years, were submitted to off pump CABS, using an initial sodium heparin dose of 1mg/kg of weight. Ten minutes after that drug was administered, if the ACT was > 200 seconds, we initiated the revascularization procedure. If not, we administered an additional of 0.5mg/kg heparin. During the

  13. Non-atherosclerotic spontaneous coronary artery dissection revascularized by intravascular ultrasonography-guided fenestration with cutting balloon angioplasty.

    Science.gov (United States)

    Ito, Tsuyoshi; Shintani, Yasuhiro; Ichihashi, Taku; Fujita, Hiroshi; Ohte, Nobuyuki

    2017-07-01

    A 46-year-old woman was referred to our hospital due to chest pain. Twelve-lead electrocardiogram revealed ST-segment elevation suggesting acute myocardial infarction. Emergent coronary angiography showed diffuse narrowing and occlusion in the middle to distal left anterior descending artery (LAD). To investigate the cause of occlusion, an intravascular ultrasound (IVUS) examination was performed and we diagnosed spontaneous coronary artery dissection (SCAD) as the cause of occlusion. After a cutting balloon was dilated at the distal LAD, coronary flow recovered. IVUS-guided angioplasty with cutting balloon could be a choice of treatment in SCAD patients who need revascularization.

  14. Redefining the boundaries of drug-eluting stent utilization: from in-stent restenosis to acute myocardial infarction

    NARCIS (Netherlands)

    F. Saia (Francesco)

    2004-01-01

    textabstractPercutaneous Coronary Interventions Percutaneous coronary angioplasty was first introduced by Andreas Gruentzig in 1977 as a non surgical method for coronary artery revascularization. Although initially restricted to stable patients with single, discrete, concentric, noncalcified

  15. Myocardial injury during off-pump surgery: The effect of intraoperative risk factors

    International Nuclear Information System (INIS)

    Ketenci, B.; Enc, Y.; Ozay, B.; Cimen, S.; Gunay, R.; Orhan, G.; Gurer, O.; Gorur, A.; Teskin, O.; Demirtas, Mahmut M.

    2008-01-01

    Objective was to achieve better outcomes, the degree of myocardial injury due to off-pump coronary artery bypass surgery (OPCAB) must be reduced. We studied the factors that render patients scheduled for OPCAB vulnerable to myocardial injury, using troponin T (cTnT) as a marker of myocardial injury. We prospectively investigated 123 patients being operated by a group of surgeons with off-pump technique between January 2001 and June 2006 in Siyami Ersek Thoracic and Cardiovascular Surgery Center. Myocardial injury occurring during surgery was assessed by post-operative cTnT measurement. Then, the relation between intraoperative factors and postoperative cTnT release were statistically evaluated. Blood samples for cTnT measurement were taken for all patients before operation, immediately after arrival at the intensive care unit, then at 6, 12 and 24 hours after distal revascularization. When regarding the intraopertive risk factors, we found that the heart rate, blood pressure and anastomosis time are the main determinant of myocardial cell injury occurring during OPCAB surgery. Although aortic cross-clamp and cardioplegic arrest were not used in off-pump myocardial revascularization, the ischemic myocardial cell destruction was also inevitable in off-pump technique. Therefore, management of heart rate and myocardial contractility was desirable not only for precise anastomosis but also for myocardial protection during OPCAB surgery. (author)

  16. Adjuvant revascularization of intracranial artery occlusion with angioplasty and/or stenting

    International Nuclear Information System (INIS)

    Choi, Jin Woo; Choi, Byung Se; Kim, Jeoung Hyun; Hwang, Hae Jun; Kim, Sang Joon; Suh, Dae Chul; Kim, Jae Kyun; Kim, Jong Sung

    2009-01-01

    In conjunction with intravenous and/or intra-arterial thrombolysis, adjuvant revascularization of intracranial artery occlusion by angioplasty vs. stenting remains controversial. We evaluated outcome in patients with intracranial occlusion after angioplasty and/or stenting. Thirty-three patients who underwent angioplasty or stenting (17 stenting and 16 angioplasty) for intracranial arterial occlusion during the past 5 years were enrolled from prospective neurointerventional database. We compared recanalization rate [defined as thrombolysis in myocardial infarction (TIMI) grade II/III flow], adverse events, and clinical outcome [modified Rankin scale (mRS) at 1 and 6 months]. We also tried to determine independent variables associated with clinical outcome. Median initial National Institutes of Health Stroke Scale (NIHSS) was 13 and median time to treatment was 12 h from symptom onset. The successful recanalization rate was mean 79%. Symptomatic hemorrhage occurred in 15% (5/33). Events (27%, 9/33) at 1 month included four deaths, four major, and one minor stroke. Good outcome (mRS ≤ 2) was achieved in 17 patients (52%) at 6 months and was significantly related to age, initial NIHSS, TIMI flow, and stenting on bivariate analysis. On multivariable analysis, stenting was the only variable significantly associated with a 6-month, good clinical outcome (OR, 14.48; 95% CI, 1.76 to 118.93; p = 0.013) Intracranial revascularization with angioplasty and/or stenting may improve the clinical outcome in selected patients with intracranial occlusion. Multiple factors are related to favorable clinical outcome. (orig.)

  17. Reversible congestive heart failure caused by myocardial hibernation.

    OpenAIRE

    Wilson, J M

    1999-01-01

    Myocardial hibernation is reversible contractile dysfunction of cardiac myocytes caused by chronic ischemia. Animal studies and observations in human beings suggest that the term hibernation is a misnomer. Repetitive ischemic insult that does not produce necrosis results in functional and histologic tissue deterioration, which culminates in myocyte apoptosis. Revascularization of "hibernating" myocardium results in partial or complete recovery of function, depending upon the duration of ische...

  18. Imaging techniques in nuclear cardiology for the assessment of myocardial viability

    NARCIS (Netherlands)

    Slart, RHJA; Bax, JJ; van Veldhuisen, DJ; van der Wall, EE; Dierckx, RAJO; Jager, PL

    The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with sufficient viable myocardium, patients with predominantly scar tissue should be

  19. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

    NARCIS (Netherlands)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J.; Noc, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S.; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Tebbe, Ulrich; Wöhrle, Jochen; Pachinger, Otmar; Busch, Clemens; Pfeiffer, Nathalie; Neumer, Alexander; Ouarrak, Taoufik; Reimer, Thomas; Lober, Christiane; Clemmensen, Peter; Follath, Ferenc; Wegscheider, Karl; Zeitouni, M.; Overtchouk, P.; Guedeney, P.; Hage, G.; Hauguel-Moreau, N. N.; Eitel, Ingo; Weinschenk, Sabrina; Borggrefe, Martin; Neumann, Franz-Josef; Ferenc, Miroslaw; Olbrich, Hans-Gerd; Hopf, Hans-Bernd; Kastrati, Adnan; de Waha, Antoinette; Schunkert, Heribert; Richardt, Gert; Schwarz, Bettina; Abdel-Wahab, Mohamed; Toelg, Ralph; Geist, Volker; Bahnsen-Maaß, Monika; Hennersdorf, Marcus; Graf, Jochen; Riemann, Urs; Scharpf, Dominik; Empen, Klaus; Busch, Mathias C.; Werdan, Karl; Nuding, Sebastian; Hambrecht, Rainer; Fiehn, Eduard; Gitt, Anselm K.; Mark, Bernd; Winkler, Ralph; Lauer, Bernward; Möbius-Winkler, Sven; Schulze, Christian; Minden, Hans-Heinrich; Braun-Dullaeus, Rüdiger C.; Schmeißer, Alexander; Strasser, Ruth H.; Ebner, Bernd; Ertl, Georg; Mudra, Harald; Hug, Martin; Endemann, Dierk; Hamm, Christian; Walther, Claudia; Liebetrau, Christoph; Menck, Niels; Mehilli, Julinda; Orban, Martin; Hausleiter, Jörg; Massberg, Steffen; Prondzinsky, Roland; Gielen, Stephan; Gawaz, Meinrad; Pauschinger, Matthias; Ademaj, Fadil; Bode, Christoph; Nickenig, Georg; Fichtlscherer, Stephan; Zeiher, Andreas; Viertel, Achim; Kelm, Malte; Jung, Christian; Sydow, Carsten; Karakas, Mahir; Rudolph, Volker; Baldus, Stephan; Jacobshagen, Claudius; Hasenfuß, Gerd; Pfeiffer, Dietrich; Buchter, Björn; Hügl, Burkhard; Nef, Holger; Dörr, Oliver; Reinig, Karsten; Kuck, Karl Heinz; Ghanem, Alexander; Katus, Hugo; Gori, Tommaso; Münzel, Thomas; Schnupp, Steffen; Brachmann, Johannes; Ferrari, Markus; Achenbach, Stephan; Carrié, Didier; Henry, Patrick; Manzo-Silberman, Stephane; Ledermann, Bertrand; Cayla, Guillaume; Bonnet, Jean-Louis; Windecker, Stefan; Frenk, André; Jeger, Raban; Eeckhout, Eric; Henriques, Jose P.; van Geuns, Robert-Jan; Voskuil, Michiel; Bax, M.; van der Harst, Pim; Serpytis, Rokas; Jarasuniene, Dalia; Lang, Irene Marthe; Pichler, Philipp; Weidinger, Franz; Zaruba, Marc-Michael; Dudek, Darius; Depukat, Rafal; Witkowski, Adam; Milewski, Krzysztof; Prokopczuk, Janusz; Gąsior, Mariusz; Gorycki, Bogdan; Ochała, Andrzej; Piatti, Luigi; Galvani, Marcello; Bossi, Irene; Emilia, Reggio; Pignatelli, Gianluca; Greenwood, John; Lockie, Tim; Mamas, Mamas

    2017-01-01

    In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be

  20. Clinical utility and problem of thallium myocardial imaging after coronary angioplasty

    International Nuclear Information System (INIS)

    Konishi, Tokuji; Tamai, Takuya; Nakamura, Mashio; Miyahara, Masatoshi; Isaka, Naoki; Nakano, Takeshi.

    1995-01-01

    The purpose of this study was twofold: (1) to assess the value and limits of stress thallium myocardial imaging in the diagnosis of reclosure after percutaneous transluminal coronary angioplasty (PTCA) and (2) to determine how myocardial viability, as determined on thallium imaging, influenced the therapeutic option. In study 1, 117 segments, which were treated with PTCA, were examined. Of 52 segments that showed thallium defects, 27 were treated with repeated PTCA. Of the other 25 segments, 12 were found to be reclosed. On the other hand, 65 other segments showed redistribution on thallium imaging, and 60 of these had no reclosure. The remaining 5 segments that were reclosed reflected no evidence of myocardial viability. These findings suggest that coronary arteriography may omitted when redistribution is seen on stress thallium imaging after PTCA. The population in Study 2 included 39 patients who were diagnosed as having myocardial necrosis on thallium imaging. In 22 of these patients, thallium findings ruled out coronary revascularization. One other patient did not undergo coronary revascularization because of technical problems. Thus, the remaining 16 patients were treated with coronary revascularization combined with bypass surgery for necrotic zones (n=10) or with PTCA for preserved collateral circulation (n=6). For necrotic zones evidenced on thallium imaging, factors other than necrosis were considered in determining coronary revascularization. (N.K.)

  1. : Myocardial Perfusion

    OpenAIRE

    Dacher, Jean-Nicolas; Lefebvre, V.; Dubourg, Bernard; Deux, Jean-François; Caudron, Jérôme

    2013-01-01

    International audience; The analysis of myocardial perfusion is a key step in the cardiac MRI examination. In routine work, this exploration carried out at rest is based on the qualitative first pass study of gadolinium with an ECG-triggered saturation recovery bFFE sequence. In view of recent knowledge, the analysis of the myocardial perfusion under vasodilator stress may be carried out by scintigraphy or MRI, the latter benefiting from the absence of exposure to ionizing rays and a lower co...

  2. Differential Clinical Outcomes Between Angiographic Complete Versus Incomplete Coronary Revascularization, According to the Presence of Chronic Kidney Disease in the Drug-Eluting Stent Era.

    Science.gov (United States)

    Kim, Jihoon; Lee, Joo Myung; Choi, Ki Hong; Rhee, Tae-Min; Hwang, Doyeon; Park, Jonghanne; Ahn, Chul; Park, Taek Kyu; Yang, Jeong Hoon; Song, Young Bin; Choi, Jin-Ho; Hahn, Joo-Yong; Choi, Seung-Hyuk; Gwon, Hyeon-Cheol

    2018-02-15

    There are limited data regarding the prognostic impact of angiographic complete revascularization (CR) in patients with chronic kidney disease (CKD). We sought to investigate the differential prognostic impact of angiographic CR over incomplete revascularization (IR), according to the presence of CKD in the drug-eluting stent era. Between 2003 and 2011 at Samsung Medical Center, consecutive patients with multivessel disease were stratified by the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m 2 ) and classified according to angiographic CR (residual SYNTAX score=0) or IR. Clinical outcomes were compared between angiographic CR and IR, stratified by the presence of CKD. Primary outcome was patient-oriented composite outcomes (POCO, a composite of all-cause death, myocardial infarction, any revascularization) at 3 years. Inverse probability weighting was performed between the CR and IR groups. A total of 3224 patients were eligible for analysis: 2295 without CKD; 929 with CKD. Among non-CKD patients, angiographic CR showed a significantly lower risk of POCO than IR (17.2% versus 21.7%, adjusted hazard ratio 0.76, 95% confidence interval, 0.62-0.95, P =0.014), mainly driven by a significantly lower risk of any revascularization. Among CKD patients, however, angiographic CR was associated with a significantly higher risk of POCO than IR (37.7% versus 28.4%, adjusted hazard ratio 1.42, 95% confidence interval, 1.08%-1.85%, P =0.011), mainly driven by a significantly higher risk of nonfatal target vessel myocardial infarction. Angiographic CR was associated with reduced risk of POCO than IR in patients without CKD; however, it was associated with a significantly higher risk of POCO and nonfatal myocardial infarction in CKD patients. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  3. Rationale and design of the Statins Evaluation in Coronary procedUres and REvascularization: The SECURE-PCI Trial.

    Science.gov (United States)

    Berwanger, Otavio; de Barros E Silva, Pedro G M; Dall Orto, Frederico Toledo Campo; de Andrade, Pedro Beraldo; de Castro Bienert, Igor Ribeiro; Bosso, Carlos Eduardo; Mangione, José; Polanczyk, Carisi Anne; Sousa, Amanda; Kalil, Renato; de Moura Santos, Luciano; Sposito, Andrei C; Rech, Rafael L; Sousa, Antonio Carlos Sobral; Baldissera, Felipe; Nascimento, Bruno Ramos; de Andrade Jesuíno, Isabella; Santucci, Eliana Vieira; Damiani, Lucas Petri; Laranjeira, Ligia N; Borges de Oliveira, Juliana A; Giraldez, Roberto R; Cavalcanti, Alexandre Biasi; Pereira, Sabrina Bernardez; Mattos, Luiz Alberto; Armaganijan, Luciana Vidal; Guimarães, Hélio Penna; Sousa, José Eduardo; Alexander, John H; Granger, Christopher B; Lopes, Renato D

    2018-04-01

    Previous evidence suggests that acute treatment with statins reduce atherosclerotic complications, including periprocedural myocardial infarction, but currently, there are no large, adequately powered studies to define the effects of early, high-dose statins in patients with acute coronary syndrome (ACS) and planned invasive management. The main goal of Statins Evaluation in Coronary procedUres and REvascularization (SECURE-PCI) Trial is to determine whether the early use of a loading dose of 80 mg of atorvastatin before an intended percutaneous coronary intervention followed by an additional dose of 80 mg 24 hours after the procedure will be able to reduce the rates of major cardiovascular events at 30 days in patients with an ACS. The SECURE-PCI study is a pragmatic, multicenter, double-blind, placebo-controlled randomized trial planned to enroll around 4,200 patients in 58 different sites in Brazil. The primary outcome is the rate of major cardiovascular events at 30 days defined as a composite of all-cause mortality, nonfatal acute myocardial infarction, nonfatal stroke, and coronary revascularization. The SECURE PCI is a large randomized trial testing a strategy of early, high-dose statin in patients with ACS and will provide important information about the acute treatment of this patient population. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

    Science.gov (United States)

    Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

    2017-02-10

    Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

  5. Myocardial scintigraphy

    International Nuclear Information System (INIS)

    Bunko, Hisashi; Hisada, Kinichi

    1982-01-01

    Among the various methods of image diagnosis of the cardiovascular disorder, nuclear cardiology provides noninvasive means for evaluation of myocardial perfusion as well as morphological and functional informations. In this article, clinical application and image diagnosis of myocardial scintigraphy including Tl-201 myocardial perfusion scintigraphy, single photon emission computed tomography with Tl-201, acute myocardial infarction scintigraphy with Tc-99m-pyrophosphate and Ga-67 imaging of the heart, were discussed. Multiplanar imaging of the heart with Tl-201 after stress and at redistribution was the accepted method for detection and evaluation of the ischemic heart disease. Although it achieved high sensitivity and specificity for ischemic heart disease, detection of the small ischemia and quantation of the regional Tl-201 accumulation were difficult with conventional multiplanar imaging. Application of emission computed tomography improved detectability and quantitativity of the ischemia. However, 7-pinhole tomography did not increase the diagnostic accuracy significantly. It had limited clinical applicability due to poor quantitativity in spite of improved image contrast and its tomographic nature. Advantage and limitation of these tomographic imaging and multiplanar imaging were discussed. Problems and prognostic significance of pyrophosphate imaging of the acute myocardial infarction were also discussed. Visualization of the heart with Ga-67 was helpful for identification of the tumor or inflammation of the heart as well as evaluation of the effect of the therapy. (author)

  6. Application of myocardial perfusion quantitative imaging for the evaluation of therapeutic effect in canine with myocardial infarction

    International Nuclear Information System (INIS)

    Liang Hong; Chen Ju; Liu Sheng; Zeng Shiquan

    2000-01-01

    Myocardial blood perfusion (MBP) ECT and quantitative analysis were performed in 10 canines with experimental acute myocardial infarct (AMI). The accuracy of main myocardial quantitative index, including defect volume (DV) and defect fraction (DF), was estimated and correlated with histochemical staining (HS) of infarcted area. Other 21/AMI canines were divided into Nd:YAG laser trans-myocardial revascularization treated group LTMR and control group. All canines were performed MBP ECT after experimental AMI. Results found that the infarcted volume (IV) measured by HS has well correlated (r 0.88) with DV estimated by myocardial quantitative analysis. But the DF values calculated by both methods was not significantly different (t = 1.28 P > 0.05). In LTMR group 27.5% +- 3.9%, the DF is smaller than control group 32.1% +- 4.6% (t = 2.49 P 99m Tc-MIBI myocardial perfusion SPECT and quantitative study can accurately predict the myocardial blood flow and magnitude of injured myocardium. Nd:YAG LTMR could improve myocardial blood perfusion of ischemic myocardium and decrease effectively the infarct areas

  7. Dobutamine cine magnetic resonance imaging after myocardial infarction

    International Nuclear Information System (INIS)

    Giovagnoni, A.; Ligabue, G.; Romagnoli, R.; Reggio Emilia Univ., Reggio Emilia; Rossi, R.; Muia, N.; Modena, M.G.; Reggio Emilia Univ.

    1999-01-01

    Dobutamine Cine MRI is a new diagnostic imaging technique in the pretreatment (revascularization) assessment of myocardial infarction patients. In this issue are reported the result of a comparative study of the diagnostic yield of dobutamine Cine MRI with that of stress echocardiography in the assessment of viable myocardium. A new method for analysis of Cine MR images, employing digital subtraction, aimed at decreasing subjectivity in the quantitative assessment of myocardial wall thickening. Twenty-six patients (21 men and 5 women) with a history of myocardial infarction who were scheduled for revascularization were submitted to stress echocardiography and dobutamine Cine MRI to evaluate contractile recovery of the segments considered akinetic or hypo kinetic at baseline echocardiography. Dobutamine was administered in growing doses (5, 10, 15γ/kg/min). 16 segments of the left ventricle in each patient were considered. In the 416 segments studied, it was found that 307 normo kinetic, 64 scarred and 45 viable segments with stress echocardiography, versus 302 normo kinetic, 83 scarred and 31 viable segments with dobutamine MRI. Three months after revascularization 15 patients were examined to check contractile recovery of the segments considered as viable. Echocardiography had 79% sensitivity and 97% specificity, while Cine MRI had 96% and 86%, respectively. In patients with anteroseptal wall myocardial infarction stress echocardiography had 75% sensitivity and 97% specificity. Echocardiography permits to distinguish viable myocardium and scarred myocardial tissue with good sensitivity and specificity, but Cine MRI performs better. Cine MRI has much higher sensitivity than stress echocardiography and thus makes the technique of choice to evaluate viable myocardium in these sites. The digital subtraction technique is as accurate as manual measurements, but reduces the error rate and permits quicker evaluation, particularly in subendocardial thickening [it

  8. Endothelial progenitor cells and revascularization following stroke.

    Science.gov (United States)

    Ma, Feifei; Morancho, Anna; Montaner, Joan; Rosell, Anna

    2015-10-14

    Brain injury after ischemia induces the mobilization of endothelial progenitor cells (EPCs), a population of bone marrow-derived cells with angio-vasculogenic capabilities. These cells have been also tested in pre-clinical models and proposed for neurorepair therapy aiming to treat patients in the delayed phases of stroke disease. Promising results in the pre-clinical field encourage the translation into a clinical therapeutic approach. In this review, we will describe EPCs actions for enhanced revascularization and neurorepair, which on one hand are by their direct incorporation into new vascular networks/structures or by direct cell-cell interactions with other brain cells, but also to indirect cell-cell communication thorough EPCs secreted growth factors. All these actions contribute to potentiate neurovascular remodeling and neurorepair. The data presented in this review encourages for a deep understanding of the mechanisms of the cross-talks between EPCs and other brain and progenitor cells, which deserves additional investigations and efforts that may lead to new EPCs-based therapies for stroke patients. This article is part of a Special Issue entitled SI: Cell Interactions In Stroke. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Revascularização do miocárdio sem circulação extracorpórea com derivação intraluminal temporária (DILT na emergência pós angioplastia transluminal coronária (ATC Myocardial revascularization without cardiopulmonary bypass with temporary intraluminal shunt: emergential approach after transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Ana M. Rocha Pinto

    1996-09-01

    Full Text Available No período de novembro 1989 a dezembro 1995, 18 doentes foram submetidos a cirurgia de emergência para revascularização do miocárdio sem circulação extracorpórea (CEC, devido a insucesso de angioplastia transluminal percutânea (ATC. Todos os pacientes apresentavam lesões do ramo interventricular anterior (RIA, coronária direita (CD ou coronária diagonal (Dg, passíveis de abordagem sem CEC. Em todos utilizamos derivação intraluminal temporária (DITL para manter o fluxo coronariano e minimizar a isquemia. Três (16,66% doentes foram operados na vigência de infarto agudo do miocárdio e 4 (22,22% doentes com importante corrente de lesão ao ECG. O choque cardiogênico estava presente em 3 (16,66% doentes. Não houve mortalidade. Realizamos estudo estatístico para comparação da mortalidade referida por diversos autores utilizando revascularização com CEC.From November 1989 through December 1995, eighteen patients underwent emergency coronary artery bypass grafting without cardiopulmonary bypass following percutaneous transluminal coronary angioplasty (PTCA. All patients had lesions in the left anterior descending coronary artery, diagonal coronary artery or right coronary artery, when we could reach without using cardiopulmonary bypass. In all cases we used a temporary intraluminal shunt in order to allow perfusion through the coronary artery and prevent ischemic effects. Three (16.66% patients had myocardial infarction before going to emergency surgery and 4 (22.22% patients had important ST segment elevation. The cardiogenic shock was present in 3 (16.66% patients. The in-hospital mortality was zero. We compared the several authors mortality rates and ours by a statistic analysis.

  10. Myocardial scintigraphy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Faerestrand, S.

    1984-01-01

    The sensitivity and specificity of 99m Tc-PYP myocardial scintigraphy for detecting an acute myocardial infarction were studied in 39 patients hospitalized because of central chest pain. One myocardial scintigraphic examination was done in each patient between the first and sixth day after the chest pain had started. Twenty-two patients had a myocardial infarction based on history, ECG and enzym values and myocardial scintigraphy was positive in twenty of these. Three patients with left bundle branch block and myocardial infarction all had a positive myocardial scintigram and the one patient with negative ECG and myocardial infarction also had a positive myocardial scintigram. The sensitivity is 91% and the specificity is 91.7% for 99m Tc-PYP myocardial scintigraphy in the detection of acute myocardial infarction. No complications were seen. (Auth.)

  11. Patient Satisfaction with Care After Coronary Revascularization.

    Science.gov (United States)

    Mosby, Danielle L; Manierre, Matthew J; Martin, Steve S; Kolm, Paul; Abuzaid, A Sami; Jurkovitz, Claudine T; Elliott, Daniel J; Weintraub, William S

    2017-09-05

    Bridging the Divides (Bridges), a Centers for Medicare and Medicaid Services-funded program, developed a post-hospitalization care management infrastructure integrating information technology-enabled informatics with patient care for ischemic heart disease patients. The objective of this study was to assess patient satisfaction with the Bridges program and determine the patient characteristics associated with higher satisfaction. All adult English-speaking patients who underwent a percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction and agreed to participate in the Bridges program were eligible. A survey instrument was administered to address patient satisfaction of care received, aspects of care that patients appreciated, and challenges faced. Descriptive statistics were calculated, and primary analyses included comparisons of overall patient satisfaction after discharge between procedure type, and according to age, sex, race, Elixhauser comorbidity count, and length of stay. Four hundred and sixty-seven (46%) had complete or partial response rates. There was a statistically significant difference in the overall satisfaction among patients undergoing percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction (p = 0.023). There were significant procedure by sex (p = 0.052) and procedure by age (p = 0.039) interactions. There were no statistically significant differences in overall satisfaction according to age, sex, race, comorbidity count, or length of stay. This study identified several important components related to patient satisfaction for patients with ischemic heart disease. Results found that patients who underwent coronary artery bypass grafting were reportedly "very satisfied" when compared with patients who underwent percutaneous coronary intervention and catheterization plus acute myocardial infarction, as well as

  12. Infrarenal abdominal aortic aneurysm repair in presence of coronary artery disease: Optimization of myocardial stress by controlled phlebotomy

    Directory of Open Access Journals (Sweden)

    Neema Praveen

    2009-01-01

    Full Text Available The repair of abdominal aortic aneurysm (AAA in the presence of significant coronary artery disease (CAD carries a high-risk of adverse peri-operative cardiac event. The options to reduce cardiac risk include perioperative β-blockade, preoperative optimization by myocardial revascularization and simultaneous (combined coronary artery bypass grafting and aneurysm repair. We describe intra-operative controlled phlebotomy to optimize myocardial stress during repair of infrarenal AAA in a patient with significant stable CAD.

  13. Infrarenal abdominal aortic aneurysm repair in presence of coronary artery disease: optimization of myocardial stress by controlled phlebotomy.

    Science.gov (United States)

    Neema, Praveen Kumar; Vijayakumar, Arun; Manikandan, S; Rathod, Ramesh Chandra

    2009-01-01

    The repair of abdominal aortic aneurysm (AAA) in the presence of significant coronary artery disease (CAD) carries a high-risk of adverse peri-operative cardiac event. The options to reduce cardiac risk include perioperative beta-blockade, preoperative optimization by myocardial revascularization and simultaneous (combined) coronary artery bypass grafting and aneurysm repair. We describe intra-operative controlled phlebotomy to optimize myocardial stress during repair of infrarenal AAA in a patient with significant stable CAD.

  14. Buckberg's blood cardioplegia for protection of adult and senile myocardium in a rat in vitro model of acute myocardial infarction.

    Science.gov (United States)

    Boening, Andreas; Assling-Simon, Lena; Heep, Martina; Boengler, Kerstin; Niemann, Bernd; Grieshaber, Philippe

    2018-04-01

    In patients undergoing surgical myocardial revascularization for acute myocardial infarction, excellent myocardial protection can be achieved by blood cardioplegia. We investigated the influence of age on cardiac function, metabolism, and infarct size using Buckberg's blood cardioplegia (BCP). The hearts of male Wistar rats ("adult", age 3 months, n = 8; "senile", age 24 months, n = 8) were excised and mounted on a blood-perfused isolated heart apparatus. An acute myocardial infarction was induced by coronary artery ligation for 30 min before aortic clamping and infusion of Buckberg's BCP. Throughout the experiment, functional parameters were recorded: coronary blood flow (normalized by heart weight), left ventricular peak developed pressure (LVpdP), and positive and negative derived left ventricular pressure over time (dLVPdt max and dLVPdt min ). Oxygen consumption (MVO 2 ) and lactate production of the hearts were calculated. The infarct size after 90 min of reperfusion (in % of the area at risk) was measured with triphenyl tetrazolium chloride staining of the myocardium. The baseline coronary flow normalized by heart weight was significantly lower in the senile hearts (1.6 ± 0.4 ml/(min ∗ g)) compared with the adult hearts (2.0 ± 0.3 ml/(min ∗ g); p = 0.04). After 90 min of aortic clamping, hemodynamic function of senile hearts recovered better than that of adult hearts: LVpdP (adult 57% of baseline [BL]; senile 88% BL; p = 0.044) and dLVPdt max (adult 74% BL, senile 102% BL; p = 0.12). In contrast, myocardial infarct size was similar between the adult (26%) and senile (21%; p = 0.45) hearts, and coronary flow recovered to a similar extent (55% BL and 58% BL, respectively). During reperfusion, MVO 2 (80% BL and 81% BL) and lactate production (1.2 and 1.3 μmol/min) were similar in the two groups. After acute myocardial infarction in a rat model, hearts recovered function after reperfusion with

  15. ST segment elevation after myocardial infarction: Viability or ventricular dysfunction? Comparison with myocardial scintigraphy

    International Nuclear Information System (INIS)

    Chalela, William Azem; Soares, J. Jr.; Meneghetti, J.C.; Olivera, C.G.; Moffa, P.J.; Falcao, A.M.; Ramires, J.A.F.

    2004-01-01

    The detection of viable myocardium after myocardial infarction is an important indication for revascularization. We compared exercise-induced ST segment elevation with reversibility at Thallium-201 SPECT scintigraphy and regional wall motion assessment by ventriculography. Thirty two patients with previous myocardial infarction and with left ventricular ejection fraction of < 50% were studied. Patients underwent coronary angiography and Thallium-201 SPECT scintigraphy with re-injection protocol before and after coronary artery bypass graft surgery. Group I comprised 11 patients with ST segment elevation during treadmill stress testing. Group II comprised 21 patients without ST segment elevation. Minimal or moderate hypokinesis was present in 2 patients of Group I and in 4 patients of Group II. Nine patients of Group I and 17 patients of Group II had severe hypokinetic, akinetic or dyskinetic myocardium. Scintigraphy revealed reversibility in the myocardial infarction area in 4 patients from Group I (36.4%) and 11 (52.4%) patients from Group II. Improvement in perfusion after coronary artery bypass grafting was observed in 4 patients from Group I and 8 patients from Group II. Sensitivity, specificity, accuracy, and positive and negative predictive values of ST segment elevation were 33.3, 70.6, 55.2, 44.5 and 60% respectively. It was concluded that exercise-induced ST segment elevation after myocardial infarction is present more frequently in cases of severe regional myocardial dysfunction. (author)

  16. Prognosis after maternal placental events and revascularization: PAMPER study.

    Science.gov (United States)

    Ray, Joel G; Booth, Gillian L; Alter, David A; Vermeulen, Marian J

    2016-01-01

    Middle-aged women are at higher risk than men of death after coronary artery revascularization. Maternal placental syndromes (gestational hypertension, preeclampsia, placental abruption, and placental infarction) are associated with premature coronary artery disease, but their influence on survival after coronary artery revascularization is unknown. The purpose of this study was to determine whether a history of maternal placental syndromes alters the risk of death after coronary artery revascularization in middle-aged women. We completed a population-based retrospective cohort study among all hospitals in Ontario, Canada, where universal health care includes all aspects of antenatal and delivery care as well as all outpatient and inpatient health care, which includes coronary revascularization. We included 1985 middle-aged women who underwent a first percutaneous coronary intervention or coronary artery bypass grafting between 1993 and 2012 and who had ≥1 previous delivery. We excluded those with cardiovascular disease ≤1 year before or coronary revascularization ≤90 days after any delivery. The main study outcome, determined a priori, was all-cause death. Hazard ratios were adjusted for age, socioeconomic status, parity, revascularization type, time since last delivery, hypertension, diabetes mellitus, obesity, dyslipidemia, tobacco or drug dependence, and kidney disease. Three hundred sixty-two of 1985 women (18.2%) who underwent coronary artery revascularization had a previous maternal placental syndrome event. The mean age at index coronary revascularization was 45 years; percutaneous coronary intervention comprised approximately 80% of procedures. After a mean follow-up time of approximately 5 years, 41 deaths (2.2 per 100 person-years) occurred in women with previous maternal placental syndromes and 83 deaths (1.1 per 100 person-years) in women without maternal placental syndrome (adjusted hazard ratio, 1.96; 95% confidence interval, 1.29-2.99). Of the

  17. the Perspective of an Angiosome-Oriented Revascularization Strategy

    Directory of Open Access Journals (Sweden)

    Francisco Acín

    2014-01-01

    Full Text Available Our aim was to describe our experience with infrapopliteal endovascular procedures performed in diabetic patients with ischemic ulcers and critical ischemia (CLI. A retrospective study of 101 procedures was performed. Our cohort was divided into groups according to the number of tibial vessels attempted and the number of patent tibial vessels achieved to the foot. An angiosome anatomical classification of ulcers were used to describe the local perfusion obtained after revascularization. Ischemic ulcer healing and limb salvage rates were measured. Ischemic ulcer healing at 12 months and limb salvage at 24 months was similar between a single revascularization and multiple revascularization attempts. The group in whom none patent tibial vessel to the foot was obtained presented lower healing and limb salvage rates. No differences were observed between obtaining a single patent tibial vessel versus more than one tibial vessel. Indirect revascularization of the ulcer through arterial-arterial connections provided similar results than those obtained after direct revascularization via its specific angiosome tibial artery. Our results suggest that, in CLI diabetic patients with ischemic ulcers that undergo infrapopliteal endovascular procedures, better results are expected if at least one patent vessel is obtained and flow is restored to the local ischemic area of the foot.

  18. Sex differences in the management and outcomes of Ontario patients with cardiogenic shock complicating acute myocardial infarction.

    Science.gov (United States)

    Abdel-Qadir, Husam M; Ivanov, Joan; Austin, Peter C; Tu, Jack V; Džavík, Vladimír

    2013-06-01

    Sex differences in the management of acute myocardial infarction (AMI) patients with cardiogenic shock (CS) have not been well studied. We examined mortality and revascularization rates of 9750 patients with CS between 1992 and 2008 in the Ontario Myocardial Infarction Database. Men and women were compared in the entire cohort and in subgroups divided by age (aged patients; P < 0.001). Women with CS were older than men (mean age: 75.5 vs 71.1 years; P < 0.001) and less likely to present to revascularization-capable sites (16% vs 19.2%; P < 0.001). Unadjusted 1-year mortality rates were higher in women (80.3% vs 75.4%; P < 0.001). Women were less likely to be revascularized (12.6% vs 17.6%; P < 0.001) and less likely to be transferred when they presented to nonrevascularization sites (11.3% vs 14.2%; P < 0.001). The strongest predictor of revascularization was presentation to a revascularization-capable site (odds ratio, 17.69; P < 0.001). After regression adjustment, there were no significant differences in mortality or revascularization between the sexes. Women with CS are older than men with CS and are less likely to present to revascularization-capable sites. This accounts for the lower unadjusted revascularization rates among women compared with men. However, there are no significant sex-based differences in adjusted mortality rates. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Influências temporais nas características e fatores de risco de pacientes submetidos a revascularização miocárdica The influence of time on the characteristics and risk factors for patients submitted to myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Flávia H. Feier

    2006-10-01

    Full Text Available OBJETIVO: Comparar perfil clínico e cirúrgico entre dois grupos de pacientes submetidos a Cirurgia de Revascularização Miocárdica (CRM no Instituto de Cardiologia do Rio Grande do Sul, com intervalo de 10 anos; observar sua influência na mortalidade hospitalar e verificar previsibilidade deste resultado mediante escore de risco. MÉTODOS: Estudo de coorte retrospectivo, envolvendo 307 pacientes submetidos a CRM isolada em período semestral de 1991/92 (grupo INICIAL, n=153 ou 2001/02 (grupo ATUAL, n=154. Foram analisados características demográficas, doenças cardíacas, co-morbidades e eventos operatórios, visando à comparação entre grupos e definição do escore de risco de morte hospitalar (conforme Cleveland Clinic. RESULTADOS: O grupo ATUAL tinha idade mais avançada, condição cardíaca mais grave (classe funcional, prevalência de insuficiência cardíaca e número de vasos com lesão severa e maior prevalência de co-morbidades. Os pacientes iniciais mostraram maior prevalência na indicação cirúrgica de urgência. Não ocorreu diferença no escore médio de risco calculado para ambos os grupos (2,8 + 3,1 no INICIAL e 2,2 + 2,5 no ATUAL ou na mortalidade hospitalar (respectivamente 3,3% e 1,9%, valores comparáveis com os comunicados pela Cleveland Clinic (para escore de risco 3, mortalidade prevista de 2,0 %, com limite de confiança 95% de 0-4,3% e mortalidade real em estudo de confirmação de 3,4%. CONCLUSÃO: Pacientes atualmente submetidos a CRM são mais idosos e em pior condição clínica (cardíaca e sistêmica que os operados há 10 anos, mas a pontuação no escore de risco e a mortalidade hospitalar foram discretamente aumentadas no grupo inicial. Para isto, pode ter contribuído maior prevalência de cirurgias de urgência. Um escore de risco pode ser utilizado para identificar pacientes que requerem maiores cuidados e predizer o resultado cirúrgico.OBJECTIVE: To compare clinical and surgical and clinical

  20. Nationwide trends in development of heart failure and mortality after first-time myocardial infarction 1997-2010

    DEFF Research Database (Denmark)

    Gjesing, Anne; Gislason, Gunnar H; Køber, Lars

    2014-01-01

    AIMS: Pharmacological and revascularization strategies following myocardial infarction (MI) have changed substantially during the last two decades. We investigated the temporal trends in heart failure (HF) incidence and mortality during the first 90 days following first-time MI between 1997...

  1. Off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial.

    Science.gov (United States)

    Benedetto, Umberto; Altman, Douglas G; Gerry, Stephen; Gray, Alastair; Lees, Belinda; Flather, Marcus; Taggart, David P

    2018-04-01

    The long-term effects of off-pump coronary artery bypass continue to be controversial because some studies have reported increased adverse event rates with off-pump coronary artery bypass when compared with on-pump coronary artery bypass. The Arterial Revascularization Trial compared survival after bilateral versus single internal thoracic artery grafting. The choice of off-pump coronary artery bypass versus on-pump coronary artery bypass was based on the surgeon's discretion. We performed a post hoc analysis of the Arterial Revascularization Trial to compare 5-year outcomes with 2 strategies. Among 3102 patients enrolled in the Arterial Revascularization Trial, we selected 1260 patients who underwent off-pump coronary artery bypass versus 1700 patients who underwent on-pump coronary artery bypass with cardioplegic arrest for the present comparison. Primary outcomes were 5-year mortality and incidence of major cardiac and cerebrovascular events, including cardiovascular death, myocardial infarction, cerebrovascular accident, and revascularization after index procedure. Propensity score matching selected 1260 pairs for final comparison. Stratified Cox models were used for treatment effect estimate. Hospital mortality was comparable between off-pump coronary artery bypass and on-pump coronary artery bypass groups (12 [1.0%] vs 15 [1.2%]; P = .7). Conversion rate to on-pump during off-pump coronary artery bypass was 29 of 1260 (2.3%). When compared with off-pump coronary artery bypass not converted, off-pump coronary artery bypass converted to on-pump presented a remarkably higher hospital mortality (10.3% vs 0.7%; P pump coronary artery bypass and on-pump coronary artery bypass groups, respectively, with no significant difference (hazard ratio, 1.14; 95% confidence interval, 0.86-1.52; P = .35). Incidence of major cardiac and cerebrovascular events was 175 (14.3) versus 169 (13.8) in the off-pump coronary artery bypass and on-pump coronary artery bypass groups

  2. Hipotensão arterial em cirurgia de revascularização do miocárdio: influência dos inibidores da enzima conversora de angiotensina Hipotensión arterial en cirugía de revascularización del miocardio: influencia de los inhibidores de la enzima conversora de angiotensina Arterial hypotension in myocardial revascularization surgery: influence of angiotensin-converting enzyme inhibitors

    Directory of Open Access Journals (Sweden)

    Míriam Gomes Jordão

    2002-04-01

    incidencia de hipotensión arterial en la inducción anestésica, necesitando, con mayor frecuencia, de drogas para mantener la presión arterial sistémica en niveles adecuados.BACKGROUND AND OBJECTIVES: Angiotensin-converting enzyme inhibitors (ACEI are widely used in hypertension and heart failure. Their prolonged use may lead to hemodynamic instability and hypotension during anesthetic induction. This study aimed at comparing the incidence of hypotension in patients chronically treated and non treated with ACEI, submitted to anesthesia for myocardial revascularization. METHODS: Participated in this study 50 patients, physical status ASA II, III and IV, who were distributed in two groups: Group 1 - patients treated with ACEI for more than two months. Group 2 - patients not treated with ACEI. Parameters evaluated were mean blood pressure (MBP, heart rate (HR, and analysis of the ST segment in D II and V5. Systemic vascular resistance was determined during CPB. RESULTS: The incidence of arterial hypotension in anesthetized patients under ACEI was higher than in the control group in several anesthetic moments, but was predominant during anesthetic induction. This group needed dopamine for longer periods. From the 26 patients previously treated with ACEI, 23% needed drugs to correct hypotension from induction to CPB, and 19.1% in other anesthetic periods, totaling 42.3%. No control group patient needed drug infusion to increase systemic blood pressure, from induction to CPB. However, 21% of patients in this group needed dopamine or araminol in one or more anesthetic moments. CONCLUSIONS: In our study, patients treated whit ACEI for prolonged periods had a higher incidence of hypotension on anesthetic induction, requiring more drugs to maintain systemic pressure in adequate levels.

  3. Revascularization heart team recommendations as an adjunct to appropriate use criteria for coronary revascularization in patients with complex coronary artery disease.

    Science.gov (United States)

    Sanchez, Carlos E; Dota, Anthony; Badhwar, Vinay; Kliner, Dustin; Smith, A J Conrad; Chu, Danny; Toma, Catalin; Wei, Lawrence; Marroquin, Oscar C; Schindler, John; Lee, Joon S; Mulukutla, Suresh R

    2016-10-01

    To evaluate how a comprehensive evidence-based clinical review by a multidisciplinary revascularization heart team on treatment decisions for revascularization in patients with complex coronary artery disease using SYNTAX scores combined with Society of Thoracic Surgeons-derived clinical variables can be additive to the utilization of Appropriate Use Criteria for coronary revascularization. Decision-making regarding the use of revascularization for coronary artery disease has come under major scrutiny due to inappropriate overuse of revascularization. There is little data in routine clinical practice evaluating how a structured, multidisciplinary heart team approach may be used in combination with the Appropriate Use Criteria for revascularization. From May 1, 2012 to January 1, 2015, multidisciplinary revascularization heart team meetings were convened to discuss evidence-based management of 301 patients with complex coronary artery disease. Heart team recommendations were adjudicated with the Appropriate Use Criteria for coronary revascularization for each clinical scenario using the Society for Cardiovascular Angiography and Interventions' Quality Improvement Toolkit (SCAI-QIT) Appropriate Use Criteria App. Concordance of the Heart Team to Appropriate Use Criteria had a 99.3% appropriate primary indication for coronary revascularization. Among patients who underwent percutaneous revascularization, 34.9% had an inappropriate or uncertain indication as recommended by the Heart Team. Patients with uncertain or inappropriate percutaneous coronary interventions had significantly higher SYNTAX score (27.3 ± 6.6; 28.5 ± 5.5; 19.2 ± 6; P coronary artery disease. A formal, multidisciplinary revascularization heart team can provide proper validation for clinical decisions and should be considered in combination with the Appropriate Use Criteria for coronary revascularization to formulate revascularization strategies for individuals in a patient

  4. Nationwide Trends in Hospital Outcomes and Utilization After Lower Limb Revascularization in Patients on Hemodialysis.

    Science.gov (United States)

    Garimella, Pranav S; Balakrishnan, Poojitha; Correa, Ashish; Poojary, Priti; Annapureddy, Narender; Chauhan, Kinsuk; Patel, Achint; Patel, Shanti; Konstantinidis, Ioannis; Chan, Lili; Agarwal, Shiv Kumar; Jaar, Bernard G; Gidwani, Umesh; Matsushita, Kunihiro; Nadkarni, Girish N

    2017-10-23

    This study aimed to describe the temporal trends and outcomes of endovascular and surgical revascularization in a large, nationally representative sample of patients with end-stage renal disease on hemodialysis hospitalized for peripheral artery disease (PAD). PAD is prevalent among patients with end-stage renal disease on hemodialysis and is associated with significant morbidity and mortality. There is a paucity of information on trends in endovascular and surgical revascularization and post-procedure outcomes in this population. We used the Nationwide Inpatient Sample (2002 to 2012) to identify hemodialysis patients undergoing endovascular or surgical procedures for PAD using diagnostic and procedural codes. We compared trends in amputation, post-procedure complications, mortality, length of stay, and costs between the 2 groups using trend tests and logistic regression. There were 77,049 endovascular and 29,556 surgical procedures for PAD in hemodialysis patients. Trend analysis showed that endovascular procedures increased by nearly 3-fold, whereas there was a reciprocal decrease in surgical revascularization. Post-procedure complication rates were relatively stable in persons undergoing endovascular procedures but nearly doubled in those undergoing surgery. Surgery was associated with 1.8 times adjusted odds (95% confidence interval: 1.60 to 2.02) for complications and 1.6 times the adjusted odds for amputations (95% confidence interval: 1.40 to 1.75) but had similar mortality (adjusted odds ratio: 1.05; 95% confidence interval: 0.85 to 1.29) compared with endovascular procedures. Length of stay for endovascular procedures remained stable, whereas a decrease was seen for surgical procedures. Overall costs increased marginally for both procedures. Rates of endovascular procedures have increased, whereas those of surgeries have decreased. Surgical revascularization is associated with higher odds of overall complications. Further prospective studies and clinical

  5. Revascularization of the testis using a vascular induction technique: a potential approach for staged orchiopexy in high-undescended testis.

    Science.gov (United States)

    Erçöçen, Ali Riza; Soejima, Kazutaka; Sakurai, Hiroyuki; Yenidünya, Sibel; Kikuchi, Yuji; Nozaki, Motohiro

    2004-02-01

    The present study was designed to determine whether a fasciovascular flap as a vascular carrier could be used to revascularize the undescended testis for avoiding the hazardous effects of the Fowler-Stephens procedure, high division of the spermatic vessels, and for bringing high-undescended testes into the scrotum. A total of 25 Wistar rats were divided into five groups of five rats each. In each group, surgical procedures were performed bilaterally, i.e. ten testes in each group, as follows: sham-operated controls (group 1), undescended testes (group 2), high division of the spermatic vessels (group 3), vascular induction with immediate division of spermatic vessels (group 4), and with delayed division of spermatic vessels (group 5). Evaluations were done by measuring the testicular weight and volume, testicular blood flow, and testicular biopsy scores and by microangiography. A moderate to severe decrease in testicular weight and volume in all experimental groups was observed compared with the sham-operated controls (group 1), but this was significantly less in groups 2 and 5. High division of the spermatic vessels in groups 3 and 4 resulted in a significantly greater decrease in the testicular blood flow, but this did not occur in group 5. Microangiographically, an impaired vascular supply from the deferential artery in group 3 and insufficient revascularization from the fasciovascular carrier in group 4 were observed. However, efficient revascularization stemming from the superficial epigastric artery of the fasciovascular flap was found in group 5. The testicular biopsy scores of groups 2 and 5 were significantly greater than those of groups 3 and 4. The results of the present study demonstrate that the fasciovascular flap as a vascular carrier revascularizes the testis through spermatic vessels after delayed division and provides an adjuvant treatment modality or first-stage procedure in a salvage operation for high-undescended testis during staged

  6. The usefulness of the nuclear cardiology in the cellular implant in patients with severe myocardial damage

    International Nuclear Information System (INIS)

    Omelas A, M.; Arguero S, R.; Garrido G, M.H.; Rodriguez C, A.; Careaga, G.; Castano G, R.; Nambo, M.J.; Pascual P, J.; Ortega R, A.; Gaxiola A, A.; Magana S, J.A.; Estrada A, H.; Equipo de Tecnicos en Medicina Nuclear

    2005-01-01

    The recent therapeutic advances as the cellular implant as well as those different protocols of image acquisition in the field of the Nuclear Cardiology its have allowed that the patient with severe myocardial damage and without some possibility of revascularization is benefited with these advances. Doubtless the Tl-201 par excellence has an important paper for standardize the more appropriate therapeutic behavior for the heart attack patient; reason by this investigation protocol was developed. The objective of the study was to identify the heart attack regions without viable tissue with SPECT in patient with important myocardial damage without some possibility of traditional revascularization; for the 'Stem cell' cellular implantation therapy. The methodology it was carried out by a study of myocardial perfusion in 10 patients with important myocardial damage previous cellular implants, with PICANUC/ SPECT methodology and using a software (Emory Tool Box) for the image processing validated by the University of Emory Atlanta GA; and using as tracer the Tl - 201 to identify the heart attack regions without presence of viable tissue with an analysis model of 17 segments standardized for the left ventricle; qualifying this way the myocardial perfusion in: 0 (normal), 1 (light), 2 (moderate), 3 (severe), 4 (absent) and x (bad technique). The conclusions were that the SPECT study with PICANUC methodology with Tl-201 is safe and effective for the precise localization for the cellular implantation via direct intra myocardial. (Author)

  7. Left subclavian artery revascularization as part of thoracic stent grafting

    NARCIS (Netherlands)

    Saouti, N.; Hindori, V.; Morshuis, W.J.; Heijmen, R.H.

    2015-01-01

    OBJECTIVES: Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our

  8. Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

    African Journals Online (AJOL)

    Total Arterial Off‑pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases). Jun-Feng Yang, Hong-Chao Zhang1, Cheng-Xiong Gu, Hua Wei. INTRODUCTION. AY graft is a graft formed by the left internal mammary artery (LIMA) connected to the left anterior descending (LAD) artery and ...

  9. Sequential and simultaneous revascularization in adult orthotopic piggyback liver transplantation

    NARCIS (Netherlands)

    Polak, WG; Miyamoto, S; Nemes, BA; Peeters, PMJG; de Jong, KP; Porte, RJ; Slooff, MJH

    The aim of the study was to assess whether there is a difference in outcome after sequential or simultaneous revascularization during orthotopic liver transplantation (OLT) in terms of patient and graft survival, mortality, morbidity, and liver function. The study population consisted of 102 adult

  10. Pulp revascularization of immature dens invaginatus with periapical periodontitis.

    Science.gov (United States)

    Yang, Jie; Zhao, Yuming; Qin, Man; Ge, Lihong

    2013-02-01

    Dens invaginatus is a rare developmental malformation of a tooth caused by the invagination of the tooth crown before biological mineralization occurs. The complex anatomy of these teeth makes nonsurgical endodontic treatment difficult and more so when there is presence of periapical periodontitis with open apex. The endodontic treatment of dens invaginatus is a challenge, especially in the case of periapical periodontitis with open apex. Pulp revascularization is a conservative endodontic treatment that has been introduced in recent years. Presented here is a variant approach for the treatment of immature dens invaginatus type II with periapical periodontitis, which combines filling of the invagination and pulp revascularization. After accessing the pulp chamber, the main canal and the invagination were explored. The root was thoroughly disinfected by irrigating and medication, invagination was filled, and the main canal was revascularized. Then the coronal sealing was made by glass ionomer cement and composite resin. Radiograph taken regularly and computed tomography scan were used to investigate the healing of the periapical lesion and development of the root. In the subsequent follow-up, the periapical lesion was completely eliminated, the open apex was closed, and the wall of the root was thickened. For type II immature dens invaginatus with large periapical lesion, conservative endodontic treatment should be considered before periapical surgery. With sufficient infection control, pulp revascularization can be an effective alternative method. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  11. Reconstruction of congenital tibial pseudarthrosis by revascularized fibular transplants

    NARCIS (Netherlands)

    Bos, K. E.; Besselaar, P. P.; van der Eyken, J. W.; Taminiau, A. H.; Verbout, A. J.

    1993-01-01

    Seven patients with congenital Boyd type II pseudoarthrosis of the tibia and fibula were treated with a revascularized osteocutaneous fibular graft from the contralateral side. Follow-up ranged from 20 to 96 months (mean 67 months). All patients had previously undergone major surgery (mean three

  12. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis

    International Nuclear Information System (INIS)

    Cerqueira, M.D.; Jacobson, A.F.

    1989-01-01

    Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using 111 In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities

  13. Prognostic Implication of Functional Incomplete Revascularization and Residual Functional SYNTAX Score in Patients With Coronary Artery Disease.

    Science.gov (United States)

    Choi, Ki Hong; Lee, Joo Myung; Koo, Bon-Kwon; Nam, Chang-Wook; Shin, Eun-Seok; Doh, Joon-Hyung; Rhee, Tae-Min; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Kim, Kyung-Jin; Hu, Xinyang; Wang, Jianan; Ye, Fei; Chen, Shaoliang; Yang, Junqing; Chen, Jiyan; Tanaka, Nobuhiro; Yokoi, Hiroyoshi; Matsuo, Hitoshi; Takashima, Hiroaki; Shiono, Yasutsugu; Akasaka, Takashi

    2018-02-12

    The aim of this study was to investigate the prognostic implication of functional incomplete revascularization (IR) and residual functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score. IR is associated with poor clinical outcomes in patients who underwent percutaneous coronary intervention. A total of 385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as residual SYNTAX score measured only in vessels with FFR ≤0.8. The study population was divided into the functional IR group (rFSS ≥1) and the functional complete revascularization (CR) group (rFSS = 0). The primary outcome was major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) at 2 years. Functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk for MACEs (functional IR vs. CR, 14.6% vs. 4.2%; hazard ratio: 4.09; 95% confidence interval: 1.82 to 9.21; p system (rFSS) after stent implantation better discriminated the risk for adverse events than anatomic or physiological assessment alone. (Clinical Implication of 3-Vessel Fractional Flow Reserve [FFR]; NCT01621438). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs.

    Science.gov (United States)

    Zhu, Gang-jie; Sun, Li-na; Li, Xing-hai; Wang, Ning-fu; Wu, Hong-hai; Yuan, Chen-xing; Li, Qiao-qiao; Xu, Peng; Ren, Ya-qi; Mao, Bao-gen

    2015-09-01

    The aim of this study was to explore myocardial protection of early extracorporeal membrane oxygenation (ECMO) support for acute myocardial infarction with cardiogenic shock in pigs. 24 male pigs (34.6 ± 1.3 kg) were randomly divided into three groups-control group, drug therapy group, and ECMO group. Myocardial infarction model was created in drug therapy group and ECMO group by ligating coronary artery. When cardiogenic shock occurred, drugs were given in drug therapy group and ECMO began to work in ECMO group. The pigs were killed 24 h after cardiogenic shock. Compared with in drug therapy group, left ventricular end-diastolic pressure in ECMO group decreased significantly 6 h after ligation (P myocardial infarct size of ECMO group did not reduce significantly, but myocardial enzyme and troponin-I decreased significantly. Compared with drug therapy, ECMO improves left ventricular diastolic function, and may improve systolic function. ECMO cannot reduce myocardial infarct size without revascularization, but may have positive effects on ischemic areas by avoiding further injuring.

  15. QT-interval evaluation in primary percutaneous coronary intervention of ST-segment elevation myocardial infarction for prediction of myocardial salvage index.

    Directory of Open Access Journals (Sweden)

    Andrea Igoren Guaricci

    Full Text Available Assessing the efficacy of revascularization therapy in patients with ST-segment elevation myocardial infarction (STEMI is extremely important in order to guide subsequent management and assess prognosis. We aimed to determine the relationship between corrected QT-interval (QTc changes on standard sequential ECG and myocardial salvage index in anterior STEMI patients after successful primary percutaneous coronary intervention. Fifty anterior STEMI patients treated by primary percutaneous coronary intervention underwent quantitative ECG analysis and cardiac magnetic resonance. For each patient the difference (ΔQTc between the QTc of ischemic myocardium (maximum QTc in anterior leads versus remote myocardium (minimum QTc in inferior leads during the first six days after STEMI was measured. The QTc in anterior leads was significantly longer than QTc in inferior leads (p<0.0001. At multivariate analysis, ΔQTC and peak troponin I were the only independent predictors for late gadolium enhancement while ΔQTc and left ventricular ejection fraction were independent predictors of myocardial salvage index <60%. The receiver operative curve of ΔQTc showed an area under the curve of 0.77 to predict a myocardial salvage index <0.6. In conclusion, in a subset of patients with a first occurrence of early revascularized anterior STEMI, ΔQTc is inversely correlated with CMR-derived myocardial salvage index and may represent a useful parameter for assessing efficacy of reperfusion therapy.

  16. Moving Beyond SHOCK: New Paradigms in the Management of Acute Myocardial Infarction Complicated by Cardiogenic Shock.

    Science.gov (United States)

    Kalavrouziotis, Dimitri; Rodés-Cabau, Josep; Mohammadi, Siamak

    2017-01-01

    The current management of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with a high rate of mortality, despite widespread regional implementation of rapid transfer to percutaneous coronary intervention-capable centres for prompt infarct-related artery reperfusion. The limited clinical effectiveness of early revascularization in patients with AMI-CS might be secondary to the extent of coronary artery disease in these patients and the risk of incomplete revascularization, as well as the lower probability of achieving successful reperfusion compared with acute myocardial infarction without hemodynamic instability. Also, the severity of end-organ injury is a critical determinant of outcome. We review adjunctive therapies to early revascularization in AMI-CS, specifically with a focus on the role of short-term mechanical circulatory support. In selected patients with AMI-CS, there might be a benefit associated with early institution of mechanical circulatory support before revascularization. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  17. Risk and benefit of dual antiplatelet treatment among nonrevascularized myocardial infarction patients in different age groups

    DEFF Research Database (Denmark)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring

    2017-01-01

    revascularization. METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all.......63; 95% CI 1.17-2.26), 60-69 years (HR=1.22; 95% CI 0.97-1.59, NS), 70-79 years (HR=1.42; 95% CI 1.17-1.72) and >79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. CONCLUSION: Dual anti-platelet treatment use was less likely...... among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted....

  18. Expectations of patients submitted to myocardial revascularization surgery at the time of hospital discharge

    Directory of Open Access Journals (Sweden)

    Cibele Cielo

    2015-07-01

    Full Text Available Objetivo: conhecer as expectativas de pacientes submetidos à cirurgia de revascularização do miocárdio no momento da alta hospitalar. Método: estudo descritivo-exploratório de abordagem qualitativa, realizado com dez pacientes pós-cirúrgicos de revascularização miocárdica de um hospital universitário do sul do Brasil. Os dados foram coletados de julho a agosto de 2012, utilizando-se entrevista semiestruturada e analisados por meio de análise de conteúdo. Resultados: os resultados foram agrupados em uma categoria que versa sobre as expectativas dos pacientes frente ao processo de recuperação e retorno às atividades diárias. Evidenciou-se que essa fase mostra-se desafiadora para os sujeitos, sobressaindo-se sentimentos de ansiedade e preocupação com o futuro, além de terem fragilidades em relação ao conhecimento sobre as mudanças de hábitos impostas pelo processo de adoecimento. Conclusões: a cirurgia provoca um impacto significativo na vida dos pacientes, sendo necessária a intervenção efetiva da enfermagem, a fim de otimizar o processo de recuperação.

  19. Transesophageal Echocardiography in the Assessment of Indications for and Contraindications to Early Activation after Myocardial Revascularization

    Directory of Open Access Journals (Sweden)

    Ye. V. Dzybinskaya

    2011-01-01

    Full Text Available Цель исследования — изучить возможность применения интраоперационной чреспищеводной эхокардиографии для определения показаний и противопоказаний к ранней активизации в операционной после реваскуляризации миокарда в условиях ИК. Материал и методы. Обследовали 186 больных в возрасте 55,0±0,6 лет. Для ультразвукового исследования использовали аппарат Sonos Agilent 5500 и мультиплановый датчик Omni-2 (Philips. Определяли фракцию изгнания левого желудочка в 4-камерной (Simpson и в трансгастральной позициях (визуализация поперечного сечения левого желудочка на уровне папиллярных мышц. Для выявления нарушений сократительной функции миокарда, препятствующих немедленной активизации, проанализировали данные обследования 142 больных, у которых могла быть выполнена экстубация трахеи в операционной. В качестве противопоказания к активизации рассматривали снижение фракции изгнания левого желудочка в трансгастральной позиции до уровня менее 50%. Чувствительность эхокардиографии в дифференциальной диагностике острого инфаркта миокарда изучили у 44-х больных с электрокардиографическими признаками острого ишемического повреждения сердечной мышцы. Результаты. Значения фракции изгнания левого желудочка в трансгастральной позиции менее 50% (41,5±2,2% явились критерием отказа от немедленной активизации больных. У этой категории больных более продолжительны, чем у больных с фракцией изгнания левого желудочка 60,1±1,7%, были продолжительность инотропной терапии (45,2±2,1 и 13±1,1 ч; р<0,05 и пребывания в отделении послеоперационной интенсивной терапии (36,2±1,7 и 18,8±0,75 ч; р<0,05. Коэффициент корреляции между фракцией изгнания левого желудочка в конце операции и длительностью инотропной терапии составил 0,51 (р<0,0001, с продолжительностью госпитализации в отделении интенсивной терапии — 0,48 (р=0,00018. Среди больных с электрокардиографическими признаками острого ишемического повреждения миокарда ультразвуковое исследование в 65,9% наблюдений не подтвердило диагноз, что позволило выполнить раннюю активизацию без осложнений. Остро возникший акинез стенок левого желудочка в 93,8 % был признаком острого инфаркта миокарда, в дальнейшем подтвержденного методами рентгеноконтрастного и лабораторного обследования. Заключение. Чреспищеводный эхокардиографический мониторинг является высоко эффективной диагностической мерой, позволяющей выявлять больных с нарушением систолической функции левого желудочка и проводить верификацию острой ишемии и инфаркта миокарда, что существенно повышает безопасность активизации в операционной больных после реваскуляризации миокарда. Ключевые слова: ультразвуковой мониторинг, чреспищеводная эхо-кардиография, ранняя экстубация трахеи, ранняя активизация кардиохирургических больных, реваскуляризация миокарда, аортокоронарное шунтирование.

  20. Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease.

    Science.gov (United States)

    Pineda, Andrés M; Chandra, Ramesh; Gowani, Saqib A; Santana, Orlando; Mihos, Christos G; Kirtane, Ajay J; Stone, Gregg W; Kurlansky, Paul; Smith, Craig R; Beohar, Nirat

    2016-09-01

    A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes. A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by two cardiologists blinded to outcomes and were then categorized into two groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index PCI and before MIVS. Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively. The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi-vessel coronary artery disease. There were no differences in the post-operative complications, 30-day mortality, or 3-year survival (84 vs. 83%, P = 0.68). After a median follow-up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05). In patients undergoing a staged approach of PCI followed by MIVS, incomplete revascularization did not significantly impact the short or mid-term survival, but was associated with an increased incidence of acute coronary syndrome at follow-up. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  1. Pre-hospital diagnosis and transfer of patients with acute myocardial infarction—a decade long experience from one of Europe's largest STEMI networks

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Schoos, Mikkel Malby; Lindholm, Matias Greve

    2013-01-01

    Early reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) is essential. Although primary percutaneous coronary intervention (pPCI) is the preferred revascularization technique, it often involves longer primary transportation or secondary inter-hospital transfers and th...

  2. Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Wang, Tracy Y.; Bhatt, Deepak L.; Wiviott, Stephen D.; Amsterdam, Ezra A.; Li, Shuang; Thomas, Laine; de Winter, Robbert J.; Roe, Matthew T.

    2014-01-01

    Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization. We evaluated patterns of use and patient features

  3. Accuracy of Dobutamine Stress Echocardiography in Detecting Recovery of Contractile Reserve after Revascularization of Ischemic Myocardium

    Directory of Open Access Journals (Sweden)

    Abas Ali karimi

    2007-09-01

    Full Text Available Background: This study was designed to investigate the accuracy of dobutamine stress echocardiography (DSE in detecting the post-revascularization recovery rate of contractile reserve (CR in ischemic myocardium. Methods: A total of 112 segments from seven patients with low ejection fraction (<35% and coronary artery disease were evaluated with DSE one week before and 12 weeks after coronary artery bypass graft surgery (CABG. Sensitivity, specificity, and positive and negative predictive values of DSE for detecting the recovery rate of CR were calculated based upon their standard definition and were presented with 95% confidence intervals (CI. Results: The mean baseline left ventricular ejection fraction was 31±4%, which reached 35±7% after CABG unremarkably. The recovery rates of resting function and CR were 18.2% and 50% for hypokinetic and 15.6% and 24.1 for akinetic segments respectively. Specificity, sensitivity, and positive and negative predictive values of DSE for detecting the recovery of CR were 83% (CI=69-97, 89% (CI=83-96, 94% (CI = 88-99, and 73 % (CI = 55-88, respectively. Conclusion: Despite acceptable sensitivity, specificity, and positive predictive value, DSE has a relatively lower negative predictive value for detecting the recovery of CR in ischemic myocardium and, consequently, the full extent of myocardial viability. Further sensitive techniques may, therefore, be needed to provide complementary information regarding long-term functional outcome.

  4. Left ventricular function and functional recovery early and late after myocardial infarction: a prospective pilot study comparing two-dimensional strain, conventional echocardiography, and radionuclide myocardial perfusion imaging.

    Science.gov (United States)

    Carasso, Shemy; Agmon, Yoram; Roguin, Ariel; Keidar, Zohar; Israel, Ora; Hammerman, Haim; Lessick, Jonathan

    2013-11-01

    Visual left ventricular (LV) wall motion scoring is well established for the assessment of LV function, yet it is subjective, circumstantial, and relative and requires long training. Quantification of myocardial shortening (strain) using two-dimensional speckle-tracking is potentially less subjective. In this study, quantifiable LV contraction (two-dimensional strain) was prospectively cross-related with wall motion score (WMS) and radionuclide myocardial perfusion imaging (MPI) score in 20 patients (mean age, 54 ± 9 years) with acute myocardial infarctions, early and late after percutaneous revascularization. Echocardiography and rest MPI were performed 3 to 5 days after acute myocardial infarction. Echocardiography was repeated at 4 months. Peak segmental and global endocardial longitudinal strain (LS) and circumferential strain (CS) were measured, and principal strain was calculated. Volumes, WMS, MPI scores, and strain were assessed independently. Two-dimensional strain, visual WMS, and radionuclide MPI score correlated closely. Strain thresholds for abnormal WMS were 11.7% for early LS, 18.2% for early CS, 13.9% for late LS, and 19.1% for late CS. Late principal strain correlated better with WMS and MPI score than either LS or CS. CS varied minimally over time, while LS improved in most segments. Higher early CS (>15%) was predictive of segmental functional recovery. MPI score correlated better with late rather than early strain, probably because early resting perfusion defects represent permanent damage. In this pilot study, strain correlated with echocardiographic WMS and the extent of ischemia (MPI score) early and late after revascularization in patients with acute myocardial infarction. Longitudinal and circumferential strain uncoupling was observed. LS appeared to be more sensitive to acute ischemia, whereas CS correlated better with improvement after revascularization. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All

  5. CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass).

    Science.gov (United States)

    Chen, Yueqin; Xu, Wenjian; Guo, Xiang; Shi, Zhitao; Sun, Zhanguo; Gao, Lingyun; Jin, Feng; Wang, Jiehuan; Chen, Weijian; Yang, Yunjun

    2016-01-01

    To evaluate the utility of CT perfusion (CTP) for the assessment of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with Moyamoya syndrome (MMS). Twenty-four consecutive MMS patients, who underwent unilateral STA-MCA bypass surgery, received CTP before and after surgery. The relative perfusion parameter values of surgical hemispheres before treatment were compared with post-treatment values. All patients underwent CT angiography (CTA) before and after surgery in order to confirm the patency of bypass. The follow-up CTA after surgery clearly demonstrated 20 (20/24, 83.3 %) bypass arteries, whereas four (16.7 %) bypass arteries were occluded or very small. Postoperative rMTT and rTTP values (P 0.05) in the patients (n = 4) without bypass patency after revascularization. This study demonstrates that CTP can provide a crucial quantitative assessment of cerebral haemodynamic changes in MMS before and after STA-MCA anastomosis. Twenty-four MMS patients undergoing STA-MCA bypass received CTP pre- and post-surgery. Cerebral haemodynamics improved on the surgical side post-surgery on CTP maps. rCBF might have a better correlation with patency of the bypass artery. CTP can evaluate cerebral perfusion changes in MMS patients after cerebral revascularization.

  6. Enxerto venoso intercoronariano na revascularização de artéria coronária comprometida por dissecção de aorta tipo I Intercoronary venous graft in revascularization of the coronary artery involved by aortic dissection type I

    Directory of Open Access Journals (Sweden)

    Carlos Alberto C Abreu Filho

    1995-03-01

    Full Text Available Paciente de 39 anos, portador de hipertensão arterial não controlada, submetido a cirurgia para tratamento de dissecção aguda de aorta tipo I. Devido ao grande envolvimento do óstio coronário direito pela dissecção aórtica, optou-se pela ressecção da porção comprometida do vaso, com interposição de tubo não valvulado de Dacron na aorta ascendente, suspensão da valva aórtica e ligadura do óstio da artéria coronária direita. Como não havia presença de aterosclerose no ramo interventricular anterior e na artéria coronária direita, decidimos realizar um enxerto venoso entre as artérias. O enxerto intercoronário apresentou bom funcionamento e todo o território dependente da coronária direita manteve boa contratilidade. O paciente recebeu alta hospitalar em boas condições clínicas, com função rniocárdica preservada.A thirty nine-year-old patient presenting arterial hypertension was operated upon for type I acute aortic dissection. Due to important alterations in the ascendent aorta with involvement of the right coronary ostium, the surgical procedure included resection of the segment of aorta containing the intimal tear and replacement with a Dacron prosthesis, suspension of the aortic valve and ligadure of the right coronary ostium. Technical difficulties brought the necessity of a different approach for the myocardium revascularization. Instead of the traditional described procedures, an intercoronary venous graft was put between the anterior interventricular artery (branch of the left coronary artery and the right coronary artery. The intercoronary graft presented a good flow since the begining, keeping a good myocardial contratility. Patient left the hospital in a good clinical condition, with preserved myocardial function. Intercoronary graft should be an efficient alternative for revascularization of a corohary artery involved by aortic dissections.

  7. Comparably improved health-related quality of life after total arterial revascularization versus conventional coronary surgery--Copenhagen arterial revascularization randomized patency and outcome trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Lund, Jens T; Lilleør, Nikolaj B

    2011-01-01

    OBJECTIVE: We compared health-related quality of life up to 11 months after coronary artery bypass grafting using total arterial revascularization versus conventional coronary surgery. METHODS: In this randomized single-center trial, 161 patients underwent total arterial revascularization using s...

  8. Platelet neuropeptide Y is critical for ischemic revascularization in mice

    OpenAIRE

    Tilan, Jason U.; Everhart, Lindsay M.; Abe, Ken; Kuo-Bonde, Lydia; Chalothorn, Dan; Kitlinska, Joanna; Burnett, Mary Susan; Epstein, Stephen E.; Faber, James E.; Zukowska, Zofia

    2013-01-01

    We previously reported that the sympathetic neurotransmitter neuropeptide Y (NPY) is potently angiogenic, primarily through its Y2 receptor, and that endogenous NPY is crucial for capillary angiogenesis in rodent hindlimb ischemia. Here we sought to identify the source of NPY responsible for revascularization and its mechanisms of action. At d 3, NPY−/− mice demonstrated delayed recovery of blood flow and limb function, consistent with impaired collateral conductance, while ischemic capillary...

  9. Endovascular revascularization for non-acute basilar artery occlusion

    International Nuclear Information System (INIS)

    He Yingkun; Wang Ziliang; Li Tianxiao; Zhu Liangfu; Xue Jiangyu; Bai Weixing; Feng Guang

    2014-01-01

    Objective: To evaluate the technical feasibility, safety and mid-term effect of endovascular revascularization for non-acute intracranial basilar artery occlusion. Methods: During the period from Feb. 2010 to Apr. 2012, endovascular revascularization was carried out in 12 patients with non- acute basilar artery occlusion, and the onset of the occlusion was beyond 24 hours. The clinical data were retrospectively analyzed. Complications and recurrent events occurring during the follow-up period were recorded. The modified Rankin scale (mRS) scores were determined, and the preoperative scores were compared with postoperative ones. Results: Successful revascularization was obtained in all the 12 patients except one. After the procedure, the clinical condition was improved in 6, remain stable in 4, and became worse in 2 patients. The preoperative median mRS score was 5 (R, 3-5), it decreased to 4.5 (R, 1-5) on discharge. The difference was statistically significant (P=0.020, Z=2.333). Two patients developed procedural complications, including dissection (n=1) and acute re-occlusion (n=1) after operation. During a median follow-up time of 17.5 months, death occurred in 3 cases, recurrent stroke in 2 cases and transient ischemic attack in one case. The latest median mRS scores were 3 (IR, 0-6). Follow-up check with imaging examination was employed in 8 patients during a median follow -up time of 12 months, and symptomatic restenosis occurred in two cases. Conclusion: Endovascular revascularization for the non-acute intracranial vertebrobasilar artery occlusion beyond 24 hours is technically feasible, it can improve the mid-term prognosis. However, further research is needed to confirm its efficacy. (authors)

  10. The use of the inferior epigastric artery for accessory lower polar artery revascularization in live donor renal transplantation.

    Science.gov (United States)

    El-Sherbiny, M; Abou-Elela, A; Morsy, A; Salah, M; Foda, A

    2008-01-01

    This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after declamping. Between 1988 and 2004, 477 consecutive live donor renal transplants were performed, including 429 with single and 48 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 15 grafts with multiple arteries. Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning +/- MRA in some patients. In live donor renal transplantation with multiple arteries, the anastomosis of the lower polar artery to the inferior epigastric artery after declamping avoids prolongation of the ischemia time that occurs with other surgical and microsurgical techniques of intracorporeal and ex vivo surgeries.

  11. Dietary nitrate supplementation improves revascularization in chronic ischemia.

    Science.gov (United States)

    Hendgen-Cotta, Ulrike B; Luedike, Peter; Totzeck, Matthias; Kropp, Martina; Schicho, Andreas; Stock, Pia; Rammos, Christos; Niessen, Michael; Heiss, Christian; Lundberg, Jon O; Weitzberg, Eddie; Kelm, Malte; Rassaf, Tienush

    2012-10-16

    Revascularization is an adaptive repair mechanism that restores blood flow to undersupplied ischemic tissue. Nitric oxide plays an important role in this process. Whether dietary nitrate, serially reduced to nitrite by commensal bacteria in the oral cavity and subsequently to nitric oxide and other nitrogen oxides, enhances ischemia-induced remodeling of the vascular network is not known. Mice were treated with either nitrate (1 g/L sodium nitrate in drinking water) or sodium chloride (control) for 14 days. At day 7, unilateral hind-limb surgery with excision of the left femoral artery was conducted. Blood flow was determined by laser Doppler. Capillary density, myoblast apoptosis, mobilization of CD34(+)/Flk-1(+), migration of bone marrow-derived CD31(+)/CD45(-), plasma S-nitrosothiols, nitrite, and skeletal tissue cGMP levels were assessed. Enhanced green fluorescence protein transgenic mice were used for bone marrow transplantation. Dietary nitrate increased plasma S-nitrosothiols and nitrite, enhanced revascularization, increased mobilization of CD34(+)/Flk-1(+) and migration of bone marrow-derived CD31(+)/CD45(-) cells to the site of ischemia, and attenuated apoptosis of potentially regenerative myoblasts in chronically ischemic tissue. The regenerative effects of nitrate treatment were abolished by eradication of the nitrate-reducing bacteria in the oral cavity through the use of an antiseptic mouthwash. Long-term dietary nitrate supplementation may represent a novel nutrition-based strategy to enhance ischemia-induced revascularization.

  12. Coronary revascularization treatment based on dual-source computed tomography

    International Nuclear Information System (INIS)

    Dikkers, R.; Willems, T.P.; Jonge, G.J. de; Zaag-Loonen, H.J. van der; Ooijen, P.M.A. van; Oudkerk, M.; Piers, L.H.; Tio, R.A.; Zijlstra, F.

    2008-01-01

    Therapy advice based on dual-source computed tomography (DSCT) in comparison with coronary angiography (CAG) was investigated and the results evaluated after 1-year follow-up. Thirty-three consecutive patients (mean age 61.9 years) underwent DSCT and CAG and were evaluated independently. In an expert reading (the ''gold standard''), CAG and DSCT examinations were evaluated simultaneously by an experienced radiologist and cardiologist. Based on the presence of significant stenosis and current guidelines, therapy advice was given by all readers blinded from the results of other readings and clinical information. Patients were treated based on a multidisciplinary team evaluation including all clinical information. In comparison with the gold standard, CAG had a higher specificity (91%) and positive predictive value (PPV) (95%) compared with DSCT (82% and 91%, respectively). DSCT had a higher sensitivity (96%) and negative predictive value (NPV) (89%) compared with CAG (91% and 83%, respectively). The DSCT-based therapy advice did not lead to any patient being denied the revascularization they needed according to the multidisciplinary team evaluation. During follow-up, two patients needed additional revascularization. The high NPV for DSCT for revascularization assessment indicates that DSCT could be safely used to select patients benefiting from medical therapy only. (orig.)

  13. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  14. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons.

    Science.gov (United States)

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-04-01

    ) indicate that coronary revascularization may be appropriate for the clinical scenario. Seventeen clinical scenarios were developed by a writing committee and scored by the rating panel: 10 were identified as appropriate, 6 as may be appropriate, and 1 as rarely appropriate. As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction were considered appropriate. Likewise, clinical scenarios with unstable angina and intermediate- or high-risk features were deemed appropriate. Additionally, the management of nonculprit artery disease and the timing of revascularization are now also rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

  15. Persistent T-wave inversion predicts myocardial damage after ST-elevation myocardial infarction.

    Science.gov (United States)

    Reindl, Martin; Reinstadler, Sebastian Johannes; Feistritzer, Hans-Josef; Niess, Lea; Koch, Constantin; Mayr, Agnes; Klug, Gert; Metzler, Bernhard

    2017-08-15

    Persistent T-wave inversion (PTI) after ST-elevation myocardial infarction (STEMI) is associated with worse clinical outcome; however, the underlying mechanism between PTI and poor prognosis is incompletely understood. We sought to investigate the relationship between PTI and myocardial damage assessed by cardiac magnetic resonance (CMR) following STEMI. In this prospective observational study, we included 142 consecutive revascularized STEMI patients. Electrocardiography to determine the presence and amplitude of PTI and pathological Q-waves was conducted 4months after infarction. CMR was performed within 1week after infarction and at 4months follow-up to evaluate infarct characteristics and myocardial function. Patients with PTI (n=103, 73%) showed a larger acute (21[11-29] vs. 6[1-13]%; pwave and other IS estimators (high-sensitivity cardiac troponin T and C-reactive protein, N-terminal pro B-type natriuretic peptide, culprit vessel, pre-interventional TIMI flow). The value of PTI amplitude for the prediction of large chronic IS>11% (AUC: 0.84, 95%CI 0.77-0.90) was significantly higher compared to Q-wave amplitude (AUC: 0.72, 95%CI 0.63-0.80; p=0.009); the combination of PTI with pathological Q-wave (Q-wave/T-wave score) led to a net reclassification improvement of 0.43 (95% CI 0.29-0.57; pwave allows for a highly accurate IS estimation post-STEMI. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Consulta de enfermagem: espaço para criação e utilização de protocolo para pacientes após revascularização miocárdica Consulta de enfermería: espacio para la creación y utilización de protocolo para pacientes después de la revascularización del miocardio Nursing consultation: space for creation and use of protocol for patients after myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Francisca Elisângela Teixeira Lima

    2010-09-01

    .A descriptive study aiming to describe a protocol for nursing consultation tested for patients after myocardial revascularization. The protocol is implemented in a hospital cardiac unit, has goals that must be achieved during the consultation period or in between. For reaching each goal have been established that nursing actions should be implemented by the nurse, displayed in three tables: Strategies for nursing consultation relating to the first care; Strategies for nursing consultations regarding the nursing visits nº 2, 3 and 4; Strategies for nursing consultations regarding the nursing visit nº 5 referring to the sixth month after surgery. It is believed that the implementation of the protocol allow a systematic evaluation of the patient, raising their real problems, for planning and implementation of nursing interventions, especially those related to behavioral changes.

  17. Qualidade de vida após revascularização do miocárdio: avaliação segundo duas perspectivas metodológicas Calidad de vida después de revascularización del miocardio: evaluación según dos perspectivas metodológicas Quality of life after myocardial revascularization: evaluation according to two methodological perspectives

    Directory of Open Access Journals (Sweden)

    Rosana Aparecida Spadoti Dantas

    2010-04-01

    dominios que componen la Escala de Calidad de vida de Flanagan. La espiritualidad/religiosidad, no abordada en la escala, es destacada por los participantes como una dimensión de la CV.OBJECTIVE: To analyze the quality of life (QL as proposed by Flanagan, in two groups of revascularized patients; to compare and combine results from this research with data from an ethnography study that interprets the meanings that revascularized patients gave to QL. METHOD: The methodological triangulation was used in two researches: one qualitative (ethnographic and the other quantitative; the scale of Flanagan was applied in 124 individuals. RESULTS: In the quantitative study the QL was related to "bear and raise children" and "relationships with friends"; in the qualitative study a good QL was related to wellbeing, happiness, satisfaction, opportunities in life. The identified issues were: health (physical, emotional and spiritual, work and family harmony. CONCLUSION: The dimensions of quality of life identified in the ethnographic study were similar to the domains of Flanagan's QL-Scale. The spirituality/religiosity, not contemplated in the scale, is highlighted by participants as an aspect of the QL.

  18. Long-term prognostic implications of myocardial perfusion imaging in octogenarians: an all-comer, cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Katsikis, Athanasios [Onassis Cardiac Surgery Center, Nuclear Medicine Department, Athens (Greece); 401 General Military Hospital of Athens, Cardiology Department, Athens (Greece); Theodorakos, Athanasios; Manira, Vassiliki; Koutelou, Maria [Onassis Cardiac Surgery Center, Nuclear Medicine Department, Athens (Greece); Papaioannou, Spyridon [Athens Naval Hospital, Cardiology Department, Athens (Greece); Kolovou, Genovefa; Voudris, Vassilios [Onassis Cardiac Surgery Center, Cardiology Department, Athens (Greece)

    2017-08-15

    Evaluation of the long-term prognostic value of myocardial perfusion imaging (MPI) in octogenarians. Six hundred and twenty-nine octogenarians [51% previous myocardial infarction (MI) or revascularization] who underwent single-isotope MPI (78% {sup 201}Tl, 22% {sup 99m}Tc-tetrofosmin) with exercise (38% Bruce, 2% leg ergometry) or pharmacologic (58% adenosine, 2% dobutamine) stress were studied. All patients had LVEF determined by echocardiography within 1 month from MPI. Myocardial perfusion scoring was performed on a 17-segment LV-model with a 5-point grading system and three summed stress score (SSS)-based risk categories were formed [high-(SSS > 12), low-(SSS < 4), medium]. Prospective follow-up was performed to document all-cause (ACD), cardiac death (CD), MI, and revascularization. Revascularization was used to censor follow-up in survival analysis regarding ACD, CD, and CD/MI. For analysis of the CD, MI, or late revascularization (LR) composite, only revascularizations within 3 months from MPI (early revascularizations) were used for censoring. After 9.3 years there were 187 ACDs, 86 CDs, 28 MIs, and 77 revascularizations, including 28 early revascularizations. Adjusting for LVEF and stress-modality type, SSS was identified as an independent predictor of ACD [HR 1.03 (1.01-1.05)], CD [HR 1.05 (1.03-1.08)], CD,MI [HR 1.05 (1.02-1.07)], and CD,MI or LR [HR 1.05 (1.03-1.07)] (p ≤ 0.001 in all cases). Increased lung uptake had independent prognostic value only for the CD, MI, or LR end-point [HR 3 (1.2-7.7), p = 0.02]. Survival modeling demonstrated that LVEF and SSS, but not non-perfusion scintigraphic data provided incremental prognostic value over pre-test available clinical and historical information for all end-points. Differences between Kaplan-Meier survival curves of SSS-based risk groups were significant for all end-points (p < 0.001 in all cases). In octogenarians, MPI provides effective long-term risk stratification, regardless of stress type used

  19. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

    Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction the prevale...

  20. Classification of myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Hosbond, Susanne

    2013-01-01

    The classification of myocardial infarction into 5 types was introduced in 2007 as an important component of the universal definition. In contrast to the plaque rupture-related type 1 myocardial infarction, type 2 myocardial infarction is considered to be caused by an imbalance between demand...

  1. Myocardial Factor Revisited: The Importance of Myocardial Fibrosis in Adults with Congenital Heart Disease

    Science.gov (United States)

    Broberg, Craig S.; Burchill, Luke J.

    2015-01-01

    Pioneers in congenital heart surgery observed that exercise capacity did not return to normal levels despite successful surgical repair, leading some to cite a “myocardial factor” playing a role. They conjectured that residual alterations in myocardial function would be significant for patients’ long-term outlook. In fulfillment of their early observations, today’s adult congenital heart disease (ACHD) population shows well-recognized features of heart failure, even among patients without clear residual anatomic or hemodynamic abnormalities, demonstrating the vital role of the myocardium in their morbidity and mortality. Whereas the ‘myocardial factor’ was an elusive concept in the early history of congenital heart care, we now have imaging techniques to detect and quantify one such factor – myocardial fibrosis. Understanding the importance of myocardial fibrosis as a final common pathway in a variety of congenital lesions provides a framework for both the study and treatment of clinical heart failure in this context. While typical heart failure pharmacology should reduce or attenuate fibrogenesis, efforts to show meaningful improvements with standard pharmacotherapy in ACHD repeatedly fall short. This paper considers the importance of myocardial fibrosis and function, the current body of evidence for myocardial fibrosis in ACHD, and its implications for research and treatment. PMID:25897907

  2. Risky Cerebrovascular Anatomic Orientation: Implications for Brain Revascularization.

    Science.gov (United States)

    Nagm, Alhusain; Horiuchi, Tetsuyoshi; Yanagawa, Takao; Hongo, Kazuhiro

    2016-12-01

    This study documents a risky vascular anatomic orientation that might play an important role in the postoperative hemodynamics following anterior cerebral artery (ACA) revascularization. A 71-year-old woman presented with uncontrollable frequent right lower limb transient ischemic attacks (TIAs) attributed to a left cerebral ischemic lesion due to severe left ACA stenosis. She underwent successful left-sided superficial temporal artery-ACA bypass using interposed vascular graft. The patient awoke satisfactory from anesthesia; however, on postoperative day 1, she developed right-sided hemiparesis. Extensive postoperative investigations disclosed that watershed shift infarction was considered the etiology for this neurologic deterioration. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Management of Traumatized Permanent Incisors. Revascularization and Delayed Replantation.

    Science.gov (United States)

    Gharechahi, Maryam; Shojaeian, Shiva

    2016-01-01

    This article reports a clinical case of a 9-year-old boy with a traumatic injury to the maxillary central incisors 24 hours after a fall in his schoolyard. The upper left central incisor was avulsed and was kept in saliva for four hours from the moment of trauma until its replantation. The right one was necrotized after one month. We describe successful revascularization treatment of right necrotic immature upper incisor and delayed replantation of left one. After 18 months, radiolucent lesions in the periapical areas of both maxillary central incisors had healed, and root apex development was noted with thickening of the walls in tooth #8.

  4. Adult hemorrhagic moyamoya disease: The paradoxical role of combined revascularization

    Directory of Open Access Journals (Sweden)

    Vikas C Jha

    2012-01-01

    Full Text Available Background: Moyamoya disease (MMD in adults often manifests with hemorrhage. Combined revascularization in hemorrhagic MMD is controversial as improvement in hemodynamics may be offset by hypervascularity-induced rebleeding. Aim: Long-term outcome assessment of adult patients from non-endemic region with hemorrhagic MMD undergoing combined revascularization. Setting: Tertiary care, academic setting. Materials and Methods: Both Suzuki′s internal carotid artery (ICA grade (1-6 and Mugikura′s posterior cerebral artery (PCA grade (1-4 were applied to 11 patients with hemorrhagic MMD (mean symptom duration 6.11±6.46 months undergoing direct [superficial temporal artery-middle cerebral artery (STA-MCA bypass] and indirect encephalomyosynangiosis (EMSA revascularization. They were clinically graded at follow-up (F/U as: excellent, preoperative symptoms resolved; good, preoperative symptoms resolved, neurological deficits remained; fair, symptom frequency decreased; and poor, symptoms unchanged/worsened. Digital subtraction angiogram/magnetic resonance angiography (DSA/MRA assessed the patency of anastomosis and cerebral hemodynamics as: 0 = non-patent; 1 = patent bypass, STA perfused recipient artery, moyamoya vessels unchanged; and, 2 = patent bypass, STA widely perfused MCA territory, moyamoya vessels diminished. An acetazolamide stimulated single photon emission computed tomography (SPECT study evaluated regional cerebral vascular reserve (RCVR. Results: Angiographic ICA grades were 5 (n=2, 4 (n=2, 3 (n=4, and 2 (n=3, and PCA grades were 1 (n=8 and 3 (n=3. At F/U (mean: 36.55±21.6 months, clinical recovery was excellent in eight and fair in one. Two patients developed delayed re-hemorrhage (in one at a site remote from previous bleed. F/U DSA/MRA (n=6 showed a good caliber, patent anastomosis with collaterals in five patients, and a narrow caliber anastomotic vessel in one patient. SPECT (n=6 revealed improved perfusion in two and normal

  5. Myocardial imaging. Coxsackie myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-09-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

  6. Myocardial imaging. Coxsackie myocarditis

    International Nuclear Information System (INIS)

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-01-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1

  7. Detection of hibernating myocardium in patients with myocardial infarction by low-dose dobutamine echocardiography. Comparison with thallium-201 scintigraphy with reinjection

    International Nuclear Information System (INIS)

    Takagi, Tsutomu; Yoshikawa, Junichi; Yoshida, Kiyoshi; Akasaka, Takashi; Honda, Yasuhiro; Yonezawa, Yoshihiro; Shakudo, Masahiro

    1995-01-01

    The identification of hibernating myocardium is important for selecting patients who will benefit from coronary revascularization. The relationship between echocardiographic and radioisotopic markers of hibernating myocardium and postrevascularization recovery of myocardial function was investigated in 21 patients who underwent successful revascularization. Each patient underwent low-dose dobutamine stress echocardiography and thallium-201 ( 201 Tl) scintigraphy with reinjection before revascularization. The presence of contractile reserve in dobutamine stress echocardiography and Tl uptake in 201 Tl scintigraphy with reinjection were defined as markers of hibernating myocardium. Follow-up echocardiograms were evaluated for improved regional wall motion in all patients at a mean of 8.6 months after revascularization. Sensitivity, specificity, and positive and negative predictive values of low-dose dobutamine stress echocardiography for indicating recovery of function after revascularization were 75.0%, 77.8%, 81.8%, and 70.0%, respectively. Sensitivity, specificity, and positive and negative predictive values of 201 Tl scintigraphy with reinjection for indicating recovery of function after revascularization were 91.7%, 55.6%, 73.3%, and 83.3%, respectively. There were no statistical differences between low-dose dobutamine echocardiography and 201 Tl scintigraphy in predicting postrevascularization recovery of function in patients with hibernating myocardium. (author)

  8. Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

    International Nuclear Information System (INIS)

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B

    2004-01-01

    Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP

  9. Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2004-07-01

    Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP.

  10. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

    the prevalence of ambulatory or transient myocardial ischemia is lower than in patients with chronic, stable coronary artery disease. A greater proportion of ischemic episodes, however, are silent than in other subgroups with ischemic heart disease. Early after the infarction, transient myocardial ischemia...... exhibits a circadian variation with a peak activity occurring in the late evening hours. Patients with non-Q wave infarction have more transient myocardial ischemia, whereas thrombolytic therapy seems to result in less residual ischemia. Exercise testing is more sensitive than ambulatory monitoring...

  11. Prognostic significance of nonsustained ventricular tachycardia after revascularization.

    Science.gov (United States)

    Mittal, Suneet; Lomnitz, David J; Mirchandani, Sunil; Stein, Kenneth M; Markowitz, Steven M; Slotwiner, David J; Iwai, Sei; Das, Mithilesh K; Lerman, Bruce B

    2002-04-01

    Two randomized trials (Multicenter Automatic Defibrillator Implantation Trial [MADIT] and Multicenter Unsustained Tachycardia Trial [MUSTT]) suggest that implantable cardioverter defibrillator (ICD) placement is associated with improved survival in patients with coronary artery disease, depressed left ventricular function, and nonsustained ventricular tachycardia (VT) who also have inducible sustained VT. However, neither study directly addresses the management of such patients who develop nonsustained VT early after revascularization. We evaluated 109 consecutive patients who underwent electrophysiologic testing to evaluate nonsustained VT, which occurred 5 +/- 4 days following revascularization. Sustained monomorphic VT was inducible in 46 (42%) patients; these patients received an ICD. The remaining 63 (58%) noninducible patients received neither antiarrhythmic drug therapy nor an ICD. During 27 +/- 12 months of follow-up, 15 (33%) of 45 patients with an implanted ICD received at least one appropriate therapy from the device and 26 (24%) of the 109 study patients died. The 1- and 2-year freedom from ventricular tachycardia/fibrillation or sudden death in noninducible patients (97% and 93%) was significantly greater than that of inducible patients (84% and 71%; P = 0.001). However, no difference was observed in total mortality. Patients with nonsustained VT during the early postrevascularization period who have inducible VT have a high incidence of arrhythmic events. Although this study was not designed to assess the impact of ICD placement on the total mortality of inducible patients, the finding that one third of these patients received appropriate ICD therapy suggests that the device may have a protective effect in these patients.

  12. One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Wetterslev, Jørn; Lund, Jens T

    2009-01-01

    AIMS: To investigate clinical and angiographic outcomes after coronary surgery using total arterial revascularization (TAR). METHODS AND RESULTS: We randomized 331 patients with multivessel or isolated left main disease to TAR [internal thoracic (ITA) and radial arteries] vs. conventional...... revascularization (CR) using left ITA and vein grafts. The primary angiographic outcome was the patency index: number of patent grafts (

  13. Combination of Carbon Dioxide Angiography and Outback® Elite for Revascularization of a Patient with Renal Insufficiency with Bilateral Femoropopliteal Chronic Total Occlusions

    Directory of Open Access Journals (Sweden)

    Yuhei Nojima

    2017-01-01

    Full Text Available A new reentry device (Outback Elite system has been available in Japan since June 2016. This new device enables easier treatment of chronic total occlusion (CTO in the lower extremities. We report a case of a woman in her 70s who underwent revascularization using this new device twice to treat both of her femoropopliteal CTO lesions. She was referred to our hospital complaining of intermittent claudication in both legs. She had a long history of diabetes mellitus complicated with severe chronic kidney disease. Her estimated glomerular filtration rate was <20. She refused surgical revascularization; therefore, we performed our treatment without iodine contrast medium. First, magnetic resonance imaging was performed to confirm that the CTO lesions had caused severe claudication before intervention. Subsequently, the Outback Elite device and carbon dioxide (CO2 angiography made it possible to revascularize both of her legs without iodine contrast medium. At 6 months after the procedures, we did not observe exacerbation of claudication in her legs.

  14. Endovascular revascularization of TASC C and D femoropopliteal occlusive disease using carbon dioxide as contrast

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, Cynthia de Almeida; Teivelis, Marcelo Passos; Kuzniec, Sergio; Fukuda, Juliana Maria; Wolosker, Nelson [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2016-07-01

    To analyze the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO{sub 2} as primary contrast in patients with no formal contraindication to iodine, aiming to decrease allergic reactions and potential nephrotoxicity in high-risk patients. We describe the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO{sub 2} as primary contrast in patients with high risk for open revascularization and no formal contraindication to iodine. We analyzed feasibility of the procedures, complications, quality of the angiographic images, clinical and surgical outcomes, and costs of C and D lesions treated using CO{sub 2} as contrast medium. The use of CO{sub 2} in C and D lesions needed iodine complementation in most of the cases (nine cases) but decreased the potential nephrotoxicity of iodine contrast medium by the reduction of its volume in this group of high-risk patients. The extension of the arterial lesions was the factor that most contributed to the need for iodine supplementation due to the difficulty to visualize the refill after a long arterial occlusion. The use of CO{sub 2} as contrast in patients with C and D lesions with no restriction for iodine contrast medium was an alternative that did not dismiss the need of iodine supplementation in most of the cases, but could decrease the potential nephrotoxicity of iodine constrast medium.

  15. Optimized noninvasive monitoring of thermal changes on digital B-mode renal sonography during revascularization therapy.

    Science.gov (United States)

    Abolhassani, Mohammad D; Tavakoli, Vahid; Sahba, Nima

    2009-11-01

    Noninvasive real-time thermal change monitoring of human internal organs can play a critical role in diagnosis and treatment of many disorders, including reperfusion of renal arteries during anticoagulation therapy. This article focuses on tissue temperature detection using ultrasound velocity changes in different structures and their related speckle shift from their primary locations on high-quality B-mode digital sonography. We evaluated different speckle-tracking techniques and optimized them using appropriate motion estimation methods to determine the best algorithm and parameters. Performing thermal detection methods on simulated phantoms showed a good correlation between speckle shifts and the ground truth temperature. For the simulated images, average thermal error was 0.5 degrees C with an SD of 0.5 degrees C, where lower errors can be obtained in noiseless (motionless) data. The proposed technique was evaluated on real in vivo cases during surgical occlusion and reopening of the renal segmental artery and showed the potential of the algorithm for observation of internal organ changes using only digital ultrasound systems for diagnosis and therapy. The adaptive Rood pattern search proved to be the best block-matching technique, whereas the multiresolution Horn-Schunck technique was the best gradient optical flow method. The extracted thermal change during in vivo revascularization therapy is promising. In addition, we present an evaluation of several block-matching and optical flow motion estimation techniques.

  16. The challenging topic of diabetic foot revascularization: does the angiosome-guided angioplasty may improve outcome.

    Science.gov (United States)

    Alexandrescu, V; Hubermont, G

    2012-02-01

    The angiosome model was first pioneered by Jan Taylor in 1987 by his influential anatomical works in the plastic reconstructive surgery field. The concept depicts the human body into three-dimensional blocks of tissue, fed by specific arterial and venous irrigation sources, the "angiosomes". Adjacent angiosomes are linked by a vast compensatory collateral web "the choke vessels". This collateral network provides a remarkable "rescue system" in non-atherosclerotic and non-diabetic patients. However, it could be dramatically damaged in chronic limb ischemia (CLI) subjects witnessing miscellaneous systemic arterial disease. The angiosome concept may provide useful information on the human vascular anatomy and related pathology, with specific applications in surgical and vascular interventional therapies. This knowledge may become particularly beneficial in CLI while treating advanced atherosclerotic disease that adds extended collateral depletion. The concept may allow to deliberately focus arterial flow reconstruction in specific limb ischemic areas that exhibit tissue loss and fluctuating "rescue-vessels" supply. The implementation of angiosome-derived strategies in Rutherford grade III CLI presentations, may afford encouraging wound healing and limb preservation rates for both, bypass or endovascular techniques. The present paper proposes a parallel review of the main contemporary publications that share this theory in dedicated CLI literature, with practical considerations for its daily use. Recent applications of the angiosome concept in current CLI revascularization seem to evince benefic results in tissue cicatrization, although comparative and prospective data are further mandatory to cast any pertinent clinical validation.

  17. Assessment of coronary atherosclerosis by cardiac image: complementary amount of the calcium score to myocardial perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Vitola, Joao Vicente; Cerci, Rodrigo J.; Zapparoli, Marcello, E-mail: joaovitola@quantamn.com.br [Quanta Diagnostico Nuclear, Curitiba, PR (Brazil)

    2011-04-15

    Over the last decades we have witnessed significant advances on diagnostic tools and management of patients with or suspected cardiovascular disease, and consequently a significant reduction in mortality. Nevertheless, cardiovascular disease remains the leader cause of death in many countries, including Brazil. Identifying the high risk patient is important, so we can intensify prevention strategies. Non invasive diagnostic tools have been developed to identify the high risk patient in need of a myocardial revascularization, notably using myocardial scintigraphy. However, many clinicians still question, what is the best management for a patient with traditional risk factors, who has a positive treadmill test result and a completely normal myocardial scintigraphy? What is the literature showing in relation to the role of coronary calcium score for these patients? In this article we will reflect over these issues which are so frequently encountered in daily cardiology practice. (author)

  18. Effects of coronary artery bypass surgery on regions showing persistent defects in thallium myocardial images

    International Nuclear Information System (INIS)

    Konishi, Yutaka; Ban, Toshihiko; Okamoto, Yoshifumi

    1989-01-01

    The indications for revascularization surgery and its effects on myocardial regions showing persistent defects in thallium myocardial images are controversial. The effects of aortocoronary bypass surgery on myocardial perfusion and wall motion in the regions with persistent defects were evaluated in 47 patients with thallium-201 single photon emission computed tomography and left ventriculography. In areas showing persistent thallium defects preoperatively the rate of improvement of perfusion was only 24% by postoperative thallium imaging, and 57% by wall motion analysis. These results were significantly inferior to those of regions with transient defects, which were 84% and 82%, respectively. A persistent defect may not be a definitive marker of a non-viable scar, but the results of surgery on such regions were unsatisfactory. It is concluded, therefore, that revascuralization surgery in regions with persistent defects is not always recommended and that the indications for surgery should be individually determined with operative risk balanced against benefits. (author)

  19. ASSESSMENT OF EFFICACY OF SURGICAL CEREBRAL REVASCULARIZATION IN PATIENTS WITH LARGE POST-STROKE CYSTS

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    R. N. Lar'kov

    2015-01-01

    Full Text Available Background: At present, efficacy of carotid endarterectomy for prevention of cerebrovascular accidents has been convincingly proven. Its results in patients with a history of an ischemic stroke depend on multiple factors.Aim: To study results of reconstructive interventions on internal carotid arteries in patients with post-stroke cerebral cysts.Materials and methods: We analyzed data from 210 patients who had undergone an intervention (159 men and 51 women, aged 61 ± 2.7 years with occluding lesions of the internal carotid artery and a history of an ischemic stroke. Depending on the size of a post-stroke lesion, patients were divided into 5 groups: patients from group 1 had a lesion of more than 5 cm in diameter, from group 2, from 2 to 5 cm, from group 3, ≤ 2 cm, patients from group 4 had a lacunar cysts and patients from group 5 had no focal lesions.Results: A clear positive correlation between the size of a post-stroke cyst and the degree of hemodynamic abnormalities in internal carotid arteries was found. The most prominent asymmetry of blood flow in the middle cerebral artery (on average, 34.1% was seen in patients from the group 1. Patients from the group 1 more often had low and critical brain tolerance to ischemia (42.9%. In patients with large post-stroke cysts (group 1 mean Barthell index was 69 ± 8.1, and NIHSS score 8.2 ± 1.6. In patients from other groups neurological deficiency was less pronounced: 80 ± 6.8 and 7.6 ± 1.9 in the group 2, 82 ± 5.7 and 4.1 ± 1.3 in the group 3, 94 ± 4.6 and 3.2 ± 1 in the groups 4 and 5. The differences between groups in the rates of postoperative complications were not statistically significant (p > 0.5. However, signs of hyperperfusion without any clinical manifestations were more often observed in patients from the group 1 (19%. Assessment of changes in neurological status at 1 year after the intervention, depending on the size of post-stroke lesions, showed that in patients with large cysts the regression of neurological deficiency was less obvious, than in other groups (NIHSS 7.5 ± 1.7, Barthell index 76 ± 7.7. The best restoration of impaired neurological functions was seen in patients with small cysts (NIHSS 2.2 ± 0.7, Barthell index 91 ± 3.4.Conclusion: In patients with large and intermediate post-stroke cerebral cysts surgery is associated with a higher complication rate, and, first of all, of hyperperfusion syndrome. However, the risk of these complications is significantly smaller than the probability of repeated acute cerebrovascular accidents.

  20. "Mushroom cloud": a giant left ventricular pseudoaneurysm after a myocardial infarction due to myocardial bridging – a case report

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    Ferreira Manuel M

    2009-07-01

    Full Text Available Abstract Left ventricular pseudoaneurysm is an uncommon complication after transmural myocardial infarction, occurring when a free wall rupture is contained by adhesions of the overlying pericardium preventing acute tamponade. In this report, an unusual case of a 61 year-old male with a giant apical left ventricular pseudoaneurysm after an unnoticed myocardial infarction is presented. On coronary angiogram myocardial bridging of the distal left anterior descending artery was judged to be the infarct related lesion. The echocardiographic diagnosis allowed for a timely surgical intervention which resulted in the patient's full recovery.

  1. A METHOD FOR RESTORING ORAL CAVITY AND TONGUE USING A COMPOSITE, FREE, CHIMERIC, REVASCULARIZED, REINNERVED, MUSCULOCUTANEOUS FLAP AFTER TOTAL GLOSSECTOMY

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    A. P. Polyakov

    2017-01-01

    Full Text Available Background. Combination therapy is the main method used for treatment of patients with locally advanced cancer of the oral floor and tongue. Radical surgery is a key stage of this therapy. These surgeries are inevitably associated with extensive defects in the oral cavity and tongue and, therefore, the loss of necessary organism functions. Currently, there is no optimal autotransplant for tongue reconstruction after total or subtotal removal of the tongue and oral floor muscles; it appears to be one of the most significant challenges in modern reconstructive surgery.Materials and methods. The authors describe a case of successful repair of the oral floor and tongue after total glossectomy using a novel method developed in the Department of Microsurgery at the P. A. Herzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia. This method implies tongue reconstruction using a revascularized, reinnerved, chimeric, thoracodorsal flap with inclusion of a muscular portion from the serratus anterior muscle and a musculocutaneous portion from the latissimus dorsi muscle. We performed tongue reconstruction in a 62-year-old patient diagnosed with stage IVA (Т3N2bМ0 tongue cancer. Results. The novel method of surgical treatment of locally advanced tongue cancer with simultaneous repair of defects using a revascularized, reinnerved, chimeric flap with inclusion of the serratus anterior muscle and latissimus dorsi muscle allowed to remove the tumor, stabilize the laryngeal complex, restore the diaphragm of the oral floor, create an adequate volume of neotongue, obtain good functional and cosmetic results, and reduce the length of hospital stay. Conclusion. Novel method of surgical treatment of locally advanced tongue cancer facilitates health, employment, and social rehabilitation of patients with oropharyngeal cancer. This method can be considered as an alternative method of choice

  2. Assessment of the effect of revascularization early after CABG using ECG-gated perfusion single-photon emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Shigeto; Tadamura, Eiji; Kudoh, Takashi; Inubushi, Masayuki; Konishi, Junji [Dept. of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate (Japan); Ikeda, Tadashi; Koshiji, Takaaki; Nishimura, Kazunobu; Komeda, Masashi [Dept. of Cardiovascular Surgery, Kyoto University (Japan); Tamaki, Nagara [Dept. of Nuclear Medicine, Hokkaido University, Sapporo (Japan)

    2001-02-01

    When an arterial graft is used, reversible perfusion defects on single-photon emission tomography (SPET) perfusion images are occasionally observed early after coronary artery bypass graft surgery (CABG), owing to the restricted flow capacity. The purpose of this study was to determine whether the functional information obtained with electrocardiography (ECG)-gated perfusion SPET could be helpful in evaluating the effect of revascularization early after CABG. Twenty-three patients (18 men and 5 women, mean age 65{+-}9 years) underwent stress/re-injection thallium-201 ECG-gated SPET before and 4 weeks after CABG (13 with exercise and 10 with dipyridamole). Patency of all grafts was confirmed by coronary angiography 1 month after CABG. Cardiac functional data including the left ventricular ejection fraction (LVEF) and the transient ischaemic dilatation (TID) ratio were analysed using a commercially available automated program. The conventional stress and re-injection tomograms were interpreted by means of a five-point scoring system in a nine-segment model. Stress-induced reversible {sup 201}Tl perfusion defects were present in 64% of the myocardial segments bypassed by patent arterial grafts, in contrast to 42% of the myocardial segments bypassed by patent venous grafts ({chi}{sup 2}=7.8, P=0.005). Of the 23 patients, 12 showed improvement in summed ischaemic scores (group 1), while 11 had no change or deterioration (group 2), although all grafts were patent on postoperative catheterization. The TID ratio improved in both group 1 and group 2 before and after CABG (1.14{+-}0.13 vs 0.99{+-}0.07, P=0.001 and 1.09{+-}0.07 vs 0.94{+-}0.05, P=0.002, respectively). However, LVEF did not significantly improve in group 1 or group 2 after CABG (42.5%{+-}9.9% vs 47.5%{+-}11.8%, and 52.1%{+-}7.5% vs 53.1%{+-}5.9%, respectively). Perfusion imaging or LVEF assessment is of limited value early after CABG. The TID ratio obtained with ECG-gated perfusion SPET may be a useful marker

  3. Myocutaneous revascularization following graded ischemia in lean and obese mice

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    Clark RM

    2016-09-01

    Full Text Available Ross M Clark,1 Brittany Coffman,2 Paul G McGuire,3 Thomas R Howdieshell1,3 1Department of Surgery, 2Department of Pathology, 3Department of Cell Biology and Vascular Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA Background: Murine models of diabetes and obesity have provided insight into the pathogenesis of impaired epithelialization of excisional skin wounds. However, knowledge of postischemic myocutaneous revascularization in these models is limited. Materials and methods: A myocutaneous flap was created on the dorsum of wild type (C57BL/6, genetically obese and diabetic (ob/ob, db/db, complementary heterozygous (ob+/ob− , db+/db−, and diet-induced obese (DIO mice (n=48 total; five operative mice per strain and three unoperated mice per strain as controls. Flap perfusion was documented by laser speckle contrast imaging. Local gene expression in control and postoperative flap tissue specimens was determined by quantitative reverse transcription polymerase chain reaction (RT-PCR. Image analysis of immunochemically stained histologic sections confirmed microvascular density and macrophage presence. Results: Day 10 planimetric analysis revealed mean flap surface area necrosis values of 10.8%, 12.9%, 9.9%, 0.4%, 1.4%, and 23.0% for wild type, db+/db−, ob+/ob−, db/db, ob/ob, and DIO flaps, respectively. Over 10 days, laser speckle imaging documented increased perfusion at all time points with revascularization to supranormal perfusion in db/db and ob/ob flaps. In contrast, wild type, heterozygous, and DIO flaps displayed expected graded ischemia with failure of perfusion to return to baseline values. RT-PCR demonstrated statistically significant differences in angiogenic gene expression between lean and obese mice at baseline (unoperated and at day 10. Conclusion: Unexpected increased baseline skin perfusion and augmented myocutaneous revascularization accompanied by a control proangiogenic transcriptional

  4. Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion

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    Khayat Andre

    2011-01-01

    Full Text Available Abstract We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.

  5. The Informative Value of N-Terminal Pro-type B Natriuretic Peptide in Cardiac Surgical Patients with Hypercreatininemia

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    M. G. Burzhunova

    2011-01-01

    Full Text Available Objective: to study the informative value of a dramatic increase in the preoperative blood level of the inactive moiety of the precursor of N-terminal pro-type B natriuretic peptide (NT-proBNP in cardiac surgical patients with hypercreatininemia. Subjects and materials. Twenty-one patients with a preoperative NT-proBNP level of 1000 pg/ml or more, who underwent myocardial revascularization under extracorporeal circulation (ECC, were examined. The patients were divided into groups with normal (up to 120 ^mol/l (Group 1; n=11 and elevated (Group 2; n=10 creatinine concentrations. The values of circulation were processed after skin incision and at the end of surgery. The clinical features of a perioperative period were analyzed. Results. Creatininemia was 103±3.3 and 183±12.9 ^mol/l in Groups 1 and 2, respectively (p<0.05; NT-proBNP was 1397±139 and 1908±170 pg/ml (p<0.05. EuroSCORE-predicted mortality ran to 9.8±1.6 and 9.1±1.7% (p>0.05. There were no intergroup differences in intraoperative circulatory parameters. The intensity of sympatomimetic therapy after ECC was equal in the identified patient groups and there were either no differences (p>0.05 in the frequency of intra-aortic balloon counterpulsation (18.2 and 10.0%, the length of mechanical ventilation (15±1.5 and 18.7±2.3 hours and intensive care unit stay (1.8±0.5 and 2.0±0.7 days in survivors, and inpatient mortality (23.7 and 20.0% that proved to be substantially higher than the EuroSCORE-predicted one. Regression analysis showed that in the entire group of operated patients, the level of NT-proBNP turned out to be a more significant predictor of inpatient mortality (p=0.012 than EuroSCORE-predicted one (p = 0.04. The similar regularity was characteristic for patients with hypercreatininemia. In the patients with hypercholesterolemia, the EuroSCORE-predicted mortality completely lost its significance (p=0.61 in predicting actual mortality rates. In this group, NT

  6. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Cerqueira, M.D.; Jacobson, A.F.

    1989-05-01

    Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using /sup 111/In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities.

  7. Triple-Vessel Percutaneous Coronary Revascularization In Situs Inversus Dextrocardia

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    Nikolaos Kakouros

    2010-01-01

    Full Text Available Dextrocardia with situs inversus occurs in approximately one in 10,000 individuals of whom 20% have primary ciliary dyskinesia inherited as an autosomal recessive trait. These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population. We report what is, to our knowledge, the first case of total triple-vessel coronary revascularization by percutaneous stent implantation in a 79-year-old woman with situs inversus dextrocardia. We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques. The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

  8. [How to detect myocardial ischemia in patients following acute coronary syndrome treated by PCI?

    Science.gov (United States)

    Amabile, Nicolas; Malergue, Marie Christine; Achkouty, Guy; Czitrom, Daniel; Caussin, Christophe

    Unstable coronary artery disease is a more aggressive condition than stable coronary artery disease, accounting for the high incidence of major adverse cardiovascular events following acute coronary syndromes (ACS), which includes the need for iterative repeat revascularization. The aim of myocardial ischemia screening in post-ACS patients is to detect this unfavourable evolution (either on initial culprit or non culprit lesions) and to prevent any clinical complication. Although there is no strict recommendation in this particular situation, screening should be based on the use of stress imaging techniques. The optimal timing and frequency for testing will depend on the clinical characteristics of the patients and the coronary revascularization procedure features. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. Ulcer healing after peripheral intervention-can we predict it before revascularization?

    Science.gov (United States)

    Azuma, Nobuyoshi; Koya, Atsuhiro; Uchida, Daiki; Saito, Yukihiro; Uchida, Hisashi

    2014-01-01

    Complete ulcer healing is one of the most important goals of treatment for critical limb ischemia; however, it is still difficult to inform patients of the time to ulcer healing before performing revascularization. The time to ulcer healing has a great impact on the cost of treatment and patient's quality of life. To predict it, the factors that influence delayed ulcer healing should be explored. According to a review of the literature investigating ulcer healing after revascularization, the influential factors can be classified into 5 categories: (1) systemic factors; (2) clinical state of tissue defect; (3) infection; (4) wound management strategy; and (5) revascularization strategy (endovascular or open repair, the angiosome concept). It is also important to ensure sufficient blood supply to predict ulcer healing probability in the individual patient. Several new methodologies, such as measuring tissue circulation around the tissue defect and intraoperative imaging techniques, have been reported. Because the status of ischemic tissue loss and wound healing ability can affect the decision-making process in selecting the revascularization strategy, understanding the many factors that influence ulcer healing after revascularization is indispensable for physicians performing revascularization. Accumulating ulcer healing data via well-designed clinical research can help to establish a new paradigm for the revascularization strategy from the viewpoint of ulcer healing.

  10. The effect of percutaneous transmyocardial laser revascularization on left ventricular function in a porcine model of hibernating myocardium

    International Nuclear Information System (INIS)

    Almeda, Francis Q.; Glock, Dana; Sandelski, Joanne; Ibrahim, Osama; Macioch, James E.; Allen, Trisha; Dainauskas, John R.; Parrillo, Joseph E.; Snell, R. Jeffrey; Schaer, Gary L.

    2004-01-01

    Background: Hibernating myocardium is defined as a state of persistently impaired myocardial function at rest due to reduced coronary blood flow that can partially or completely be restored to normal if the myocardial oxygen supply/demand relationship is favorably altered. Percutaneous laser revascularization (PMR) is an emerging catheter-based technique that involves creating channels in the myocardium, directly through a percutaneous approach with a laser delivery system, and has been shown to reduce symptoms in patients with severe refractory angina; however, its effect on improving regional wall motion abnormalities in hibernating myocardium has not been clearly established. We sought to determine the effect of PMR using the Eclipse System (Cardiogenesis) on left ventricular function in a porcine model of hibernating myocardium. Methods: A model of hibernating myocardium was created by placement of an ameroid constrictor in the proximal left anterior descending artery of a 35 kg male Yorkshire pig. The presence of hibernating myocardium was confirmed with dobutamine stress echocardiography (DSE) and defined as severe hypocontractility at rest, with an improvement in systolic wall thickening with low-dose dobutamine in myocardial regions with a subsequent deterioration in function at peak stress (biphasic response). After the demonstration of hibernating myocardium, PMR was performed in the area of hypocontractile function, and the serial echocardiography was performed. The echocardiograms were reviewed by an experienced echocardiologist blinded to the results, and regional wall motion was assessed using the American Society of Echocardiography Wall Motion Score. Six weeks after PMR, the animal was sacrificed and the heart sent for histopathologic studies. Results: A comparison of the regional wall motion function of the area distal to the ameroid constrictor and in the contralateral wall at baseline, post-ameroid placement, and post-PMR was performed

  11. Review Paper: Myocardial Rupture After Acute Myocardial Infarction ...

    African Journals Online (AJOL)

    Myocardial rupture complications after acute myocardial infarction are infrequent but lethal. They mainly involve rupture of the ventricular free wall, ventricular septum, papillary muscle, or combined. We compare features of different kinds of myocardial ruptures after acute myocardial infarction by reviewing the clinical ...

  12. Evaluation of myocardial bridging by coronary computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Rabelo, Daniel Rocha; Siqueira, Maria Helena Albernaz, E-mail: marciovlbarros@uol.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil); Garretto, Luiza Samarane; Paula, Marcela Mascarenhas De; Carvalho, Marina Oliveira; Alves, Marina Rangel Moreira Barros [Faculdade de Saude e Ecologia Humana (FASEH), Vespasiano, MG (Brazil)

    2013-01-15

    The myocardial bridge (MB) is defined as a segment of an epicardial coronary artery that has an intramural course in the myocardium. Although MB is clinically silent in most cases, has been associated with myocardial ischemia, arrhythmias and sudden death. Coronary conventional angiography is the gold standard for detection of MB, but is invasive and cannot be sufficiently sensitive compared to autopsy studies. Recently, multislice computed tomography of coronary arteries (MCTCA) has allowed the detection of coronary artery course, including PM. Objectives: to evaluate MB prevalence in patients with suspected coronary artery disease undergoing MCTCA and to evaluate the predictive value of this method at medium term. Methods: during the period 2008 to 2011, 498 consecutive patients were examined by TMC for the diagnosis of coronary artery disease, being conducted to evaluate the presence of BM and followed for a mean follow-up of 23 months for the occurrence of cardiovascular hard events (death, hospitalization or revascularization). Results: patients mean age was 55.3 ± 14.2, being male 71.1%. Among the patients, 7.6% (38 patients) showed MB. Main findings included angina pectoris in 40% and a positive stress test in 34%. 34.2% had atherosclerotic disease, and one patient had significant coronary stenosis. During follow-up, no patients showed adverse events. Conclusion: MCTCA is a noninvasive technique with high accuracy in anatomical evaluation of the coronary arteries and may be particularly useful to assess the incidence, location and morphology of myocardial bridging in vivo. (author)

  13. Intervenções percutâneas para revascularização do miocárdio no Brasil em 1996 e 1997 comparadas às do biênio 1992 e 1993. Relatório do registro CENIC (Central Nacional de Intervenções Cardiovasculares Percutaneous myocardial revascularization procedures in Brazil during 1996-1997 compared to the 1992-1993 period. A report from the Brazilian national registry -- CENIC

    Directory of Open Access Journals (Sweden)

    Amanda G. M. R. Sousa

    1998-06-01

    .000001, with lower residual stenosis (22% vs 19%, p=0.001. Besides, there were lower major complications rates: acute myocardial infarction (2.5% vs 1.2%, p=0.002 and death (1.8% vs 1.4%, p=0,0003. CONCLUSION: The procedures most often carried out in both periods were balloon angioplasty (60.67% and implantation of stents (36.57%; the success rate high, abrupt closure rate was low (1.5%. These favorable results corroborate the high standards of the Brazilian Interventional Cardiology.

  14. THE ROLE OF LIPOTROPIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE BEFORE AND AFTER CORONARY REVASCULARIZATION

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    R. N. Adzhiev

    2013-01-01

    Full Text Available Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011. The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

  15. Root canal revascularization. The beginning of a new era in endodontics.

    Science.gov (United States)

    Alrahabi, Mothanna K; Ali, Mahmoud M

    2014-05-01

    Endodontic management of immature anterior teeth with necrotic pulps is a great challenge. Although there are different treatment procedures to deal with this problem such as apexification by using calcium hydroxide dressings or applying a barrier of mineral trioxide aggregate and gutta-percha obturation, the outcomes are still unsatisfactory and the root might still be weak. Recently, a new treatment protocol by revascularization of immature non-vital, infected teeth was introduced to regenerate dental structure and complete the root maturation. However, larger case series with longer follow-up periods are required to accept revascularization as the standard protocol for management of immature non-vital, infected teeth. In this review, we discuss the concept of root canal revascularization, revascularization mechanisms, and the structure of the regenerated tissues.

  16. Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

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    Richard Kones

    2010-08-01

    Full Text Available Richard KonesThe Cardiometabolic Research Institute, Houston, Texas, USAAbstract: The objectives in treating angina are relief of pain and prevention of disease ­progression through risk reduction. Mechanisms, indications, clinical forms, doses, and side effects of the traditional antianginal agents – nitrates, ß-blockers, and calcium channel ­blockers – are reviewed. A number of patients have contraindications or remain unrelieved from anginal discomfort with these drugs. Among newer alternatives, ranolazine, recently approved in the United States, indirectly prevents the intracellular calcium overload involved in cardiac ischemia and is a welcome addition to available treatments. None, however, are disease-modifying agents. Two options for refractory angina, enhanced external counterpulsation and spinal cord stimulation (SCS, are presented in detail. They are both well-studied and are effective means of treating at least some patients with this perplexing form of angina. Traditional modifiable risk factors for coronary artery disease (CAD – smoking, hypertension, dyslipidemia, ­diabetes, and obesity – account for most of the population-attributable risk. Individual therapy of high-risk patients differs from population-wide efforts to prevent risk factors from appearing or reducing their severity, in order to lower the national burden of disease. Current American College of Cardiology/American Heart Association guidelines to lower risk in patients with chronic angina are reviewed. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE trial showed that in patients with stable angina, optimal medical therapy alone and percutaneous coronary intervention (PCI with medical therapy were equal in preventing myocardial infarction and death. The integration of COURAGE results into current practice is discussed. For patients who are unstable, with very high risk, with left main coronary artery lesions, in

  17. Availability and efficacy of revascularization in outpatients with neuroischemic diabetic foot

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    O V Udovichenko

    2011-06-01

    Full Text Available Aim: to analyze treatment results in patients with neuroischemic diabetic foot referred to vascular clinics for revascularization.Methods: Follow-up data of 88 consecutive outpatients with neuroischemic diabetic foot ulcers or postsurgery wounds were analyzed. Initially the patients received treatment in one outpatient diabetic foot clinic form 1st March to 30th June 2010. As conservative ulcer / wound treatment during 3–4 weeks was not effective, all they were referred to vascular surgeon / endovascular specialist consultation in several Moscow hospitals. Data were collected on follow-up visits to the foot clinic or by phone. Median follow-up time was 16 months (3 mo – 2.5 yrs.Results: Of 88 referred, revascularization procedures were performed in 38 patients (21 – endovascular, 17 – bypass surgery. 18 patients were considered as inoperable and 24 refused of vascular specialist consultation or treatment. Ulcer treatment results were satisfactory (primary healing or healing after minor amputation in59% of revascularized patients, in 33% of inoperable ones and in 32% of those who refused of revascularization. Patients’ refusal rate of vascular intervention was higher in a period of time when treatment appeared to be less successful due to several reasons. Later treatment results were improved and refusal rate decreased. Conclusions: (1 nowadays revascularization is relatively available for diabetic foot patients in Moscow; (2 more than 2/3 of non-revascularized patients have unsuccessful results of ulcer treatment, vascular intervention improves results significantly; (3 revascularization does not increase mortality in elderly patients with neuroischemic diabetic foot; (4 following is necessary for improvement of revascularization efficacy: active combination of bypass surgery and endovascular interventions, considering of pulsatile blood flow in all vascular bed segments as an aim of intervention and close interdisciplinary

  18. Quality of life and functional status after revascularization or conservative treatment in patients with intermittent claudication

    DEFF Research Database (Denmark)

    Hedeager Momsen, Anne-Mette; Bach Jensen, Martin; Norager, Charlotte Buchard

    2011-01-01

    Revascularization of patients with intermittent claudication (IC) is recommended only for selected patients who have chronic pain or disabling disease. However, improvement in the quality of life (QoL) could justify more widespread use.......Revascularization of patients with intermittent claudication (IC) is recommended only for selected patients who have chronic pain or disabling disease. However, improvement in the quality of life (QoL) could justify more widespread use....

  19. Periodontitis and myocardial hypertrophy.

    Science.gov (United States)

    Suzuki, Jun-Ichi; Sato, Hiroki; Kaneko, Makoto; Yoshida, Asuka; Aoyama, Norio; Akimoto, Shouta; Wakayama, Kouji; Kumagai, Hidetoshi; Ikeda, Yuichi; Akazawa, Hiroshi; Izumi, Yuichi; Isobe, Mitsuaki; Komuro, Issei

    2017-04-01

    There is a deep relationship between cardiovascular disease and periodontitis. It has been reported that myocardial hypertrophy may be affected by periodontitis in clinical settings. Although these clinical observations had some study limitations, they strongly suggest a direct association between severity of periodontitis and left ventricular hypertrophy. However, the detailed mechanisms between myocardial hypertrophy and periodontitis have not yet been elucidated. Recently, we demonstrated that periodontal bacteria infection is closely related to myocardial hypertrophy. In murine transverse aortic constriction models, a periodontal pathogen, Aggregatibacter actinomycetemcomitans markedly enhanced cardiac hypertrophy with matrix metalloproteinase-2 activation, while another pathogen Porphyromonas gingivalis (P.g.) did not accelerate these pathological changes. In the isoproterenol-induced myocardial hypertrophy model, P.g. induced myocardial hypertrophy through Toll-like receptor-2 signaling. From our results and other reports, regulation of chronic inflammation induced by periodontitis may have a key role in the treatment of myocardial hypertrophy. In this article, we review the pathophysiological mechanism between myocardial hypertrophy and periodontitis.

  20. Serial Holter ST-segment monitoring after first acute myocardial infarction. Prevalence, variability, and long-term prognostic importance of transient myocardial ischemia

    DEFF Research Database (Denmark)

    Mickley, H; Nielsen, J R; Berning, J

    1998-01-01

    Based on serial Holter monitoring performed 7 times within 3 years after a first acute myocardial infarction, we assessed the prevalence, variability and long-term clinical importance of transient myocardial ischemia (TMI) defined as episodes of ambulatory ST-segment depression. In all, 121...... consecutive male patients Holter recordings varied around 20% ranging between 18 and 27%. Fifty-five of the patients (46%) had TMI on at least 1 of the 7 Holter recordings. Considerable variability was found within and between patients...... for the presence of TMI. No high-risk group for cardiac death, nonfatal reinfarction or coronary revascularization during up to 10 years of follow-up could be identified by the detection of TMI. From these results we conclude that a routine search for TMI on serial Holter monitoring cannot be recommended in male...

  1. Management of myocardial damage in muscular dystrophy

    International Nuclear Information System (INIS)

    Tamura, Takuhisa

    2011-01-01

    Heart failure (HF) is a fatal complication in many muscular dystrophy cases and has become the most common cause of death in Duchenne muscular dystrophy (DMD) since 2001. HF deaths in DMD occur in young patients and increase, along with respiratory failure, in older patients. Managing HF, therefore, is the most important component of DMD treatment. Management of HF is necessary in DMD patients of all ages because myocardial damage progresses regardless of age and disability. Electrocardiography, echocardiography, myocardial single-photon emission computed tomography (SPECT), and natriuretic peptides are used for the diagnosis of myocardial damage and chronic HF. Tissue Doppler echocardiography is in particularly useful for early detection of minute myocardial damage and dysfunction in DMD. The first-line drugs for chronic HF are angiotensin-converting enzyme inhibitors, and the prognosis of DMD patients has been improved using these drugs and beta-blockers. Diuretics are added in the presence of pulmonary congestion. Digoxin is most effective at a blood level of 0.5-0.8 ng/mL because of its pharmacokinetics in DMD. Surgical treatment may be necessary in cases of intractable HF. Cardiac resynchronization therapy (biventricular pacing), a treatment with an artificial pacemaker, is indicated for cases that meet specific criteria, including HF with ventricular dyssynchrony. Applications of partial left ventriculectomy (Batista procedure) and left ventricular assist devices in muscular dystrophy are likely in the near future. (author)

  2. Histologic observation of a human immature permanent tooth with irreversible pulpitis after revascularization/regeneration procedure.

    Science.gov (United States)

    Shimizu, Emi; Jong, George; Partridge, Nicola; Rosenberg, Paul A; Lin, Louis M

    2012-09-01

    Histological studies of immature human permanent necrotic teeth with or without apical periodontitis after revascularization have not been reported. This case report describes the histological findings of tissue formed in the canal space of an immature permanent tooth #9 with irreversible pulpitis without apical periodontitis after revascularization. An immature human permanent tooth #9 was fractured 3.5 weeks after revascularization and could not be retained. The tooth was extracted and prepared for routine histological and immunohistochemical evaluation in order to examine the nature of tissue formed in the root canal following the revascularization procedure. At 3.5 weeks after revascularization, more than one half of the canal was filled with loose connective tissue similar to the pulp tissue. A layer of flattened odontoblast-like cells lined along the predentin. Layers of epithelial-like cells, similar to the Hertwig's epithelial root sheath, surrounded the root apex. No hard tissue was formed in the canal. Based on the histological findings in the present case, regeneration of pulp-like tissue is possible after revascularization. In this case, both the apical papilla and the Hertwig's epithelial root sheath survived in an immature permanent tooth despite irreversible pulpitis but without apical periodontitis. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  3. Time to Wound Healing and Major Adverse Limb Events in Patients with Critical Limb Ischemia Treated with Endovascular Revascularization.

    Science.gov (United States)

    Reed, Grant W; Salehi, Negar; Giglou, Pejman R; Kafa, Rami; Malik, Umair; Maier, Michael; Shishehbor, Mehdi H

    2016-10-01

    There are few studies that quantify the impact of time to wound healing on outcomes after endovascular revascularization of critical limb ischemia (CLI). In this retrospective study, 179 patients with CLI and tissue loss were assessed for adverse events after endovascular therapy. Associations between time to wound healing and outcomes were determined via Cox proportional hazards analysis. The long-term probability of events was assessed with Kaplan-Meier analysis. The primary end point was major adverse limb events (MALE-major amputation, surgical endarterectomy, or bypass). Secondary end points were major amputation, need for repeat endovascular therapy, and mortality. After multivariable adjustment for time-dependent wound healing, age, renal function, diabetes, and Rutherford class, independent predictors of MALE included the presence of an unhealed wound (hazard ratio [HR], 5.2; 95% confidence interval (CI), 2.3-11.8; P wounds compared with healed wounds (log-rank P wounds healed within 4 months had a lower probability of MALE than patients who did not heal by 4 months (log-rank, P = 0.04). Unhealed wounds were also independently associated with major amputation (HR, 9.0; 95% CI, 2.6-31.1; P = 0.0004), and patients whose wounds healed by 3 months had less major amputation (log-rank, P = 0.04). Unhealed wounds were independently associated with increased risk of mortality (HR, 42.7; 95% CI, 5.7-319.0; P = 0.002) but not repeat revascularization. Unhealed wounds are an independent risk factor for MALE, major amputation, and mortality after endovascular treatment of CLI. Wound healing within 3 months is associated with less risk of major amputation, and within 4 months less risk of MALE. A focus should be on achieving wound healing as fast as possible in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Positron emission tomography for the assessment of myocardial viability

    International Nuclear Information System (INIS)

    Schelbert, H.R.

    1991-01-01

    The detection of viable myocardium or ischemically injured myocardium with a reversible impairment of contractile function remains clinically important but challenging. Detection of reversible dysfunction and distinction from irreversible tissue injury by positron emission tomography is based on identification of preserved or even enhanced glucose metabolism with F-18 2-fluoro 2-deoxyglucose. Regional patterns of myocardial glucose utilization and blood flow, defined as perfusion-metabolism mismatches or matches, on positron emission tomography in patients with chronic or even acute ischemic heart disease are highly accurate in predicting the functional outcome after interventional revascularization. Compared with thallium-201 redistribution scintigraphy, positron emission tomography appears to be diagnostically more accurate, especially in patients with severely impaired left ventricular function. While larger clinical trials are needed for further confirmation, positron emission tomography has already proved clinically useful for stratifying patients with poor left ventricular function to the most appropriate therapeutic approach

  5. Análise da celularidade do lavado bronco-alveolar em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea: relato de três casos Análisis de la celularidad del lavado bronco-alveolar en pacientes sometidos a revascularización del miocardio con circulación extracorpórea: relato de tres casos Broncho-alveolar lavage cellularity in patients submitted to myocardial revascularization with cardiopulmonary bypass: three case reports

    Directory of Open Access Journals (Sweden)

    Luciano Brandão Machado

    2006-06-01

    response (SIRS during cardiac procedures. It has been shown in an experimental model that CPB may increase cytokine production. This study aimed at evaluating post-CPB lung cell activation by investigating broncho-alveolar lavage (BAL cellularity in patients submitted to myocardial revascularization (MR with CPB. CASE REPORTS: Participated in this prospective study 3 adult patients submitted to MR with CPB. After general anesthesia induction and tracheal intubation, mechanical ventilation was installed with valve circle system; except during CPB, tidal volume was maintained between 8 and 10 mL.kg-1 with 50% O2 and air. Before aortic unclamping, 40 cmH2O pulmonary inflations were performed. Two BAL samples were collected from all patients at beginning and end of procedure, after anticoagulation reversion. BAL was aspired after 60 mL infusion of 0.9% saline through the bronchofibroscope tube. Material was then referred to laboratorial processing. Analysis has evidenced mean increase in total number of cells from 0.6 × 10(6cel.dL-1 to 6.8 × 10(6 cel.dL-1 with increased neutrophils from 0.8% to 4.7%; 0.6% to 6.2% and 0.5% to 5.3% for each patient, respectively. There has been increased pulmonary fluid cellularity after CPB. CONCLUSIONS: Leukocyte inflow is described in different clinical pulmonary inflammatory conditions, such as adult respiratory distress syndrome. It is known that CPB is related to systemic and pulmonary inflammation with increased number of cells after CPB and predominance of macrophages.

  6. Impacto hemodinâmico de manobra de recrutamento alveolar em pacientes evoluindo com choque cardiogênico no pós-operatório imediato de revascularização do miocárdio Impacto hemodinámico de maniobra de reclutamiento alveolar en pacientes evolucionando con choque cardiogénico en el postoperatorio inmediato de revascularización del miocardio Hemodynamic impact of alveolar recruitment maneuver in patients evolving with cardiogenic shock in the immediate postoperative period of myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Luiz Marcelo Sá Malbouisson

    2008-04-01

    RM. Los ajustes de ventilación fueron volumen corriente de 8 mL.kg-1, PEEP 5 cmH2O, FR de 12 ipm y FiO2 de 0,6. Presión continua de 40 cmH2O se aplicó en las vías aéreas por 40 segundos en tres ciclos. Entre los ciclos, los pacientes fueron ventilados por 30 segundos y después del último ciclo, la PEEP fue ajustada en 10 cmH2O. Fueron obtenidas medidas hemodinámicas después de 1, 10, 30 y 60 minutos de la MRA y recogidas muestras de sangre arteriales y venosas para la medida de lactato y de los gases sanguíneos 10 y 60 minutos después. Datos analizados a través de ANOVA y test de Friedman. Valor de p fijado en 0,05. RESULTADOS: La MRA aumentó la relación PaO2/FiO2 de 87 para 129,5 después de 10 minutos y 120 después de 60 minutos (p BACKGROUND AND OBJECTIVES: Alveolar recruitment maneuver (ARM with pressures of 40 cmH2 O in the airways is effective in the reversal of atelectasis after myocardial revascularization (MR; however, there is a lack of studies evaluating the hemodynamic impact of this maneuver in patients who evolve with cardiogenic shock after MR. The objective of this study was to test the hemodynamic tolerance to ARM in patients who develop cardiogenic shock after MR. METHODS: Ten hypoxemic patients in cardiogenic shock after MR were evaluated after admission to the ICU and hemodynamic stabilization. Ventilatory adjustments included tidal volume of 8 mL.kg-1, PEEP 5 cmH2O, RR 12, and FiO2 0.6. Continuous pressure of 40 cmH2O was applied to the airways for 40 seconds in three cycles. Between cycles, patients were ventilated for 30 seconds, and after the last cycle, PEEP was set at 10 cmH2O. Hemodynamic measurements were obtained 1, 10, 30, and 60 minutes after ARM, and arterial and venous blood samples were drawn 10 and 60 minutes after the maneuver to determine lactate levels and blood gases. ANOVA and the Friedman test were used to analyze the data. A p of 0.05 was considered significant. RESULTS: Alveolar recruitment maneuver increased

  7. Coronary Artery Bypass Graft Surgery: The Past, Present, and Future of Myocardial Revascularisation

    Directory of Open Access Journals (Sweden)

    Michael Diodato

    2014-01-01

    Full Text Available The development of the heart-lung machine ushered in the era of modern cardiac surgery. Coronary artery bypass graft surgery (CABG remains the most common operation performed by cardiac surgeons today. From its infancy in the 1950s till today, CABG has undergone many developments both technically and clinically. Improvements in intraoperative technique and perioperative care have led to CABG being offered to a more broad patient profile with less complications and adverse events. Our review outlines the rich history and promising future of myocardial revascularization.

  8. Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Jens, Sjoerd, E-mail: s.jens@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands); Conijn, Anne P., E-mail: a.p.conijn@amc.uva.nl; Frans, Franceline A., E-mail: f.a.frans@amc.uva.nl [Academic Medical Center, Departments of Radiology and Surgery (Netherlands); Nieuwenhuis, Marieke B. B., E-mail: m.b.nieuwenhuis@amc.uva.nl; Met, Rosemarie, E-mail: rosemariemet@hotmail.com [Academic Medical Center, Department of Radiology (Netherlands); Koelemay, Mark J. W., E-mail: m.j.koelemaij@amc.uva.nl; Legemate, Dink A., E-mail: d.a.legemate@amc.uva.nl [Academic Medical Center, Department of Surgery (Netherlands); Bipat, Shandra, E-mail: s.bipat@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThis study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.MethodsA prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.ResultsIn total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.ConclusionsOverall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes.

  9. Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms.

    Science.gov (United States)

    Esposito, Giuseppe; Fierstra, Jorn; Regli, Luca

    2016-08-01

    Partial trapping with or without bypass revascularization is a well-established strategy in the surgical management of complex aneurysms. Distal outflow occlusion is performed by occluding the efferent artery downstream of the aneurysm and represents an alternative to proximal inflow occlusion in partial trapping treatment. With this article we report a case series employing distal outflow occlusion for managing posterior-inferior cerebellar artery (PICA) and middle cerebral artery (MCA) complex aneurysms and discuss the rationale of this treatment strategy. A case series of eight patients who underwent surgery for complex PICA (n = 3) and MCA (n = 5) aneurysms by means of distal outflow occlusion and flow-replacement bypass is presented. Two out of the eight patients presented with subarachnoid hemorrhage (SAH) (1 PICA and 1 MCA aneurysm). In seven out of eight patients (87.5 %), total aneurysmal thrombosis was obtained; in one patient, postoperative neuroimaging showed a partial aneurysmal thrombosis. Aneurysm growth or delayed rupture was not observed. All the bypasses were patent at the end of the procedure and all but one at follow-up (asymptomatic occlusion). One patient had postoperative worsening, unrelated to bypass patency. All other patients improved. Three patients maintained an mRS score of 1, four patients had improved mRS scores by ≥1, and 1 patient had a worsened mRS score compared to preoperatively. We believe that partial trapping with distal outflow occlusion for treating complex intracranial aneurysms represents a useful strategy as a last resort measure. To avoid cerebral ischemia, flow-replacement bypass is key to success.

  10. Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia

    International Nuclear Information System (INIS)

    Jens, Sjoerd; Conijn, Anne P.; Frans, Franceline A.; Nieuwenhuis, Marieke B. B.; Met, Rosemarie; Koelemay, Mark J. W.; Legemate, Dink A.; Bipat, Shandra; Reekers, Jim A.

    2015-01-01

    PurposeThis study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.MethodsA prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.ResultsIn total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.ConclusionsOverall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes

  11. Biomaterials for revascularization and immunomodulation after spinal cord injury.

    Science.gov (United States)

    Haggerty, Agnes E; Maldonado-Lasuncion, Ines; Oudega, Martin

    2018-01-23

    Spinal cord injury causes immediate damage to the nervous tissue accompanied by loss of motor and sensory function. The limited self-repair competence of injured nervous tissue underscores the need for reparative interventions to recover function after spinal cord injury. The vasculature of the spinal cord plays a crucial role in spinal cord injury and repair. Ruptured and sheared blood vessels in the injury epicenter and blood vessels with a breached blood-spinal cord barrier in the surrounding tissue cause bleeding and inflammation, which contribute to the overall tissue damage. The insufficient formation of new functional vasculature in and near the injury impedes endogenous tissue repair and limits the prospect of repair approaches. Limiting the loss of blood vessels, stabilizing the blood-spinal cord barrier, and promoting the formation of new blood vessels are therapeutic targets for spinal cord repair. Inflammation is an integral part of injury-mediated vascular damage, with deleterious and reparative consequences. Inflammation and the formation of new blood vessels are intricately interwoven. Biomaterials can be effectively used for promoting and guiding blood vessel formation or modulating the inflammatory response after spinal cord injury, thereby governing the extent of damage and the success of reparative interventions. This review deals with the vasculature after spinal cord injury, the reciprocal interactions between inflammation and blood vessel formation, and the potential of biomaterials to support revascularization and immunomodulation in damaged spinal cord nervous tissue. © 2018 IOP Publishing Ltd.

  12. Apical Revascularization after Delayed Tooth Replantation: An Unusual Case

    Directory of Open Access Journals (Sweden)

    Marília Pacífico Lucisano

    2016-01-01

    Full Text Available The aim of this paper is to present the clinical and radiological outcome of the treatment involving a delayed tooth replantation after an avulsed immature permanent incisor, with a follow-up of 1 year and 6 months. An 8-year-old boy was referred after dental trauma that occurred on the previous day. The permanent maxillary right central incisor (tooth 11 had been avulsed. The tooth was hand-held during endodontic therapy and an intracanal medication application with calcium hydroxide-based paste was performed. An apical plug with mineral trioxide aggregate (MTA was introduced into the apical portion of the canal. When the avulsed tooth was replanted with digital pressure, a blood clot had formed within the socket, which moved the MTA apical plug about 2 mm inside of the root canal. These procedures developed apical revascularization, which promoted a successful endodontic outcome, evidenced by apical closure, slight increase in root length, and absence of signs of external root resorption, during a follow-up of 1 year and 6 months.

  13. Hyperperfusion on Perfusion Computed Tomography Following Revascularization for Acute Stroke

    International Nuclear Information System (INIS)

    Nguyen, T.B.; Lum, C.; Eastwood, J.D.; Stys, P.K.; Hogan, M.; Goyal, M.

    2005-01-01

    Purpose: To describe the findings of hyperperfusion on perfusion computed tomography (CT) in four patients following revascularization for acute stroke. Material and Methods: In 2002-2003, among a series of 6 patients presenting with an acute stroke and treated with intra-arterial thrombolysis, we observed the presence of hyperperfusion in 3 patients on the follow-up CT perfusion. We included an additional patient who was treated with intravenous thrombolysis and who had hyperperfusion on the follow-up CT perfusion. We retrospectively analyzed their CT perfusion maps. Cerebral blood volume (CBV) and cerebral blood flow (CBF) maps were compared between the affected territory and the normal contralateral hemisphere. Results: In the four patients, the mean CBV and CBF were 3.6±2.0 ml/100 g and 39±25 ml/100 g/min in the affected territory compared to the normal side (mean CBV 2.7±2.1 ml/100 g, mean CBF = 27±23 ml/100 g/min). There was no intracranial hemorrhage in the hyperperfused territories. At follow-up CT, some hyperperfused brain areas progressed to infarction, while others retained normal white to gray matter differentiation. Conclusion: CT perfusion can demonstrate hyperperfusion, which can be seen in an ischemic brain territory following recanalization

  14. Platelet neuropeptide Y is critical for ischemic revascularization in mice.

    Science.gov (United States)

    Tilan, Jason U; Everhart, Lindsay M; Abe, Ken; Kuo-Bonde, Lydia; Chalothorn, Dan; Kitlinska, Joanna; Burnett, Mary Susan; Epstein, Stephen E; Faber, James E; Zukowska, Zofia

    2013-06-01

    We previously reported that the sympathetic neurotransmitter neuropeptide Y (NPY) is potently angiogenic, primarily through its Y2 receptor, and that endogenous NPY is crucial for capillary angiogenesis in rodent hindlimb ischemia. Here we sought to identify the source of NPY responsible for revascularization and its mechanisms of action. At d 3, NPY(-/-) mice demonstrated delayed recovery of blood flow and limb function, consistent with impaired collateral conductance, while ischemic capillary angiogenesis was reduced (~70%) at d 14. This biphasic temporal response was confirmed by 2 peaks of NPY activation in rats: a transient early increase in neuronally derived plasma NPY and increase in platelet NPY during late-phase recovery. Compared to NPY-null platelets, collagen-activated NPY-rich platelets were more mitogenic (~2-fold vs. ~1.6-fold increase) for human microvascular endothelial cells, and Y2/Y5 receptor antagonists ablated this difference in proliferation. In NPY(+/+) mice, ischemic angiogenesis was prevented by platelet depletion and then restored by transfusion of platelets from NPY(+/+) mice, but not NPY(-/-) mice. In thrombocytopenic NPY(-/-) mice, transfusion of wild-type platelets fully restored ischemia-induced angiogenesis. These findings suggest that neuronally derived NPY accelerates the early response to femoral artery ligation by promoting collateral conductance, while platelet-derived NPY is critical for sustained capillary angiogenesis.

  15. Mechanism of neoangiogenesis development after transmyocardial laser revascularization

    Science.gov (United States)

    Popov, Gennady K.; Golovneva, Elena S.

    2000-05-01

    Pathophysiological mechanisms of transmyocardial laser revascularization (TLMR) remain insufficiently clear. Since the laser transmyocardial channels soon after their formation are closed and then substituted by the connective tissue, the laser effect is caused by neoangiogenesis in the place of injury. We have carried out TLMR in 250 Vistar rats with the help of Nd:YAG laser. In the point of lesion the development of inflammatory process with feebly marked, exudation reaction was registered. A connective tissue scar have been forming in the place of the lasers channel. The substantial growth of small vessels number is shown morphometrically in this place. The number of mast cells in have been increasing since the first hours after operation. The most part of the mast cells were degranulated, that indicates the release of bioactive substances into the extracellular space. The signs of activation of fibroblasts in the place of myocardium damage (abrupt hyperplasia of granular endoplasm reticulum on the electron microphotographs) were evident by the 5 - 6 day. At the first hours and days the platelets in the laser damaged vessels aggregated and the number of (alpha) granules decreased. It also points at the presence of bioactive substances, secreted by platelets. Zymography showed, that the activity of collagenase have been sharply increasing, with its peak on the 10 day after operation. Thus, the activation of noncontracting elements of myocardium during TMR may be the source of growth factors and proteases necessary for neoangiogenesis.

  16. How to minimize ischemic complication related to swollen temporalis muscle following indirect revascularization surgery in moyamoya disease: a technical report.

    Science.gov (United States)

    Joo, Sung Pil; Kim, Tae Sun; Moon, Hyung Sik

    2014-05-01

    There are several reports in the literature of postoperative ischemic events due to swelling of the temporalis muscle after indirect revascularization surgery. Here, we report our surgical technique for preventing ischemic events during the acute postoperative recovery period in moyamoya patients. We used various types of titanium mesh to cover the bony defect area in 8 patients (10 operations) with moyamoya disease. The mesh was cut and manipulated according to the shape of the bony defect. Surgical results were favorable, with no newly developed ischemic event or infarction in the acute recovery period. The mesh formed an outer table of skull, so there was no compressive effect on the temporalis muscle and no cosmetic defects. The titanium mesh appears to be effective and useful for prevention of ischemic insult in the treatment of moyamoya disease. The choice of this procedure depends on both the operative findings of temporalis muscle thickness and the status of ischemic vulnerability of moyamoya brain. Georg Thieme Verlag KG Stuttgart · New York.

  17. Measuring myocardial perfusion

    DEFF Research Database (Denmark)

    Qayyum, A A; Kastrup, J

    2015-01-01

    Recently, focus has changed from anatomical assessment of coronary arteries towards functional testing to evaluate the effect of stenosis on the myocardium before intervention. Besides positron-emission tomography (PET), cardiac MRI (CMR), and cardiac CT are able to measure myocardial perfusion......-known and is used in routine clinical practice. However, PET uses radioactive tracers and has a lower spatial resolution compared to CMR and CT. CMR and CT are emerging techniques in the field of myocardial perfusion imaging. CMR uses magnetic resonance to obtain images, whereas CT uses x-rays during first....... Myocardial perfusion abnormalities are the first sign of the ischaemic cascade in the development of coronary artery disease (CAD). PET is considered the non-invasive clinical reference standard for absolute quantification of myocardial perfusion. The diagnostic and prognostic value of PET is well...

  18. Direct cardiac injection of G-CSF mobilized bone-marrow stem-cells improves ventricular function in old myocardial infarction.

    Science.gov (United States)

    Archundia, Abel; Aceves, José Luis; López-Hernández, Manuel; Alvarado, Martha; Rodriguez, Emma; Díaz Quiroz, Guillermo; Páez, Araceli; Rojas, Felipe Masso; Montaño, Luis Felipe

    2005-12-05

    Autologous transplant of bone marrow stem cells (BMSC), although extremely useful after acute myocardial events, has not been evaluated in patients with old (>one-year-old) myocardial infarction. Our aim was to determine if CD34(+)-enriched peripheral-blood cells, obtained by apheresis, injected directly into the severely damaged myocardium of five patients with old myocardial infarction could restore depressed myocardial function. We found that 28 weeks after revascularization and peri-infarction injection of the enriched CD34(+) peripheral mononuclear cells, ventricular hemodynamic parameters that included left ventricular ejection fraction, left ventricular diastolic volume, ventricular systolic volume and left ventricular diastolic diameter approximated normal values and there was no restenosis; two patients have been followed for >52 weeks and their parameters are within normal values. In conclusion, intramyocardial injection of easily obtained CD34(+) enriched peripheral blood cells represent an encouraging procedure for patients with severely scarred and dysfunctional myocardium.

  19. Off-pump versus on-pump coronary revascularization: meta-analysis of mid- and long-term outcomes.

    Science.gov (United States)

    Chaudhry, Umar A R; Harling, Leanne; Rao, Christopher; Ashrafian, Hutan; Ibrahim, Michael; Kokotsakis, John; Casula, Roberto; Athanasiou, Thanos

    2014-08-01

    Early outcomes for off-pump coronary artery bypass grafting (OPCAB) have been extensively compared with on-pump coronary revascularization (ONCAB); however, the long-term effects of OPCAB continue to be debated. This study aims to compare the mid-term (>1year; ≤5 years) and long-term (>5 years) survival and major adverse cardiovascular and cerebrovascular events of OPCAB versus ONCAB. A systematic search identified 32 studies meeting our inclusion criteria. These were analyzed using random effects modeling, with subgroup evaluation according to study type. Primary outcomes were mid- and long-term survival over a follow-up period greater than 1 year. Secondary outcomes were mid- and long-term events including repeat revascularization, myocardial infarction, angina, heart failure, and cerebrovascular accidents. Off-pump coronary artery bypass grafting confers similar overall mid-term survival when compared with ONCAB (hazard ratio, 1.06; 95% confidence interval, 0.95 to 1.19; p=0.31). On-pump coronary artery bypass grafting was associated with a significant trend towards a long-term survival advantage (hazard ratio, 1.06; 95% confidence interval, 1.00 to 1.13; p=0.05); however, this was no longer present when subgroup analysis of only randomized controlled trials, registry-based studies, and propensity-matched studies was performed. There was an increase in angina recurrence among two studies after OPCAB, but no difference was seen in 11 other studies reporting data as odds ratio. No significant differences were observed in other secondary outcomes. This analysis demonstrates comparable mid-term mortality and mid- to long-term morbidity between OPCAB and ONCAB. On-pump coronary artery bypass grafting may be associated with improved long-term survival when all study types are analyzed; however, analysis of only randomized controlled trials and propensity-matched studies demonstrates comparable long-term mortality between OPCAB and ONCAB. Copyright © 2014 The

  20. Myocardial bridging: evaluation with multislice computed tomography coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, M.V.L. de; Rabelo, D.R.; Nunes, M.C.P.; Siqueira, M.H.A. [Mater Dei Hospital, Belo Horizonte, MG (Brazil)

    2012-04-15

    Myocardial bridging (MB) is defined as a segment of a major epicardial coronary artery that proceeds intramurally through the myocardium beneath the muscle bridge. Although MB is clinically silent in most cases, it has been associated with myocardial ischemia, myocardial infarction, arrhythmia, and sudden death. Conventional coronary angiography (CCA) is the gold standard for detection, but it is invasive and may not be sensitive enough to detect a thin bridge. Recently, multislice computed tomography coronary angiography (MCTCA) have made possible the clear detection of the entire running courses of coronary arteries and the MB itself. Objective: To evaluate the prevalence MB in patients suspect to coronary artery disease submitted to MCTCA and assessing the predictive value of this method in the midterm. Methods: 498 consecutive patients were examined by MCTCA for the diagnosis of coronary artery disease and followed for a mean follow-up of 17 months for the occurrence of cardiovascular events (death, hospitalization and / or revascularization myocardial). Results: The mean age of patients was 58.4 ± 12.5 years old, 74.3% male. Among the patients, 6,02% (30 patients) showed MB. The major indications were angina pectoris in 45,8% and positive stress testing in 33,3%. 62,5% showed absent atherosclerotic disease and only 1 patient showed moderade descending anterior stenosis. During the follow-up none patient showed hard events. Conclusion: Patients with MB could present with angina pectoris and positive stress testing and showed midterm excellent prognosis. MCTCA is an alternative noninvasive imaging tool that allows for easy and accurate evaluation of MB.

  1. Dynamic pathophysiology of cerebral infarction and revascularization, 3

    International Nuclear Information System (INIS)

    Kawase, Takeshi; Mizukami, Masahiro; Tazawa, Toshiaki; Araki, Goro; Nagata, Ken.

    1983-01-01

    Thirty-eight patients with occlusive cerebrovascular disease were followed with regional cerebral blood flow (rCBF) measurement, angiography and computerized tomography (CT). The rCBF study was carried out by the 133 Xe intracarotid injection method. They were allocated to two groups according to the findings on angiogramsF; 15 patients having any change of occlusive lesion (the group of norecanalization) and 23 patients showing reopening of occluded vessels (the group of recanalization). In the group of no-recanalization, a mean value of rCBF (mean rCBF) in acute stage was well correlated to the severity of ischemic stroke. Sequential change of mean rCBF was not promineFnt in the group of no-recanalization. However, rCBF change was conspiculous in the group of recanalization. In acute stage of recanalization, rCBF were markedly affected by the presence of mass sign (cerebral edema) on CT. The inhomogeneity of rCBF was characteristic in cases with recanalization. The focal hyperemia usually disappeared within one week in cases of minor stroke and lasted until 2 or 3 weeks in cases of major stroke. In chronic stage, mean rCBF decreased, and there was no significant difference of averaged rCBF between two groups. Those findings suggests that the main factor influenced on the sequential change of rCBF is reopening of occluded vessels. Regional CBF may depends both on the degree of cerebral edema and the extent of vasoparesis after revascularization. In chronic stage CBF value is not always dependent to the presence of occlusive lesion but might be reflected in the total brain function. (J.P.N.)

  2. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease

    Directory of Open Access Journals (Sweden)

    Hyung Gon Je

    2015-05-01

    Full Text Available Improvement in quality of life (QoL is a primary treatment goal for patients with peripheral arterial disease (PAD. The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ and ankle-brachial index (ABI, and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p < 0.001. PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p’s < 0.001. As expected the ABI of treated limbs showed significant improvement post-revascularization (p < 0.001. ABI after revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI < 0.15. Interestingly, poor responders reported improvement in symptoms on the PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization.

  3. The regional wall motion and the myocardial fatty acid metabolism at hibernating myocardium

    International Nuclear Information System (INIS)

    Toyama, Takuji; Hoshizaki, Hiroshi; Isobe, Naoki; Ohshima, Shigeru; Taniguchi, Koichi; Suzuki, Yasushi; Suzuki, Tadashi; Nagai, Ryozo; Endo, Keigo.

    1996-01-01

    To evaluate the regional wall motion and the myocardial fatty acid metabolism at hibernating myocardium after revascularization (PTCA or CABG), we performed dual SPECT with 201 Tl and 123 I-β-methyl-iodophenyl-pentadecanoic acid (BMIPP), and left ventriculography (LVG) in 34 patients with coronary artery disease before and 3 to 4 months after revascularization. In the SPECT, regional tracer uptake was estimated qualitatively (visual) and quantitatively (% uptake). Regional wall motion was estimated qualitatively (visual) and quantitatively (shortening fraction). At the 78 hibernating areas, the improvement of regional wall motion was more significantly (p 123 I-BMIPP (r=0.63) than 201 Tl (r=0.39), and also correlated with the improvement of the difference between 201 Tl and 123 I-BMIPP regional uptake (r=0.36). These results suggest that the improvement of wall motion at hibernating myocardium is more significantly correlated with the improvement of 123 I-BMIPP than 201 Tl uptake after revascularization. (author)

  4. Surgical Audit

    African Journals Online (AJOL)

    2010-01-06

    Jan 6, 2010 ... A good way to describe the first surgical audits is that they were 'polite, restrained discussions'. This was the situation before the development of quality assurance in the business world. As this slowly infiltrated into the medical profession the discussions changed to more cri- teria based surgical audits.

  5. Relationship between collateral circulation and myocardial viability of 18F-FDG PET/CT subtended by chronic total occluded coronary arteries.

    Science.gov (United States)

    Dong, Wei; Li, Jianan; Mi, Hongzhi; Song, Xiantao; Jiao, Jian; Li, Quan

    2018-04-01

    To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging. A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18 F-FDG uptake. There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis-dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability. In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.

  6. Trends in hospital discharges, management and in-hospital mortality from acute myocardial infarction in Switzerland between 1998 and 2008

    Science.gov (United States)

    2013-01-01

    Background Since the late nineties, no study has assessed the trends in management and in-hospital outcome of acute myocardial infarction (AMI) in Switzerland. Our objective was to fill this gap. Methods Swiss hospital discharge database for years 1998 to 2008. AMI was defined as a primary discharge diagnosis code I21 according to the ICD10 classification. Invasive treatments and overall in-hospital mortality were assessed. Results Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The percentage of hospitalizations with a stay in an Intensive Care Unit decreased from 38.0% in 1998 to 36.2% in 2008 (p for trend Switzerland, a steep rise in hospital discharges and in revascularization procedures for AMI occurred between 1998 and 2008. The increase in revascularization procedures could explain the decrease in in-hospital mortality rates. PMID:23530470

  7. Quantification of myocardial area at risk in the absence of collateral flow: the validation of angiographic scores by myocardial perfusion single-photon emission computed tomography.

    Science.gov (United States)

    Rodríguez-Palomares, José F; Alonso, Albert; Martí, Gerard; Aguadé-Bruix, Santiago; González-Alujas, M T; Romero-Farina, Guillermo; Candell-Riera, Jaume; García del Blanco, Bruno; Evangelista, Artur; García-Dorado, David

    2013-02-01

    Our study aimed to compare the area at risk (AAR) determined by single-photon emission computed tomography (SPECT) with the Bypass Angioplasty Revascularization Investigation (BARI) and modified Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) angiographic scores in the setting of patients undergoing coronary angioplasty for either unstable angina or an STEMI. Radionuclide myocardial perfusion imaging prior to reperfusion has classically been the most widely practised technique for assessing the AAR and has been successfully used to compare the efficacy of various reperfusion strategies in patients with an ST-segment elevation myocardial infarction (STEMI). The BARI and modified APPROACH scores are angiographic methods widely used to provide a rapid estimation of the AAR; however, they have not been directly validated with myocardial perfusion single-photon emission computed tomography (SPECT). Fifty-five patients with no previous myocardial infarction who underwent coronary angioplasty for single-vessel disease (unstable angina: n = 25 or an STEMI: n = 30) with no evidence of collaterals (Rentrop Collateral Score collateral flow, BARI and APPROACH scores constitute valid methods for AAR estimation in current clinical practice, with more accurate results when used for the LAD territory; both are useful not only in STEMI patients but also in patients with unstable angina.

  8. The usefulness of the nuclear cardiology in the cellular implant in patients with severe myocardial damage; La utilidad de la cardiologia nuclear en el implante celular en pacientes con dano miocardico severo

    Energy Technology Data Exchange (ETDEWEB)

    Omelas A, M.; Arguero S, R.; Garrido G, M.H.; Rodriguez C, A.; Careaga, G.; Castano G, R.; Nambo, M.J.; Pascual P, J.; Ortega R, A.; Gaxiola A, A.; Magana S, J.A.; Estrada A, H.; Equipo de Tecnicos en Medicina Nuclear [Centro Medico Nacional Siglo XXI IMSS Hospital de Cardiologia-Servicio de Medicina Nuclear Mexico DF (Mexico)

    2005-07-01

    The recent therapeutic advances as the cellular implant as well as those different protocols of image acquisition in the field of the Nuclear Cardiology its have allowed that the patient with severe myocardial damage and without some possibility of revascularization is benefited with these advances. Doubtless the Tl-201 par excellence has an important paper for standardize the more appropriate therapeutic behavior for the heart attack patient; reason by this investigation protocol was developed. The objective of the study was to identify the heart attack regions without viable tissue with SPECT in patient with important myocardial damage without some possibility of traditional revascularization; for the 'Stem cell' cellular implantation therapy. The methodology it was carried out by a study of myocardial perfusion in 10 patients with important myocardial damage previous cellular implants, with PICANUC/ SPECT methodology and using a software (Emory Tool Box) for the image processing validated by the University of Emory Atlanta GA; and using as tracer the Tl - 201 to identify the heart attack regions without presence of viable tissue with an analysis model of 17 segments standardized for the left ventricle; qualifying this way the myocardial perfusion in: 0 (normal), 1 (light), 2 (moderate), 3 (severe), 4 (absent) and x (bad technique). The conclusions were that the SPECT study with PICANUC methodology with Tl-201 is safe and effective for the precise localization for the cellular implantation via direct intra myocardial. (Author)

  9. MRI of myocardial perfusion.

    Science.gov (United States)

    Jerosch-Herold, Michael; Muehling, Olaf; Wilke, Norbert

    2006-02-01

    An overwhelming number of myocardial perfusion studies are done by nuclear isotope imaging. Magnetic resonance imaging during the first pass of an injected, contrast bolus has some significant advantages for detection of blood flow deficits, namely higher spatial resolution, absence of ionizing radiation, and speed of the test. Previous clinical studies have demonstrated that excellent sensitivity and specificity can be achieved with MR myocardial perfusion imaging for detecting coronary artery disease, and assessment of patients with acute chest pain. Furthermore, an absolute quantification of myocardial blood flow is feasible, as was demonstrated by comparison of MR perfusion imaging, to measurements with isotope labeled microspheres in experimental models. An integrated assessment of perfusion, function, and viability, is thus feasible by MRI to answer important clinical challenges such as the identification of stunned or hibernating, but viable myocardium.

  10. National priorities partnership focus on eliminating overuse: applications to cardiac revascularization.

    Science.gov (United States)

    Ballard, David J; Leonard, Bradley M

    2011-01-01

    As one of several initiatives to transform health care delivery across the United States, the National Priorities Partnership has identified "eliminating overuse while ensuring the delivery of appropriate care" as a top priority. Cardiac revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), constitute one area of focus for reduction of overuse. Despite the multiyear development of clinical guidelines to define appropriate use of cardiac revascularization, substantial variability in the application of these procedures is observed. Concurrent data collection tools to support real-time clinical decision making regarding appropriateness are needed and can be used, along with financial incentives such as pay-for-performance programs and public reporting of performance information, to support more appropriate use of cardiac revascularization. Efforts to achieve more rational use of CABG and PCI should be made carefully and with the goal that patients receive the most appropriate and effective care.

  11. Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction.

    Science.gov (United States)

    Ogunbayo, Gbolahan O; Bidwell, Katrina; Misumida, Naoki; Ha, Le Dung; Abdel-Latif, Ahmed; Elayi, Claude S; Smyth, Susan; Messerli, Adrian W

    2018-04-19

    Studies have reported sex differences in the management of patients with acute myocardial infarction (AMI) in the general population. This observational study is designed to evaluate whether sex differences exist in the contemporary management of human immunodeficiency virus (HIV) patients admitted for diagnosis of AMI. There is no difference in management of HIV patients with AMI. Using the National Inpatient Sample database, we identified patients with a primary diagnosis of AMI and a secondary diagnosis of HIV. We described baseline characteristics and outcomes using NIS documentation. Our primary areas of interest were revascularization and mortality. Among 2 977 387 patients presenting from 2010 to 2014 with a primary diagnosis of AMI, 10907 (0.4%) had HIV (mean age, 54.1 ± 9.3 years; n = 2043 [18.9%] female). Females were younger, more likely to be black, and more likely to have hypertension, diabetes, obesity, and anemia. Although neither males nor females were more likely to undergo coronary angiography in multivariate analysis, revascularization was performed less frequently in females than in males (45.4% vs 62.7%; P < 0.01), driven primarily by lower incidence of PCI. In a multivariate model, females were less likely to undergo revascularization (OR: 0.59, 95% CI: 0.45-0.78, P < 0.01), a finding driven solely by PCI (OR: 0.64, 95% CI: 0.49-0.83, P < 0.01). All-cause mortality was similar in both groups. AMI was more common in males than females with HIV. Females with HIV were more likely to be younger and black and less likely to be revascularized by PCI. © 2018 Wiley Periodicals, Inc.

  12. Determination of improved myocardial perfusion after aortocoronary bypass surgery by exercise 81Rb scintigraphy

    International Nuclear Information System (INIS)

    Lurie, A.J.; Salel, A.F.; Berman, D.S.; DeNardo, G.L.; Hurley, E.J.; Mason, D.T.

    1976-01-01

    Practical and noninvasive means are needed for evaluating efficacy of coronary bypass surgery (CBS) in improving blood flow (CBF) to ischemic myocardium in coronary patients. Revascularization was assessed in 15 patients by pre- and post-CBS rest and exercise rubidium-81 myocardial images with a scintillation camera equipped with pinhole collimator and high-energy shield. Ischemic areas were detected by decreased 81 Rb activity after exercise compared to rest. Before CBS all patients had exercise angina (EA), positive treadmill ECG (TECG), and abnormal exercise 81 Rb scans. After CBS all 15 patients had increased physical activity before angina or completion of treadmill exercise with increased heart rate-blood pressure product (HRBP) (+63 +/- 3.2 x 10(2) bpm - mm Hg) in 14 of 15 patients indicating increased CBF; four had positive TECG, and five had EA. The increased HRBP in 14 patients was associated with improved post-CBS exercise 81 Rb scans: six had normal patterns while nine were improved with less ischemic patterns. Further, lack of angina and increased exercise tolerance correlated closely with increased 81 Rb myocardial perfusion. Thus pre- and postoperative rest and exercise 81 Rb scintigraphy gives an accurate, noninvasive, objective approach for evaluation of CBF following CBS and demonstrates the usefulness of this revascularization procedure in coronary patients

  13. Outcome after revascularisation of acute myocardial infarction with cardiogenic shock on extracorporeal life support.

    Science.gov (United States)

    Overtchouk, Pavel; Pascal, Julien; Lebreton, Guillaume; Hulot, Jean-Sebastien; Luyt, Charles-Edouard; Combes, Alain; Kerneis, Mathieu; Silvain, Johanne; Barthelemy, Olvier; Leprince, Pascal; Brechot, Nicolas; Montalescot, Gilles; Collet, Jean-Philippe

    2018-02-06

    To identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with need for extracorporeal life support (ECLS). This observational single-tertiary-centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI. Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63.2%. Left main culprit vessel disease (19% of patients) (Adj. HR [95%CI]: 2.31 [1.27-4.18], p=0.006) and Sepsis-Related Organ Failure Assessment≥13 (Adj. HR 2.17 [1.25- 3.75], p=0.005) were independently associated with 30-day mortality. The use of intra-aortic balloon pump (IABP) combined with ECLS was an independent protective factor (Adj. HR 0.48 [0.28-0.80], p=0.006). Neither complete (p=0.66) nor successful (p=0.69) myocardial revascularization were associated with 30-day survival. RCS in MI patients often reveals a severe multivessel coronary artery disease with no impact of early percutaneous coronary revascularization on clinical outcome. The survival advantage of IABP when combined with ECLS further suggests that achieving an early effective haemodynamic support should be the major goal in this young patient population.

  14. Disability pension after coronary revascularization: a prospective nationwide register-based Swedish cohort study.

    Science.gov (United States)

    Zetterström, Katharina; Vaez, Marjan; Alexanderson, Kristina; Ivert, Torbjörn; Pehrsson, Kenneth; Hammar, Niklas; Voss, Margaretha

    2015-03-01

    Scientific knowledge on disability pension (DP) after revascularization by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is scarce. The aim was to study the incidence of and risk factors for being granted DP in the 5 years following a first CABG or PCI, accounting for socio-demographic and medical factors. This is a nationwide population-based study using Swedish registers including all patients 30-63 years of age (n = 34,643, 16.4% women) who had a first CABG (n = 14,107) or PCI (n = 20,536) during 1994-2003. All were alive and without reintervention 30 days after the procedure and were not on DP or old-age pension. Multivariable adjusted Cox proportional hazard ratios (HR) for DP were estimated with 95% confidence intervals (CI). In 5 years following revascularization, 32.4% had been granted DP and the hazard ratio (HR) was higher in women (HR 1.55, 95% CI 1.48-1.62), and in CABG patients compared with PCI patients (HR 1.35, 95% CI 1.30-1.40). Long-term sick leave in the year before intervention was the strongest predictor for DP following revascularization. After adjustments for socio-demographic factors and sick-leave days in the 12 months before revascularization, HR remained high in all patients with diabetes mellitus regardless of type of revascularization. DP after coronary revascularization was common, especially among women and CABG patients. Most studied medical covariates, including mental and musculoskeletal disorders, were risk factors for future DP, especially long-term sickness absence. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  15. Acute ischemic stroke treatment, part 2: TreatmentRoles of Capillary Index Score, Revascularization and Time

    Directory of Open Access Journals (Sweden)

    Firas eAL-ALI

    2015-06-01

    Full Text Available Due to recent results from clinical intra-arterial treatment for acute ischemic stroke (IAT-AIS trials such as the Interventional Management of Stroke (IMS III, IAT-AIS and the merit of revascularization have been contested. Even though intra-arterial treatment (IAT has been shown to improve revascularization rates, a corresponding increase in good outcomes has only recently been noted. Even though a significant percentage of patients achieve good revascularization in a timely manner, results do not translate into good clinical outcomes (GCOs. Based on a review of the literature, the authors suspect limited good clinical outcomes following timely and successful revascularization are due to poor patient selection that led to futile and possibly even harmful revascularization. The Capillary Index Score (CIS is a simple angiography-based scale that can potentially be used to improve patient selection to prevent revascularization being performed on patients who are unlikely to benefit from treatment. The CIS characterizes presence of capillary blush related to collateral flow as a marker of residual viable tissue, with absence of blush indicating the tissue is no longer viable due to ischemia. By only selecting patients with a favorable CIS for IAT, the rate of GCOs should consistently approach 80-90%. Current methods of patient selection are primarily dependent on time from ischemia. Time from cerebral ischemia to irreversible tissue damage seems to vary from patient to patient, however, so focusing on viable tissue based on the CIS rather than relying on an artificial time window seems to be a more appropriate approach to patient selection.

  16. For-Profit Hospital Status and Carotid Artery Stent Utilization in US Hospitals Performing Carotid Revascularization.

    Science.gov (United States)

    Chandler, Justin V; George, Benjamin P; Kelly, Adam G; Holloway, Robert G

    2017-11-01

    Carotid artery stenting may be an economically attractive procedure for hospitals and physicians. We sought to identify the association of hospital ownership (nonprofit versus for-profit) on carotid artery stenting (CAS) versus carotid endarterectomy utilization in US hospitals. Using the Nationwide Inpatient Sample admissions for cerebrovascular disease from 2008 to 2011, we identified all private, nonfederal US hospitals performing at least 20 carotid revascularization procedures annually, including carotid artery stenting ( International Classification of Diseases -Ninth Revision 00.63) or carotid endarterectomy ( International Classification of Diseases -Ninth Revision 38.12). We used a multilevel multivariable logistic regression controlling for patient demographics, comorbidities, and hospital characteristics, to assess the effect of hospital ownership on CAS use. Across 723 hospitals (600 nonprofit, 123 for-profit), 66 731 carotid revascularization admissions were identified. Approximately 1 in 5 (n=11 641; 17.4%) revascularizations received CAS. The mean CAS rate among nonprofit hospitals was 17.5 per 100 revascularizations (median, 11.5; interquartile range, 5.2-24.5), and the mean CAS rate among for-profit hospitals was 24.2 per 100 revascularizations (median, 16.0; interquartile range, 6.7-33.3; P hospital characteristics, for-profit hospital designation was associated with greater odds of CAS (adjusted odds ratio, 1.45; 95% confidence interval, 1.07-1.98). For-profit hospital ownership is associated with a higher rate of CAS compared to nonprofit hospitals in those receiving carotid revascularization. Further research is needed to understand the individual- and system-level factors driving this difference. © 2017 American Heart Association, Inc.

  17. Adverse Remodeling and Reverse Remodeling After Myocardial Infarction.

    Science.gov (United States)

    Bhatt, Ankeet S; Ambrosy, Andrew P; Velazquez, Eric J

    2017-08-01

    The purpose of this review it to summarize the current literature on remodeling after myocardial infarction, inclusive of pathophysiological considerations, imaging modalities, treatment strategies, and future directions. As patients continue to live longer after myocardial infarction (MI), the prevalence of post-MI heart failure continues to rise. Changes in the left ventricle (LV) after MI involve complex interactions between cellular and extracellular components, under neurohormonal regulation. Treatments to prevent adverse LV remodeling and promote reverse remodeling in the post-MI setting include early revascularization, pharmacotherapy aimed at neurohormonal blockade, and device-based therapies that address ventricular dyssynchrony. Despite varying definitions of adverse LV remodeling examined across multiple imaging modalities, the presence of an enlarged LV cavity and/or reduced ejection fraction is consistently associated with poor clinical outcomes. Advances in our knowledge of the neurohormonal regulation of adverse cardiac remodeling have been instrumental in generating therapies aimed at arresting adverse remodeling and promoting reserve remodeling. Further investigation into other specific mechanisms of adverse LV remodeling and pathways to disrupt these mechanisms is ongoing and may provide incremental benefit to current evidence-based therapies.

  18. Arrhythmic death and ICD implantation after myocardial infarction

    Directory of Open Access Journals (Sweden)

    Federico Lombardi

    2006-05-01

    Full Text Available Arrhythmic death remains one of the most important causes of mortality after an acute myocardial infarction also in the revascularization era. As a consequence, identification of patients at risk should be performed before discharge. Unfortunately, in the clinical practice, this evaluation is mainly based on detection of a depressed left ventricular ejection. This approach, however, cannot adequately distinguish arrhythmic versus non-arrhythmic risk. This issue is of critical relevance when considering that arrhythmic death can be significantly reduced by appropriate interventions of implantable cardioverter defibrillator. Available evidence, however, indicates that in the first month after myocardial infarction, device implantation does not significantly reduce cardiac mortality: it seems that the reduction of arrhythmic death is counterbalanced by an increase in rate of death from non arrhythmic cause. It is therefore to be hoped that, in the future, arrhythmic risk evaluation will be based not only on the extent of left ventricular dysfunction but also on the analysis of other risk markers such as those reflecting autonomic dysfunction, cardiac electrical instability and presence of subclinical inflammation.

  19. Revascularization compared to medical treatment in patients with silent vs. symptomatic residual ischemia after thrombolyzed myocardial infarction

    DEFF Research Database (Denmark)

    Madsen, Jan K; Nielsen, Torsten T; Grande, Peer

    2007-01-01

    .3-7.2%, p unstable angina in symptomatic (44.5-27.6%, p ... reinfarction and hospital admissions for unstable angina in thrombolyzed post-AMI patients with silent as well as symptomatic exercise-induced ischemia....

  20. Long-term prognostic value of Tc-99m tetrofosmin myocardial gated-SPECT imaging in asymptomatic patients after percutaneous coronary intervention.

    Science.gov (United States)

    Georgoulias, Panagiotis; Demakopoulos, Nikolaos; Tzavara, Chara; Giannakou, Stavroula; Valotassiou, Varvara; Tsougos, Ioannis; Xaplanteris, Petros; Fezoulidis, Ioannis

    2008-11-01

    To evaluate the long-term prognostic value of Tc-99m tetrofosmin myocardial gated-SPECT in asymptomatic patients after coronary artery stenting. We included 246 consecutive patients in the study. All patients underwent exercise gated-single photon emission computed tomography (SPECT) myocardial imaging 5 to 7 months after percutaneous coronary intervention (PCI) and were followed for a mean period of 8.3 years (SD = 2.9). Myocardial scintigrams were evaluated calculating the summed stress score (SSS), summed rest score, and summed difference score (SDS) indexes. Cardiovascular death and nonfatal myocardial infarction were considered hard cardiac events, whereas late revascularization (>3 months after myocardial SPECT) procedures were considered to be soft events. Cox proportional hazard models were applied to evaluate the association between several variables and the investigated outcome. During the follow-up period, hard cardiac events occurred in 32 (13%) patients (cardiac death occurred in 12 patients and nonfatal myocardial infarction in 20 patients). In addition, 60 (24.4%) patients underwent a late revascularization procedure. When multiple Cox regression analysis was implied, the factors that remained significant in the final model for soft events were SSS, SDS, and angina during exercise testing. In addition, SSS, SDS, and left ventricular dilatation were independently associated with hard cardiac events as defined from the results of multiple analysis. However, SSS and SDS were the only independent predictors for both hard and soft events. Tc-99m tetrofosmin myocardial perfusion imaging (MPI), performed 6 months post-percutaneous coronary intervention, has an independent and powerful clinical value to predict hard and soft cardiac events in asymptomatic patients after PCI.

  1. Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery.

    Science.gov (United States)

    Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric

    2018-02-01

    Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

  2. Revascularization by angioplasty of type D femoropopliteal and long infrapopliteal lesion in diabetic patients with critical limb ischemia: are TASC II recommendations suitable? A population-based cohort study.

    Science.gov (United States)

    Faglia, Ezio; Clerici, Giacomo; Airoldi, Flavio; Tavano, Davide; Caminiti, Maurizio; Curci, Vincenzo; Mantero, Manuela; Morabito, Alberto; Edmonds, Mike

    2012-12-01

    Feasibility of revascularization of type D femoropopliteal and long infrapopliteal lesions by angioplasty (peripheral translumenal angioplasty [PTA]) in diabetic patients with critical limb ischemia (CLI) according to the TransAtlantic Inter-Society Consensus (TASC) II recommendations was studied. A total of 292 diabetic patients were admitted for CLI; 308 limbs underwent a PTA. Out of 211 femoropopliteal lesions treated with PTA, 44 were TASC II type A, 45 type B, 48 type C, and 76 type D lesions. In 44 of the 76 patients with type D lesions revascularized by PTA, no artery was patent down to the foot before the PTA. In 172 limbs with all infrapopliteal arteries occluded, revascularization was carried out down to the foot in 167 limbs. Follow-up was 3.1 ± 0.3 years. A first episode of restenosis occurred in 66/308 limbs with an incidence/year of 7.9. PTA procedures were successfully repeated in 57/66 restenosis episodes: secondary patency was 97.1%. The incidence/year of type D femoropopliteal lesions was 5.4, the incidence/year in others was 5.0, without statistically significant differences: P = .417. The only variable found significantly associated with restenosis occurrence on logistic analysis was the presence of lesions in both femoropopliteal and infrapopliteal axes. A total of 26/308 above-the-ankle amputations were performed, with an incidence/year of 2.5. Multivariate analysis showed the independent role of only crural artery occlusion after PTA. These data show that the choice to refer to angioplasty diabetic patients with type D and/or long infrapopliteal lesions without good run-off at the foot and/or high surgical risk allowed high revascularization feasibility, with an optimal amputation outcome.

  3. Revascularização transmiocárdica a laser Transmyocardial laser revascularization

    Directory of Open Access Journals (Sweden)

    Maurício Galantier

    1996-06-01

    chalenge. The Transmyocardial Laser Revascularization (TMLR provides direct perfusion of ischemic myocardium vialaser by creating transmural channels. Since April 1995 we have treated 11 patients, 9 males, mean age 68 years, with TMLR. Preoperatively 9 were in angina class IV, despite adequate and even maximum clinical medical treatment. The patients were screened preoperatively by SESTAMIBI perfusion scan and pharmacological echocardiogram to identify the location and extention of their reversible ischemia. Operative exposure was obtained via a left anterior thoracotomy. Employing a 850W CO2 laser an average of 30 was created. Bleeding from the channels was controlled by direct finger pressure and rarely by epicardial suture. The early mortality was 2 out of 11 patients. There was no late mortality. All patients revealed improvement in their clinical status, and the mean angina class was 1,8 postoperatively; In 4 patients SESTAMIBI scan was performed at the third postoperative month, and 1 showed improvement in the myocardium perfusion. Those early results indicate that TMLR is a single operative technique that may improve myocardial perfusion and provide angina relief for patients not amenable to standard methods of revascularization. However a larger number of patients and a longer time of follow-up will be needed to have definitive conclusions.

  4. Traumatic myocardial laceration as a result of suspected cranial migration of a sewing needle from the stomach of a dog.

    Science.gov (United States)

    Calvo, I; Weilland, L; Pratschke, K

    2011-11-01

    This report describes a myocardial transdiaphragmatic foreign body as a consequence of a suspected cranial migration of a sewing needle from the stomach of a dog. Surgical removal of myocardial transdiaphragmatic foreign bodies may be associated with significant haemorrhage that requires immediate surgical action, so direct visualisation of the retrieval of a myocardial foreign body is mandatory. A combination of caudal midline sternotomy and cranial coeliotomy approach with diaphragmatic split allowed good visualisation and management of the haemorrhage associated with the foreign body removal in this case. © 2011 The Authors. Australian Veterinary Journal © 2011 Australian Veterinary Association.

  5. Safety and efficacy of periprocedural anticoagulation with enoxaparin in patients undergoing peripheral endovascular revascularization.

    Science.gov (United States)

    Brodmann, Marianne; Dorr, A; Hafner, F; Gary, T; Froehlich, H; Kvas, E; Deutschmann, H; Pilger, E

    2014-07-01

    Periprocedural anticoagulation is primarily used in endovascular procedures to prevent acute reocclusion of the target vessel, but periprocedural anticoagulation might also have an impact on long-term outcome. Consecutive bleeding events are feared complications. Despite changes in peripheral endovascular revascularizations (EVRs), the periprocedural management has remained unchanged for years. Unfractionated heparin is still the treatment of choice during and immediately after EVR. We performed a prospective, single-center, open-label phase III study comparing 2 different regimes of enoxaparin peri-interventional to peripheral EVR stratified into low- and high-risk groups according to the acute and long-term reocclusion risk due to their vessel morphology. In both groups, 0.5 mg/kg of enoxaparin as a bolus was administered intravenously 10 to 15 minutes before the start of the procedure. In the low-risk group, 40 mg of enoxaparin were administered once daily for 7 days; whereas in the high-risk group, 1 mg/kg of enoxaparin was administered subcutaneously (sc) 2 times a day for 48 hours after the procedure and afterward 40 mg of enoxaparin was administered sc once daily for 5 days. For the analysis of the per protocol population, 44 patients remained in the low-risk group and 140 in the high-risk group. Concerning the primary safety end point, a total of 25 (13.59%) bleeding events occurred until day 30; 5 (11.36%) of them in the low-risk group and 20 (14.29%) in the high-risk group (P = .809 for low vs high risk). None of the bleeding events observed were major according to Thrombolysis In Myocardial Infarction criteria. Concerning our primary efficacy end point, none of the patients showed an acute reocclusion classified as a significant decrease in ankle-brachial index (ABI) or elevated peak systolic velocity ratio confirmed by duplex sonography until day 30. Concerning the second end point of prevention of chronic reobstruction, at day 180 ABI has decreased in

  6. Cost-identification analysis of revascularization procedures on patients with peripheral arterial occlusive disease

    NARCIS (Netherlands)

    Jansen, R.M.G.; de Vries, S.O.; Cullen, K.A.; Donaldson, M.C.; Hunink, M.G.M.

    1998-01-01

    Objective: To determine average total in-hospital costs of various revascularization procedures for peripheral arterial occlusive disease; to examine the effect of procedure-related complications and patient characteristics on these costs; and to examine whether costs have changed over time.

  7. Effect of Revascularization on Headache Associated with Moyamoya Disease in Pediatric Patients.

    Science.gov (United States)

    Bohara, Manoj; Sugata, Sei; Nishimuta, Yosuke; Karki, Prasanna; Nagayama, Tetsuya; Sakamoto, Shigeyuki; Tokimura, Hiroshi; Arita, Kazunori

    2015-09-01

    Episodic headache is common in childhood moyamoya disease (MMD). The onset, mechanism, cause of headache and the effect of revascularization surgery on headache are not yet clear. We studied 10 cases of children (7 boys and 3 girls) younger than 18 years who underwent revascularization for MMD between 2009 and 2013. We evaluated frequency of headache and cerebral blood flow changes by single photon emission computed tomography brain imaging with [I123]-labeled iofetamine (IMP-SPECT) before and after surgery. Patients' ages ranged from 0 to 15 years at onset and 2 to 17 years at the time of surgery, mean age being 6.7 and 8.0 years respectively. 9 of 10 patients presented with ischemic symptoms and 8 had headache. 5 patients underwent indirect bypass and 5 underwent combined direct and indirect bypass. Cerebral blood flow improvement was obtained in 14 of the 15 cerebral hemispheres revascularized. The mean follow-up duration was 32.9 months. All the patients had good outcomes with improvement of ischemic neurological deficits. Headache improved in 7 (87.5%) of 8 patients. Headache in pediatric moyamoya disease is associated with change in cerebral hemodynamics. Revascularization including combined direct bypass and indirect techniques may be required to reduce headache in patients with MMD.

  8. Neuropsychological Outcome One Year after Carotid Revascularization: A before-and-after Study

    Science.gov (United States)

    Casas-Hernanz, Laura; Garolera, Maite; Badenes, Dolors; Quintana, Salvador; Millán, Susana; Calzado, Noemi; de Francisco, Jorge; Royo, Josep; Aguilar, Miquel

    2017-01-01

    Purpose The aim of our study was to determine the clinical profile of patients considered cognitive ‘responders’ to surgery in order to establish clinical variables associated with a favorable cognitive performance. Materials and Methods A total of 70 patients were included in the study. A well-validated, comprehensive standardized neurocognitive battery of tests of about 2 hours was administered. Patients were examined twice, 1-week before surgery and 1-year postoperatively. The criterion to be included in the ‘responder’ group was the following: to obtain a positive difference between post-revascularization and pre-revascularization neuropsychological assessment ≥1 standard deviation in ≥2 tests. Results Twenty-seven patients (38.6%) were cognitive responders to treatment. In bivariate analysis between responders and non-responders, presence of atrophy (P=0.003), small vessels (P=0.577), symptoms (P=0.046), and age (P=0.030) were the factors statistically significant. When comparing cognitive performance before and after carotid revascularization, significant differences were observed in semantic fluency with a lower performance after 12 months (P=0.004, d=0.29), and in the Language index (Repeatable Battery for the Assessment of Neuropsychological Status) (P=0.005, d=0.34). Conclusion Patients without neurological symptoms, of a younger age and without atrophy and white matter small vessel lesions are better cognitive responders 1-year after carotid revascularization. PMID:29354625

  9. Carotid revascularization and medical management for asymptomatic carotid stenosis: Protocol of the CREST-2 clinical trials.

    Science.gov (United States)

    Howard, Virginia J; Meschia, James F; Lal, Brajesh K; Turan, Tanya N; Roubin, Gary S; Brown, Robert D; Voeks, Jenifer H; Barrett, Kevin M; Demaerschalk, Bart M; Huston, John; Lazar, Ronald M; Moore, Wesley S; Wadley, Virginia G; Chaturvedi, Seemant; Moy, Claudia S; Chimowitz, Marc; Howard, George; Brott, Thomas G

    2017-10-01

    Rationale Trials conducted decades ago demonstrated that carotid endarterectomy by skilled surgeons reduced stroke risk in asymptomatic patients. Developments in carotid stenting and improvements in medical prevention of stroke caused by atherothrombotic disease challenge understanding of the benefits of revascularization. Aim Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) will test whether carotid endarterectomy or carotid stenting plus contemporary intensive medical therapy is superior to intensive medical therapy alone in the primary prevention of stroke in patients with high-grade asymptomatic carotid stenosis. Methods and design CREST-2 is two multicenter randomized trials of revascularization plus intensive medical therapy versus intensive medical therapy alone. One trial randomizes patients to carotid endarterectomy plus intensive medical therapy versus intensive medical therapy alone; the other, to carotid stenting plus intensive medical therapy versus intensive medical therapy alone. The risk factor targets of centrally directed intensive medical therapy are LDL cholesterol medical therapy alone arm is 4.8% higher or 2.8% lower than an anticipated 3.6% rate in the revascularization arm. Discussion Management of asymptomatic carotid stenosis requires contemporary randomized trials to address whether carotid endarterectomy or carotid stenting plus intensive medical therapy is superior in preventing stroke beyond intensive medical therapy alone. Whether carotid endarterectomy or carotid stenting has favorable effects on cognition will also be tested. Trial registration United States National Institutes of Health Clinicaltrials.gov NCT02089217.

  10. Immediate Revascularization of A Traumatic Limb Vascular Injury associated with Major Pelvic Injuries

    Directory of Open Access Journals (Sweden)

    Hanifah J

    2015-11-01

    Full Text Available High velocity pelvic injury with limb vascular injury poses difficulties as immediate surgery for limb reperfusion is indicated. However immediate vascular intervention deviates from conventional principles of damage control following major injuries. We present two cases of this rare combination of injuries. In both cases, early limb revascularization is possible despite presented with multiple injuries and pelvic fracture.

  11. Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Joshi, Francis R; Biasco, Luigi; Pedersen, Frants

    2017-01-01

    . Follow-up data were available for all patients, by means of records linked to each Danish social security number. RESULTS: In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08-3.44], P = 0...

  12. Current therapy of the right ventricle myocardial infarction

    Directory of Open Access Journals (Sweden)

    Orozović Vjekoslav

    2002-01-01

    Full Text Available Background. Acute myocardial infarction of the right ventricle (AMI-RV is a separate subgroup within the scope of inferoposterior infarction of the left ventricle. It still represents the population of patients at high risk due to numerous, often hardly predictable complications and high mortality rate. Methods. In fifteen-year period (1987-2001 3 765 patients with the acute myocardial infarction (AMI of different localizations of both sexes – 2 283 males and 1 482 females of the average age 61.4 ± 4.6 years were treated in our institution. Anterior myocardial infarction was diagnosed in 2 146 (56.9% patients, inferior in 1 619 (43.1% patients, out of whom right ventricular infarction (RVI was confirmed in 384 (23.7%. Thrombolytic therapy was administered in 163 (42.4% patients with RVI, and in 53 (41.7% of these patients balloon dilatation was performed with coronary stent implantation in 24 (45.2%. Results. Favorable clinical effect of the combined thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA was achieved in 51 (96.1%, and in only 2 (3.9% of patients the expected effect wasn't achieved. Myocardial revascularization was accomplished in 6 (3.6% and 1 patient died. In 3 (3.4% patients primary balloon dilatation with the implantation of intracoronary stent was performed within 6 hours from the onset of anginal pain. In the other group of 221 (57.5% patients with RVI who did not receive thrombolytic therapy, or it had no effect, 26 (11.7% patients died, which indicated the validity and the efficacy of this treatment (p<0,01. In the whole group of patients with myocardial infarction of the right ventricle 31 (8.1% died; in the group that received thrombolytic therapy and PTCA 5 (3.1% died, while in the group treated in a conservative way 26 (11.7% died. Conclusion. Combined therapy was successful in the treatment of patients with RVI and should be administered whenever possible, since it was the best

  13. [Retrospective analysis of pulp revascularization in immature permanent teeth with diffuse pulpitis].

    Science.gov (United States)

    Peng, C F; Zhao, Y M; Yang, Y; Liu, H; Qin, M

    2017-01-09

    Objective: To evaluate the treatment effectiveness of revascularization in immature permanent teeth with diffuse pulpitis and to provide an alternative approach for the treatment of these teeth. Methods: Clinical and radiographic data were collected from 17 immature permanent teeth which were diagnosed as diffuse pulpitis and with their pulp extirpated at Emergency Department of Peking University School and Hospital of Stomatology. All these teeth were treated using pulp revascularization at Department of Pediatric Dentistry. Clinical success rate was then evaluated based on the clinical and radiographic findings. The increase of root length and dentin wall thickness of the revascularized teeth and the contralateral control teeth were measured and compared according to the preoperative and recall periapical radiographs. Results: The average follow-uptime is (25.8±9.9) months (12-46 months). Totally 13 out of the 17 teeth showed normal clinical and radiographic manifestation and achieved the increasein root length and dentin wall thickness. They met criteria for success treatment. The rest 4 out of the 17 teeth also showed root length and dentin wall thickness increaseand apical foramen closure. However, periapical inflammations were observed during 12 to 36 monthfollow-ups. These cases were recognized as failed. In all the17 teeth, the increase of root length and dentin wall thickness was not significantly different between the revascularized teeth and the contralateral control teeth ( P> 0.05). Conclusions: Pulp revascularization in young permanent teeth with diffuse pulpitis resulted in similar clinical outcomes in root development and root canal wall formation compared with the contralateral control teeth. However, reinfection might occur during long-term follow-up.

  14. Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel.

    Science.gov (United States)

    Soares, Adriana de Jesus; Lins, Fernanda Freitas; Nagata, Juliana Yuri; Gomes, Brenda Paula Figueiredo de Almeida; Zaia, Alexandre Augusto; Ferraz, Caio Cezar Randi; de Almeida, José Flávio Affonso; de Souza-Filho, Francisco José

    2013-03-01

    Pulp revascularization may be considered a promising alternative for necrotic immature teeth. Many studies have accomplished passive decontamination associated with an antibiotic paste. To date, there is no report evaluating calcium hydroxide associated with 2% chlorhexidine gel for revascularization therapy. The aim of this case report was to describe a new proposal for pulp revascularization with mechanical decontamination and intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel. The patient, a 9-year-old girl, suffered an intrusion associated with pulp exposure caused by an enamel-dentin fracture in her maxillary left central incisor. After diagnosis, treatment consisted of revascularization therapy with gentle manual instrumentation of the cervical and medium thirds of the root in addition to intracanal medication with calcium hydroxide and 2% chlorhexidine gel for 21 days. In the second session, a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate (MTA; Angelus, Londrina, Paraná, Brazil) was used for cervical sealing of the canal. Coronal sealing was performed with temporary filling material and composite resin. During the follow-up period, the root canal space showed a progressive decrease in width, mineralized tissue deposition on root canal walls, and apical closure. A cone-beam computed tomography scan taken at the 2-year follow-up confirmed these findings and did not show complete root canal calcification. This new proposal for revascularization therapy with 2% chlorhexidine gel may be used for the treatment of necrotic immature root canals. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis

    International Nuclear Information System (INIS)

    Jeromel, Miran; Milosevic, Z. V.; Kocijancic, I. J.; Lovric, D.; Svigelj, V.; Zvan, B.

    2013-01-01

    BackgroundEndovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. The mean age of the patients was 63.1 ± 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5–19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS ≤2) 30 days after stroke. Overall, significant neurological improvement (≥4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of ≥4 or death occurred in three (5 %) patients. The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

  16. Clinical outcome after primary percutaneous coronary intervention with drug-eluting and bare metal stents in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Maeng, Michael; Thayssen, Per

    2008-01-01

    BACKGROUND: The use of drug-eluting stents (DESs) versus bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is a matter of debate. Therefore, we examined the risk of target lesion revascularization (TLR), stent thrombosis......, myocardial infarction, and death after the implantation of DES or BMS in primary PCI patients in Western Denmark. METHODS AND RESULTS: A total of 3756 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI and stent implantation, recorded in the Western Denmark Heart...... RR=1.13; 95% CI=0.81 to 1.59; P=0.47). All-cause 2-year mortality was 7.8% in the DES group and 11.4% in BMS group (P7.2% in the DES group and 8.7% in the BMS group (P=0.09; adjusted RR...

  17. SURGICAL ANATOMY

    African Journals Online (AJOL)

    SURGICAL ANATOMY. Rare high origin of the radial artery: a bilateral, symmetrical ease. I. O. ()koro and B. C. J iburum. Department of Anatomy, College of Medicine, lrno State University, Owerri, Nigeria. Reprint requests to: Dr I. O. 0k0r0, Department of Anatomy, [mo State University, P. M. B. 2000. Owerri, Nigeria.

  18. SURGICAL TECHNIQUE

    African Journals Online (AJOL)

    Conclusion:Foraminotomy with or without discectomy is a simple posterior surgical approach to T B spine with good neurological outcome. It is adapted to our ... of the spine also referred to as. (HIV/AIDS) further challenge the outcome. These .... treatment; or for spinal cord or nerve root from 2 weeks depending on patient ...

  19. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease.

    Science.gov (United States)

    Je, Hyung Gon; Kim, Bo Hyun; Cho, Kyoung Im; Jang, Jae Sik; Park, Yong Hyun; Spertus, John

    2015-05-18

    Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p's PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization.

  20. Sepsis and myocardial dysfunction

    Directory of Open Access Journals (Sweden)

    Rafaela Deczka Morsch

    2006-12-01

    Full Text Available Sepsis and septic shock are prevalent in the intensive care setting,accounting for more than 40% of mortality in this scenario. Theappropriate management and recognition of sepsis-inducedmyocardial dysfunction are paramount for its proper treatmentand probably impact mortality rates. The objective of this articleis to review its definition, pathophysiologic mechanisms, possibletreatments and current research on the subject according to acritical view.Cellular signaling involved in myocardial depression is not fullyunderstood. Disturbances in calcium homeostasis,cardiodepressant circulating factors, inflammatory mediators,nitric oxide and apoptosis act as synergistic pathways that leadto severely depressed cardiac function. The diagnosis ofmyocardial dysfunction during sepsis carries a worse prognosisand increased mortality.Myocardial dysfunction plays an important role in morbidity andmortality rate of critically ill patients. Current research in thisarea will continue to evolve; we will, therefore, soon have moreinsights into potential novel therapies that can change its mortalityrates.

  1. Carotid stenosis: current strategies for choosing between medical and surgical management.

    Science.gov (United States)

    Sila, C A

    2000-11-01

    The effectiveness of carotid revascularization depends on appropriate patient selection and balancing the expected benefits with the risks of treatment. Exceeding a rate of serious complications (strokes and deaths) of 5% for asymptomatic and 9% for symptomatic patients negates any benefit for carotid endarterectomy. Endovascular techniques such as stent-supported angioplasty will likely change the management approach for some patients with carotid occlusive disease. This paper contains the author's recommendations for choosing between medical and surgical management of carotid stenosis.

  2. Physiological assessment of myocardial perfusion using nuclear cardiology would enhance coronary artery disease patient care. Which imaging modality is best for evaluation of myocardial ischemia? (SPECT-side)

    International Nuclear Information System (INIS)

    Yoshinaga, Keiichiro; Manabe, Osamu; Tamaki, Nagara

    2011-01-01

    Nuclear cardiology has played an important role in both diagnosis and risk assessments of coronary artery disease since early 1970. Among the non-invasive diagnostic tests, the great advantage of nuclear imaging is that this technique can obtain physiological information, such as myocardial perfusion, which is difficult to obtain by other techniques. When patients have inducible myocardial ischemia and sufficient viable myocardium, coronary revascularization treatment should be performed. Both stress myocardial perfusion imaging (MPI) and viability imaging provide important information. Another important aspect of stress perfusion imaging is that normal stress perfusion is associated with low risk for future cardiac events. Therefore, stress MPI plays an important role in the selection of an invasive therapeutic regime and also in avoiding unnecessary invasive procedures. As is the case for other imaging techniques, there have been many technical and instrumental developments in recent years in nuclear cardiology imaging, including new single-photon-emission computed tomography tracers, new pharmacological stress agents, a new generation of γ camera, and positron emission tomography. This review will address the advantages of nuclear cardiology in the clinical setting and recent developments in nuclear cardiology. (author)

  3. [Bonsai induced acute myocardial infarction].

    Science.gov (United States)

    Ayhan, Hüseyin; Aslan, Abdullah Nabi; Süygün, Hakan; Durmaz, Tahir

    2014-09-01

    Incidences of drug abuse and cannabis have increased in young adults, recently. Cannabis induced myocardial infarction has rarely been reported in these people. There is no any literature about a synthetic cannabinoid, being recently most popular Bonsai, to cause myocardial infarction. In this case report we presented a 33-year-old male patient who developed acute myocardial infarction after taking high doses of Bonsai.

  4. Stem cell mobilization induced by subcutaneous granulocyte-colony stimulating factor to improve cardiac regeneration after acute ST-elevation myocardial infarction: result of the double-blind, randomized, placebo-controlled stem cells in myocardial infarction (STEMMI) trial

    DEFF Research Database (Denmark)

    Ripa, Rasmus Sejersten; Jørgensen, Erik; Wang, Yongzhong

    2006-01-01

    BACKGROUND: Phase 1 clinical trials of granulocyte-colony stimulating factor (G-CSF) treatment after myocardial infarction have indicated that G-CSF treatment is safe and may improve left ventricular function. This randomized, double-blind, placebo-controlled trial aimed to assess the efficacy......: Bone marrow stem cell mobilization with subcutaneous G-CSF is safe but did not lead to further improvement in ventricular function after acute myocardial infarction compared with the recovery observed in the placebo group....... measured by both MRI (8.5 versus 8.0; P=0.9) and echocardiography (5.7 versus 3.7; P=0.7). The risk of severe clinical adverse events was not increased by G-CSF. In addition, in-stent late lumen loss and target vessel revascularization rate in the follow-up period were similar in the 2 groups. CONCLUSIONS...

  5. Long-term mortality in patients with diabetes mellitus type 2 after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Miljković Dušan

    2014-01-01

    Full Text Available Introduction. Myocardial infarction is the most common cause of death in patients with diabetes, and several studies have shown that people with diabetes have twice the risk of dying from a heart attack compared to non diabetics. Objective. The aim of this study was to determine the mortality of patients that have survived acute myocardial infarction, in population of patients with diabetes mellitus and without diabetes. Method. The study included 135 patients recovered from myocardial infarction, of whom 51 (37.8% had type 2 diabetes mellitus, and 84 (62.2% were without diabetes, mean age 55,4±9,6 years. All patients underwent a complete cardiac and hemodynamic testing, cardiac catheterization with selective coronary angiography, and in most patients the aortocoronary bypass revascularization or percutaneous coronary intervention. Start of follow-up was the date of acute myocardial infarction. The study included only patients who survived at least one month after acute myocardial infarction. All patients with diabetes and without diabetes were monitored for an average of 84 months, i.e. 7 years. Results. The average age of patients with diabetes and myocardial infarction was 57.1±8.7 years, and of patients with myocardial infarction without diabetes 54.5 ± 9.6 years (t=1.62; p>0.05. Among patients with diabetes 14 (27.5% were women and 37 (72.5% were men, and in non-diabetics 15 (17.9% were women and 69 (82.1% were men (χ2=1.66; p>0.05. In the follow-up period died 15 (29.4% patients with diabetes, and 7 (8.3% patients without diabetes. Mortality in patients with diabetes and myocardial infarction was significantly higher than the mortality of patients with myocardial infarction without diabetes (χ2=11.2; p0.05. In the group of 27 patients who were treated with insulin, died five (18.5% and in the group of 24 patients on oral therapy died 10 (41.7%. There was no significant difference in mortality in patients with diabetes treated with

  6. Relation of periprocedural bleeding complications and long-term outcome in patients undergoing percutaneous coronary revascularization (from the Evaluation of Oral Xemilofiban in Controlling Thrombotic Events [EXCITE] Trial).

    Science.gov (United States)

    Brugts, Jasper Jan; Mercado, Nestor; Hu, Stephen; Guarneri, Mimi; Price, Matthew; Schatz, Richard; Teirstein, Paul; Wijns, William; Serruys, Patrick W; O'Neill, William W; Boersma, Eric

    2009-04-01

    Several clinical trials have shown that antagonists of the glycoprotein IIb/IIIa receptor decreased the incidence of death, nonfatal myocardial infarction, and the need for urgent revascularization when administered immediately before or during the 24- to 48-hour period after percutaneous coronary intervention (PCI). However, these agents increased the risk of thrombocytopenia and periprocedural bleeding complications. Therefore, the relation between periprocedural bleeding complications during PCI and long-term outcome was assessed in 6,995 patients in the EXCITE trial. Periprocedural bleeding was classified as none, mild, moderate, and severe. Measured outcomes included the incidence of all-cause mortality or the composite end point (cardiovascular disease) of death, myocardial infarction, or stroke. Subjects were followed up for a median of 210 days (7 months). Mean patient age was 59.1 years, and 21.8% were women. Periprocedural bleeding complications occurred in 1,869 patients (26.7%), and blood transfusion was administered to 189 patients (2.7%). In multivariate analysis, periprocedural bleeding complications were significantly associated with increased risk of the composite outcome for mild (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.64 to 0.97), moderate (HR 2.38, 95% CI 1.78 to 3.20), and severe bleeding complications (HR 3.55, 95% CI 2.20 to 5.73) during follow-up. Also, the necessity of blood transfusion was an important predictor of the composite end point (HR 2.61, 95% CI 1.96 to 3.60). Patients in the United States were more likely to be administered a blood transfusion than non-US patients independently of cardiovascular risk factors. In conclusion, moderate and severe periprocedural bleeding complications increased the risk of mortality and incident cardiovascular events after PCI.

  7. The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Høfsten, Dan Eik; Kelbæk, Henning; Helqvist, Steffen

    2015-01-01

    BACKGROUND: In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, ischemic postconditioning has been shown to reduce infarct size, but the effect on clinical outcome has not been tested in a large randomized trial. In addition, deferring...... in other coronary artery branches than the infarct-related artery. Whether a strategy of complete or partial revascularization of these patients should be preferred remains uncertain. STUDY DESIGN: The DANAMI 3 trial program was designed to investigate 3 different randomized treatment strategies...... in patients with ST-segment elevation myocardial infarction: (1) ischemic postconditioning versus conventional treatment with a primary end point of death and hospitalization for heart failure; (2) deferring stent implantation in the infarct-related lesion versus conventional treatment with a primary end...

  8. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients......Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications...... surgery, skull-base surgery, and foreign body removal were the areas of interests. Results: The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign...

  9. Optimal primary surgical management of infected pseudoaneurysm in intravenous drug abusers: ligation or reconstruction?

    International Nuclear Information System (INIS)

    Jamil, M.; Usman, R.; Afzal, M.; Malik, N.I.

    2017-01-01

    Objective: To find out the optimal primary surgical treatment options for infected pseudoaneurysm in intravenous drug abusers. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Lahore, from Jan 2010 to Jun 2015. Material and Methods: A total of 31 consecutive patients with a history of intravenous drug abuse and an infected pseudoaneurysm in the groin or elbow, presenting in emergency department; were included in this study. All patients were primarily treated with ligation of the artery, excision of infected pseudoaneurysm and debridement of necrotic tissues. Only one patient underwent additional revascularization procedure. Results: All patients who underwent ligation and excision procedures did well initially. One (3.2%) patient developed severe distal ischemia after ligation of femoral artery within first 24 hours, so extra anatomic revascularization procedure was performed. Five (16.1%) patients required revascularization procedure after 16 weeks due to disabling distal ischemia. No amputation was needed and mortality rate was zero. Conclusion: Primary ligation of the artery with excision of infected pseudoaneurysm and necrotic material was found the optimal initial management for infected pseudoaneurysm in intravenous drug addicts. Ischemic complications if develop should be treated with early or late revascularization.

  10. Modified distal revascularization with interval ligation procedure for steal syndrome after arteriovenous fistula creation for hemodialysis access

    NARCIS (Netherlands)

    van der Meer, Saskia; Zeebregts, Clark; Tielliu, Ignacc; Verhoeven, Eric; van den Dungen, Jan

    2007-01-01

    Patients diagnosed with steal syndrome after hemodialysis access surgery have a few options for symptom relief while maintaining vascular access. These include fistula lengthening, banding, distal revascularization with interval ligation (DRIL), revision using distal inflow (RUDI) or proximalization

  11. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Kim, Eun Kyoung; Choi, Jin-Ho; Song, Young Bin; Hahn, Joo-Yong; Chang, Sung-A; Park, Sung-Ji; Lee, Sang-Chol; Choi, Seung-Hyuk; Choe, Yeon Hyeon; Park, Seung Woo; Gwon, Hyeon-Cheol

    2016-01-01

    Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007). In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Myocardial perfusion modeling using MRI

    DEFF Research Database (Denmark)

    Larsson, H B; Fritz-Hansen, T; Rostrup, Egill

    1996-01-01

    In the present study, it is shown that it is possible to quantify myocardial perfusion using magnetic resonance imaging in combination with gadolinium diethylenetriaminopentaacetic acid (Gd-DTPA). Previously, a simple model and method for measuring myocardial perfusion using an inversion recovery...

  13. Vital Pulp Therapy—Current Progress of Dental Pulp Regeneration and Revascularization

    Directory of Open Access Journals (Sweden)

    Weibo Zhang

    2010-01-01

    Full Text Available Pulp vitality is extremely important for the tooth viability, since it provides nutrition and acts as biosensor to detect pathogenic stimuli. In the dental clinic, most dental pulp infections are irreversible due to its anatomical position and organization. It is difficult for the body to eliminate the infection, which subsequently persists and worsens. The widely used strategy currently in the clinic is to partly or fully remove the contaminated pulp tissue, and fill and seal the void space with synthetic material. Over time, the pulpless tooth, now lacking proper blood supply and nervous system, becomes more vulnerable to injury. Recently, potential for successful pulp regeneration and revascularization therapies is increasing due to accumulated knowledge of stem cells, especially dental pulp stem cells. This paper will review current progress and feasible strategies for dental pulp regeneration and revascularization.

  14. Carbon dioxide is a cost-effective contrast medium to guide revascularization of TASC A and TASC B femoropopliteal occlusive disease.

    Science.gov (United States)

    de Almeida Mendes, Cynthia; de Arruda Martins, Alexandre; Teivelis, Marcelo Passos; Kuzniec, Sergio; Nishinari, Kenji; Krutman, Mariana; Halpern, Helio; Wolosker, Nelson

    2014-08-01

    Iodine contrast medium (ICM) is considered gold standard in endovascular revascularization procedures. However, nephrotoxicity and hypersensitivity to ICM are causes that limit its indiscriminate use. Carbon dioxide (CO2) contrast angiography has been used as an alternative in patients with formal contraindication to ICM. However, no studies to the present date have compared in a randomized and prospective way, outcomes of revascularization procedures performed with either ICM or CO2 in patients eligible for use of both contrasts. Between April 2012 and April 2013, 35 patients with peripheral arterial disease with arterial lesions classified as Trans-Atlantic Inter-Society Consensus A or B (identified on preoperative angio computed tomography scan) and adequate runoff underwent femoropopliteal revascularization by endovascular technique in a prospective, randomized, and controlled study. Patients were randomized into 2 groups: CO2 group and ICM group, according to the contrast media selected of the procedure. We evaluated the following outcomes in both groups: feasibility of the procedures, complications, surgical outcomes (ankle-brachial index [ABI]), glomerular filtration rate using the Cockcroft-Gault formula, relationship between the volume of injected iodine and postoperative creatinine clearance, quality of the angiographic images obtained with CO2, costs of the endovascular materials, and finally, cost of contrast agents. We were able to perform the proposed procedures in all patients treated in this series (ICM group and CO2). There were no CO2-related complications. No procedures required conversion to open surgery. Clinical results were satisfactory, with regression of ischemia and increased levels of ABI in both groups. Variations in creatinine clearance levels showed a numerical increase in the CO2 group and a decrease in ICM group, however, with no statistically significant difference between the delta clearance in each group. All CO2 arteriograms of

  15. Bone scintigraphy in evaluating the viability of composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and free non-revascularized periosteal grafts

    International Nuclear Information System (INIS)

    Berggren, A.; Weiland, A.J.; Ostrup, L.T.

    1982-01-01

    Researchers studied the value of bone scintigraphy in the assessment of anastomotic patency and bone-cell viability in free bone grafts revascularized by microvascular anastomoses in twenty-seven dogs. The dogs were divided into three different groups, and scintigraphy was carried out using technetium-labeled methylene diphosphonate in composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and periosteal grafts placed in different recipient beds. The viability of the grafts were evaluated by histological examination and fluorescence microscopy after triple labeling with oxytetracycline on the first postoperative day, alizarin complexone on the fourth postoperative day, and DCAF on the eleventh postoperative day. A positive scintiscan within the first week following surgery indicated patent microvascular anastomoses, and histological study and fluorescence microscopy confirmed that bone throughout the graft was viable. A positive scintiscan one week after surgery or later does not necessarily indicate microvascular patency or bone-cell survival, because new bone formed by creeping substitution on the surface of a dead bone graft can result in this finding

  16. Histologic Findings of a Human Immature Revascularized/Regenerated Tooth with Symptomatic Irreversible Pulpitis.

    Science.gov (United States)

    Peng, Chufang; Zhao, Yuming; Wang, Wenjun; Yang, Yuan; Qin, Man; Ge, Lihong

    2017-06-01

    Pulp revascularization/regeneration in immature permanent teeth with necrotic pulp and/or apical periodontitis is an effective approach for inducing root maturation. Previous histologic studies showed cementoid/osteoid tissue and/or periodontal ligament-like tissue formed within the root canals. This case report describes the histologic findings of a human symptomatic irreversible pulpitis immature permanent tooth with most of the pulp removed after a revascularization/regeneration procedure. A human immature permanent mandibular premolar (tooth #29) was diagnosed as symptomatic irreversible pulpitis with symptomatic apical periodontitis at the emergency department. Most of the pulp was removed. The tooth was treated with revascularization/regeneration. At the 12-month recall, the radiographic examination revealed thickening of the root canal wall, narrowing of the root apex, and lengthening of the root. The tooth was extracted at 12 months for orthodontic treatment. The specimens were processed for histologic examination. Histologically, the apical third of the root canal was filled with newly formed dentinlike and pulplike tissue. There was a layer of flattened odontoblastlike cells lining the dentinal wall. In the midportion of the root canal, the newly formed dentinlike tissue gradually changed to cementumlike tissue. In the upper third of the root canal, there was a presence of cementocytelike cells housed in the lacunae of cementumlike tissue around the loose connective tissue. In the present case, regeneration of the pulplike tissue and the periodontium existed after a revascularization/regeneration procedure in an immature permanent tooth clinically diagnosed as symptomatic irreversible pulpitis. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  17. Effectiveness of revascularization surgery evaluated by proton magnetic resonance spectroscopy and single photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Uno, Masaaki; Ueda, Shin; Hondo, Hideki; Matsumoto, Keizo; Harada, Masafumi [Tokushima Univ. (Japan). School of Medicine

    1996-08-01

    Proton magnetic resonance spectroscopy (MRS) and single photon emission computed tomography (SPECT) were used to evaluate chronic ischemic regions in 26 stroke patients before and 1, 3, and 6 months after revascularization surgery. The volume of interest for proton MRS was placed in an area including part of the frontal and temporal opercula, insular cortex, and basal ganglia. Twenty healthy volunteers served as controls for proton MRS. Patients were divided into three groups according to the preoperative proton MRS. Group A (n=12) had significantly lower N-acetylaspartate/choline (NAA/Cho) and N-acetylaspartate/creatine (NAA/Cr) ratios on the operative side compared to those on the contralateral side, and also lower than those in normal subjects. In seven patients in Group A, postoperative serial proton MRS demonstrated no recovery of these ratios on the operative side. However, proton MRS of the other five patients indicated gradual improvement in these ratios on the operative side at 3 to 6 months after surgery, and SPECT indicated an increase in cerebral blood flow on the operative side in four of these five patients. In Group B (n=9), proton MRS and SPECT showed no laterality before revascularization and no remarkable change during the postoperative course. In Group C (n=5), NAA/Cho or NAA/Cr decreased on the contralateral side preoperatively. Two patients showed fluctuating values of NAA/Cho or NAA/Cr during the postoperative period. Serial proton MRS and SPECT Studies may be useful for the evaluation of revascularization surgery on ischemic regions. The efficacy of revascularization surgery on the metabolism may appear gradually within 3-6 months. (author)

  18. The influence of polymorbidity, revascularization, and wound therapy on the healing of arterial ulceration

    Directory of Open Access Journals (Sweden)

    Joerg Tautenhahn

    2008-06-01

    Full Text Available Joerg Tautenhahn1, Ralf Lobmann2, Brigitte Koenig3, Zuhir Halloul1, Hans Lippert1, Thomas Buerger11Department of General, Visceral and Vascular Surgery; 2Department of Endocrinology and Metabolism; 3Institute for Medical Microbiology, Medical School, Otto-von-Guericke University, Magdeburg, GermanyObjective: An ulcer categorized as Fontaine’s stage IV represents a chronic wound, risk factor of arteriosclerosis, and co-morbidities which disturb wound healing. Our objective was to analyze wound healing and to assess potential factors affecting the healing process.Methods: 199 patients were included in this 5-year study. The significance levels were determined by chi-squared and log-rank tests. The calculation of patency rate followed the Kaplan-Meier method.Results: Mean age and co-morbidities did not differ from those in current epidemiological studies. Of the patients with ulcer latency of more than 13 weeks (up to one year, 40% required vascular surgery. Vascular surgery was not possible for 53 patients and they were treated conservatively. The amputation rate in the conservatively treated group was 37%, whereas in the revascularizated group it was only 16%. Ulcers in patients with revascularization healed in 92% of cases after 24 weeks. In contrast, we found a healing rate of only 40% in the conservatively treated group (p < 0.001. Revascularization appeared more often in diabetic patients (n = 110; p < 0.01 and the wound size and number of infections were elevated (p = 0.03. Among those treated conservatively, wound healing was decelerated (p = 0.01/0.02; χ² test.Conclusions: The success of revascularization, presence of diabetes mellitus, and wound treatment proved to be prognostic factors for wound healing in arterial ulcers.Keywords: arterial leg ulcer, wound management, risk factors, revascularization

  19. Serial myocardial perfusion imaging: defining a significant change and targeting management decisions.

    Science.gov (United States)

    Iskandrian, Ami E; Hage, Fadi G; Shaw, Leslee J; Mahmarian, John J; Berman, Daniel S

    2014-01-01

    Myocardial perfusion imaging (MPI) with gated single-photon emission tomography provides important information on the extent and severity of myocardial perfusion abnormalities, including myocardial ischemia. The availability of software for automated quantitative assessment of myocardial perfusion in an objective and more reproducible manner than visual assessment has allowed MPI to be particularly effective in serial evaluation. Serial testing using MPI is widely used in guiding patient care despite the lack of well-defined appropriateness use criteria. This should not be surprising because ischemic heart disease is a life-long malady subject to dynamic changes throughout its natural course and particularly following man-made interventions that may improve or worsen the disease process, such as medical therapy and coronary revascularization. Serial MPI has filled an important clinical gap by providing crucial information for managing patients with changes in clinical presentations or in anticipation of such changes in patients with stable symptoms. In the research arena, serial MPI has been widely applied in randomized controlled trials to study the impact of various medical and interventional therapies on myocardial perfusion, as well as the relative merits of new imaging procedures (hardware and/or software), radiotracers, and stressor agents. Serial testing, however, unlike initial or 1-time testing, has more stringent requirements and is subject to variability because of technical, procedural, interpretational, and biological factors. The intrinsic variability of MPI becomes important in interpreting serial tests in order to define a true change in a given patient and to guide clinical decision making. The purpose of this first comprehensive review on this subject is to illustrate where serial MPI may be useful clinically and in research studies, and to highlight strategies for addressing the various issues that are unique to serial testing in order to derive

  20. Surgical endodontics.

    Science.gov (United States)

    Carrotte, P

    2005-01-22

    Root canal treatment usually fails because infection remains within the root canal. An orthograde attempt at re-treatment should always be considered first. However, when surgery is indicated, modern microtechniques coupled with surgical magnification will lead to a better prognosis. Careful management of the hard and soft tissues is essential, specially designed ultrasonic tips should be used for root end preparation which should ideally be sealed with MTA. All cases should be followed up until healing is seen, or failure accepted, and should form a part of clinical audit.

  1. Pulp Revascularization in Immature Permanent Tooth with Apical Periodontitis Using Mineral Trioxide Aggregate

    Directory of Open Access Journals (Sweden)

    Katsura Saeki

    2014-01-01

    Full Text Available Mineral trioxide aggregate (MTA is a material that has been used worldwide in several clinical applications, such as apical barriers in teeth with immature apices, repair of root perforations, root-end filling, pulp capping, and pulpotomy. The purpose of this case report was to describe successful revascularization treatment of an immature mandibular right second premolar with apical periodontitis in a 9-year-old female patient. After preparing an access cavity without anesthesia, the tooth was isolated using a rubber dam and accessed. The canal was gently debrided using 5% sodium hypochlorite (NaOCl and 3% hydrogen peroxide irrigant. And then MTA was packed into the canal. X-ray photographic examination showed the dentin bridge 5 months after the revascularization procedure. Thickening of the canal wall and complete apical closure were confirmed 10 months after the treatment. In this case, MTA showed clinical and radiographic success at revascularization treatment in immature permanent tooth. The successful outcome of this case suggests that MTA is reliable and effective for endodontic treatment in the pediatric dentistry.

  2. Persistent smoking rate after coronary revascularization and factors related to smoking cessation in Turkey.

    Science.gov (United States)

    Keskin, Kudret; Sezai Yildiz, Süleyman; Çetinkal, Gökhan; Çetin, Sükrü; Sigirci, Serhat; Kilci, Hakan; Aksan, Gökhan; Helvaci, Füsun; Gürdal, Ahmet; Balaban Kocas, Betül; Arslan, Sükrü; Orta Kiliçkesmez, Kadriye

    2017-11-22

    Although smoking is an established risk factor for coronary artery disease, smoking cessation efforts, as part of a lifestyle change, have been disappointing so far. Therefore, assessing current smoking trends and identifying patients who are at risk of smoking continuation is of paramount importance. In this study, our aim was to assess current smoking rates after coronary revascularization as of 2017, and to define factors that potentially affect smoking cessation. Overall, 350 patients who had undergone coronary revascularization, either by percutaneous coronary intervention or bypass surgery were included in this cross-sectional, observational study. Patients were queried for various sociodemographic characteristics and smoking habits. Disease related data were obtained from the hospital archives. The overall smoking rate was 57% after coronary revascularization. Age, bypass surgery and the occurrence of in-hospital adverse events were found to be independent predictors of smoking cessation in multivariate analysis. Despite efforts, smoking rates after coronary intervention remain substantially high. Therefore, a multidisciplinary approach to smoking cessation that incorporates cardiac rehabilitation programs and medications should be implemented in clinical practice. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  3. Small Islets Transplantation Superiority to Large Ones: Implications from Islet Microcirculation and Revascularization

    Directory of Open Access Journals (Sweden)

    Wenjuan Li

    2014-01-01

    Full Text Available Pancreatic islet transplantation is a promising therapy to regain glycemic control in diabetic patients. The selection of ideal grafts is the basis to guarantee short-term effectivity and longevity of the transplanted islets. Contradictory to the traditional notion, recent findings implied the superiority of small islets for better transplantation outcomes rather than the large and intact ones. However, the mechanisms remain to be elucidated. Recent evidences emphasized the major impact of microcirculation on islet β-cell mass and function. And potentials in islet graft revascularization are crucial for their survival and preserved function in the recipient. In this study, we verified the distinct histological phenotype and functionality of small islets versus large ones both in vitro and in vivo. With efforts to exploring the differences in microcirculation and revascularization of islet grafts, we further evaluated local expressions of angiotensin and vascular endothelial growth factor A (VEGF-A at different levels. Our findings reveal that, apart from the higher density of insulin-producing β-cells, small islets express less angiotensin and more angiotrophic VEGF-A. We therefore hypothesized a logical explanation of the small islet superiority for transplantation outcome from the aspects of facilitated microcirculation and revascularization intrinsically in small islets.

  4. Localized 1H-MR spectroscopy in moyamoya disease before and after revascularization surgery

    International Nuclear Information System (INIS)

    Lim, Soo Mee; Choi, Hye Young; Suh, Jung Soo; Lee, Jung Hee; Lim, Keun Ho; Suh, Dae Chul; Lee, Ho Kyu; Lim, Tae Hwan; Ra, Young Shin

    2003-01-01

    To evaluate, using localized proton magnetic resonance spectroscopy (1H-MRS), the cerebral metabolic change apparent after revascularization surgery in patients with moyamoya disease. Sixteen children with moyamoya disease and eight age-matched normal controls underwent MR imaging, MR angiography, conventional angiography, and 99m Tc- ECD SPECT. Frontal white matter and the basal ganglia of both hemispheres were subjected to localized 1 H-MRS, and after revascularization surgery, four patients underwent follow-up 1 H-MRS. Decreased NAA/Cr ratios (1.35±0.14 in patients vs. 1.55±0.24 in controls) and Cho/Cr ratios (0.96±0.13 in patients vs. 1.10±0.11 in controls) were observed in frontal white matter. After revascularization surgery, NAA/Cr and Cho/Cr ratios in this region increased. In the basal ganglia, there is no abnormal metabolic ratios. Localized 1H-MRS revealed abnormal metabolic change in both hemispheres of children with moyamoya disease. Because of its non-invasive nature, 1 H-MRS is potentially useful for the preoperative evaluation of metabolic abnormalities and their postoperative monitoring

  5. Incomplete revascularization in multivessel percutaneous transluminal coronary angioplasty: the role for stress thallium-201 imaging

    International Nuclear Information System (INIS)

    Breisblatt, W.M.; Barnes, J.V.; Weiland, F.; Spaccavento, L.J.

    1988-01-01

    Evaluation of patients with multivessel coronary disease for percutaneous transluminal coronary angioplasty raises the question: Is incomplete revascularization an acceptable procedure in these patients, or does complete revascularization need to be performed, as in coronary artery bypass grafting? To provide an answer the present study utilized exercise thallium imaging as a guide to the performance of angioplasty in 85 patients with multivessel coronary disease. Preangioplasty exercise thallium imaging helped to identify the primary stenosis (culprit lesion) in 93% of patients. Two weeks to 1 month after dilation of this lesion, repeat thallium imaging identified two patient groups: Group 1, 47 patients with no evidence of ischemia in a second vascular distribution and Group 2, 38 patients with evidence of further angioplasty. In Group 2 47% of patients had angioplasty of a second vessel and 79% required multivessel angioplasty at 1 year follow-up. In contrast, only six Group 1 patients (13%) required angioplasty of a second vessel at 1 year. Thus, incomplete revascularization may be an acceptable approach in many patients with multivessel coronary disease. Stress thallium-201 imaging may be a useful technique in the evaluation and management of these patients

  6. [Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft].

    Science.gov (United States)

    da Gama, A Dinis; Nunes, J Silva; Cunha e Sá, Diogo; Pedro, Luís Mendes

    2003-01-01

    The thrombotic occlusion of one renal artery may become completely asymptomatic, due to the functionality of the contralateral kidney. However, in rare circumstances, such is the case of individuals with a solitary kidney, a situation of anuria and acute renal failure may constitute the main presentation of the condition. The authors report the clinical case of a 43 year old male patient, with the previous diagnosis of an infrarenal aortic occlusion and a single left kidney, who developed a thrombotic occlusion of the renal artery, with anuria and acute renal failure. The patient underwent an emergency revascularization procedure, consisting in the implantation of a prosthetic bypass graft from the superceliac aorta to the renal artery, with immediate recovery of the diuresis and renal function. Seventeen months later as a consequence of an anastomotic hyperplasia, an occlusion of the bypass graft occurred, again with anuria and acute renal failure. The patient was reoperated on and due to the inadequacy of both saphenous veins to be used as the material of choice for the revascularization procedure, a redundant segment of the left colic artery (Riolan's arcade) was removed and used as an interposition graft, from the middle colic artery to the renal artery, followed by an immediate restoration of diuresis and renal function. The singular and recurrent character of this clinical condition and the utilization of an original, eventually unique and well succeeded revascularization procedure, prompted its presentation and divulgation.

  7. [Variability in the management and prognosis at short- and medium-term of myocardial infarct in Spain: the PRIAMHO study. Registration Project of Hospital Acute Myocardial Infarct].

    Science.gov (United States)

    Cabadés, A; López-Bescós, L; Arós, F; Loma-Osorio, A; Bosch, X; Pabón, P; Marrugat, J

    1999-10-01

    The paucity of data on myocardial infarction management and results in Spain lead to the design of the PRIAMHO study (Proyecto de Registro de Infarto Agudo de Miocardio Hospitalario [Acute Myocardial Infarction Hospital Registration Project]) which developed standard methods to collect information on the management of patients with such a condition and their characteristics. The variability results among hospitals in myocardial infarction management and in one-year mortality are presented. A cohort study with a one-year follow-up was designed to register all patients diagnosed with acute myocardial infarction discharged from 24 Spanish hospitals that completed all the requisites to participate. The demographic and clinical characteristics of the patients, their management during the coronary care unit stage, and the outcome and complications were prospectively registered. Standard definitions for diagnosis were used. Confidentiality regarding patient identity and participating centers was guaranteed. 5,242 (77.6%) of the 6,756 patients with myocardial infarction admitted in the 24 participating hospitals were registered in the coronary care units. Half of the centers had an on-site hemodynamic laboratory and in seven coronary surgery. The delay between symptom-onset and emergency room admission was 2 hours. Acute pulmonary edema or cardiogenic shock was developed by 16.6% of patients and 41.8% received thrombolysis. Mean time delay between symptom-onset and thrombolysis was 3 hours. A large variability in the use of beta-blockers, thrombolysis, echocardiography, coronary catheterization angiography and invasive revascularization was observed among hospitals. Mortality in the coronary care unit was 10.9% and increased to 14.0% at 28 days and to 18.5% at one year with considerable variation among hospitals. Four hospitals showed higher mortality among their patients, independently from the proportion of diabetes, hypertension, women, anterior location of myocardial

  8. Myocardial Architecture, Mechanics, and Fibrosis in Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Sarah Ghonim

    2017-05-01

    Full Text Available Congenital heart disease (CHD is the most common category of birth defect, affecting 1% of the population and requiring cardiovascular surgery in the first months of life in many patients. Due to advances in congenital cardiovascular surgery and patient management, most children with CHD now survive into adulthood. However, residual and postoperative defects are common resulting in abnormal hemodynamics, which may interact further with scar formation related to surgical procedures. Cardiovascular magnetic resonance (CMR has become an important diagnostic imaging modality in the long-term management of CHD patients. It is the gold standard technique to assess ventricular volumes and systolic function. Besides this, advanced CMR techniques allow the acquisition of more detailed information about myocardial architecture, ventricular mechanics, and fibrosis. The left ventricle (LV and right ventricle have unique myocardial architecture that underpins their mechanics; however, this becomes disorganized under conditions of volume and pressure overload. CMR diffusion tensor imaging is able to interrogate non-invasively the principal alignments of microstructures in the left ventricular wall. Myocardial tissue tagging (displacement encoding using stimulated echoes and feature tracking are CMR techniques that can be used to examine the deformation and strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1 mapping can help in detecting fibrotic myocardial changes and evolve our understanding of the pathophysiology of CHD patients. This review not only gives an overview about available or emerging CMR techniques for assessing myocardial mechanics and fibrosis but it also describes their clinical value and how they can be used to detect abnormalities in myocardial architecture and mechanics in CHD patients.

  9. Effect of controlled hypotension on myocardial ischemia marker in eye-nose related surgery.

    Science.gov (United States)

    Jin, Yuexi; Jiang, Wanna; Ye, Wenlian; Jiang, Aifen; Liu, Le

    2016-11-01

    We aimed to investigate the effect of different controlled hypotension levels on myocardial enzymes and myocardial ischemia protein in elderly hypertension patients, and then provide clinical evidence of suitable controlled hypotension level for them. Then, 45 elderly hypertension patients received elective eye-nose related surgery with nasal endoscope, who were randomly and evenly divided into three groups, including A, B and C groups, with mean arterial pressure (MAP) decreased by 20%, 30% and 40% respectively. The change of myocardial enzymes, myocardial ischemia modified albumin, score of surgical field quality and 12-lead electrocardiogram at different perioperative points were recorded. Then operative time, urine output and postoperative adverse complications of the patients were recorded too. Myocardial enzymes of group C were higher than that of both group A and B at T4, T5 points (pControlled hypotension with MAP reduced by 30% brings minimum myocardial damage and fewer complications, while meeting the demand of surgical field. Thus it is an ideal controlled hypotension level and can be used for elderly hypertension patients safely.

  10. Measurement of extracellular volume and transit time heterogeneity using contrast-enhanced myocardial perfusion MRI in patients after acute myocardial infarction.

    Science.gov (United States)

    Kunze, Karl P; Rischpler, Christoph; Hayes, Carmel; Ibrahim, Tareq; Laugwitz, Karl-Ludwig; Haase, Axel; Schwaiger, Markus; Nekolla, Stephan G

    2017-06-01

    To assess the ability of dynamic contrast-enhanced myocardial perfusion MRI to measure extracellular volume (ECV) and to investigate the possibility of estimating capillary transit time heterogeneity (CTH) in patients after myocardial infarction and successful revascularization. Twenty-four perfusion data sets were acquired on a 3 Tesla positron emission tomography (PET)/MRI scanner. Three perfusion models of different complexity were implemented in a hierarchical fashion with an Akaike information criterion being used to determine the number of fit parameters supported by the data. Results were compared sector-wise to ECV from an equilibrium T 1 mapping method (modified look-locker inversion recovery (MOLLI)). ECV derived from the perfusion analysis correlated well with equilibrium measurements (R² = 0.76). Estimation of CTH was supported in 16% of sectors (mostly remote). Inclusion of a nonzero CTH parameter usually led to lower estimates of first-pass extraction and slightly higher estimates of blood volume and flow. Estimation of the capillary permeability-surface area product was feasible in 81% of sectors. Transit time heterogeneity has a measurable effect on the kinetic analysis of myocardial perfusion MRI data, and Gd-DTPA extravasation in the myocardium is usually not flow-limited in infarct-related pathology. Measurement of myocardial ECV using perfusion imaging could provide a scan-time efficient alternative to methods based on T 1 mapping. Magn Reson Med 77:2320-2330, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  11. Surgical treatment of chronic multivascular mesenteric ischemia in a patient with antiphospholipid syndrome, abdominal aortic aneurism, and renal cancer: when planning overwhelms complexity.

    Science.gov (United States)

    Paliogiannis, Panagiotis; Ginesu, Giorgio Carlo; Feo, Claudio Francesco; Cossu, Maria Laura; Pinna, Antonio; Farina, Giulia; Vidili, Gianpaolo; Porcu, Alberto

    2016-12-20

    Chronic mesenteric ischemia is a clinical condition caused by obstructive or occlusive disease of the mesenteric vessels, with potentially lethal consequences. We describe a case of open multiple revascularization in a patient affected by antiphospholipid syndrome and diffuse atherosclerosis, with an abdominal aortic aneurism, a contracted kidney, a renal cancer affecting the contralateral kidney, and as a consequence, a chronic renal failure and hypertension. We revascularized the celiac trunk, the superior and inferior mesenteric arteries, and the right renal artery using saphenous grafts; the aneurism was corrected, and the renal tumor was treated by radiofrequency ablation. Despite the invasiveness and complexity, the surgical strategy adopted allowed to save the patient's life, to treat the chronic mesenteric ischemia and the renal cancer, and to improve the chronic renal insufficiency and hypertension. Graft, Mesenteric ischemia, Occlusion, Revascularization.

  12. Use of angiotensin-converting enzyme inhibitors and freedom from amputation after lower extremity revascularization

    Directory of Open Access Journals (Sweden)

    Kray JE

    2017-07-01

    Full Text Available Jared E Kray,1 Viktor Y Dombrovskiy,2 Todd R Vogel1 1Department of Surgery, Division of Vascular Surgery, School of Medicine, University of Missouri, Columbia, MO, 2Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA Objective: Angiotensin-converting enzyme inhibitors (ACEIs have not been well evaluated in conjunction with lower extremity revascularization (LER. This study evaluated freedom from amputation in patients who underwent either an open (OPEN or endovascular (ENDO revascularization with and without utilization of an ACEI.Materials and methods: Patients who underwent LER were identified from 2007–2008 Medicare Provider Analysis and Review files. Demographics, comorbidities, and disease severity were obtained. Post-procedural use of an ACEI was confirmed using combining them with National Drug Codes and Part D Files. Outcomes were analyzed using chi-square analysis, Kaplan–Meier test, and Cox regression.Results: We identified 22,954 patients who underwent LER: 8,128 (35.4% patients with claudication, 3,056 (13.3% with rest pain, and 11,770 (51.3% with ulceration or gangrene. More patients underwent ENDO (14,353 than OPEN (8,601 revascularization and 38% of the cohort was taking an ACEI. Overall, ACEI utilization compared to patients not taking ACEI was not associated with lower amputation rates at 30 days (13.5% vs. 12.6%, 90 days (17.7% vs. 17.1%, or 1 year (23.9% vs. 22.8% (P>0.05 for all. After adjustment for comorbidities, ACEI utilization was associated with higher amputation rates for patients with rest pain (hazard ratio: 1.4; 95% confidence interval: 1.1–1.8. Conclusion: ACEI utilization was not associated with overall improved rates of amputation-free survival or overall survival in the vascular surgery population. However, an important finding of this study was that patients presenting with a diagnosis of rest pain and taking an ACEI who underwent a LER had statistically higher

  13. Efficacy of coronary artery reconstruction in maintaining myocardial viability. Quntitative determination of local myocardial circulation with 13NH3 myocardial positron emission tomography

    International Nuclear Information System (INIS)

    Kobayashi, Satoshi; Takaba, Toshihiro; Kume, Masato; Kashima, Toshitaka; Michihata, Tetsuro.

    1996-01-01

    Thirty patients (280 areas) whose bypass grafts remained patent after surgical reconstruction of the coronary artery were examined. Before and after reconstruction, local myocardial blood circulation in infarcted regions and post-stenotic regions was measured by 13 NH 3 myocardial positron emission computed tomography (PET) at rest or during physical exercise in order to evaluate the efficacy of coronary artery reconstruction. Before operation, mean blood flow in post-stenotic regions (n=198) was 65±15 ml/min/100 g at rest and 85±23 ml/min/100 g during exercise. After coronary artery bypass grafting (CABG), mean blood flow was increased to 78±21 ml/min/100 g at rest (p, 0.01) and 105±32 ml/min/100 g during exercise (p<0.01). In infarcted regions (n=82), mean blood flow before operation was 51±23 ml/min/100 g at rest and 69±23 ml/min/100 g during exercise. After CABG, it increased to 62±19 ml/min/100 g at rest (p<0.01) and 81±29 ml/min/100 g during exercise (p<0.01). Thus, significant increases in blood flow were observed in both post-stenotic and infarcted regions at rest and physical exercise after operation. The regions of infarction were divided into three groups based on local myocardial blood flow at rest before operation: Group I: greater than 45 ml/min/100 g (n=35); Group II: less than 45 ml/min/100 g (n=30) but greater than 30 ml/min/100 g; and Group III: less than 30 ml/min/100 g (n=30). The efficacy of reconstruction was compared among these groups. The group with preoperative myocardial blood flow greater than 30 ml/min/100 g had increased blood flow after operation, indicating myocardial viability. (author)

  14. SURGICAL NUTRITION

    Directory of Open Access Journals (Sweden)

    Danny Kurniawan Darianto

    2015-07-01

    Full Text Available A patient undergoing surgery faces great physiologic and psychologic stress. so nutritional demands are greatly increased during this period and deficiencies can easily develop. If these deficiencies are allowed to develop and are not in screening, serious malnutrition and clinical problem can occur. Therefore careful attention must be given to a patient's nutritional status in preparation of surgery, as well as to the individual nutritional needs. If these needs are met, complications are less likely developing. Natural resources provide for rapid recovery. Proper nutrition can speed healing in surgical patients with major trauma, severe malnutition, burns, and other severe illnesses. New techniques for tube feeding, intravenous nutrition for patients with serious weight loss due to gastrointestinal disorders, and use of supplements can hasten wound healing and shorten recovery times.

  15. Echocardiographic and angiographic correlations in patients with cardiogenic shock secondary to acute myocardial infarction.

    Science.gov (United States)

    Berkowitz, M Joshua; Picard, Michael H; Harkness, Shannon; Sanborn, Timothy A; Hochman, Judith S; Slater, James N

    2006-10-15

    In patients with cardiogenic shock (CS) complicating acute myocardial infarction, echocardiographic and angiographic findings are used to aid diagnosis, determine prognosis, and guide management. The purpose of this analysis from the Should we emergently revascularize Occluded Coronary arteries for Cardiogenic ShocK (SHOCK) trial is to identify relations between the angiographic and echocardiographic features of patients with CS. Such an analysis of the correlations between echocardiographic and angiographic findings in patients with CS may provide insights into the etiology and treatment of CS. In 302 randomized patients, an echocardiogram and an angiogram before revascularization were available in 127 patients. Although the median ejection fraction derived by echocardiography and left ventricular angiography was identical (30%), the positive correlation was weak (R2 = 0.209, p = 0.019). Patients with a larger number of diseased vessels had worse mitral regurgitation (MR) by echocardiography (p = 0.005). There was a significant but weak association between left ventricular angiographic MR grade and echocardiographic MR severity (R2 = 0.162, p = 0.015), but there was no association between culprit vessel and degree of MR. In conclusion, worse coronary artery disease is associated with more severe MR. Echocardiography and angiography are valuable and result in similar estimated ejection fractions in a large cohort, but there is wide variation between the techniques in patients.

  16. Stress management and exercise training in cardiac patients with myocardial ischemia. Effects on prognosis and evaluation of mechanisms.

    Science.gov (United States)

    Blumenthal, J A; Jiang, W; Babyak, M A; Krantz, D S; Frid, D J; Coleman, R E; Waugh, R; Hanson, M; Appelbaum, M; O'Connor, C; Morris, J J

    1997-10-27

    Previous studies have demonstrated that myocardial ischemia can be elicited by mental stress in the laboratory and during daily life and that ischemia induced by mental stress is associated with an increased risk for future cardiac events in patients with coronary artery disease. To examine the extent to which ischemia induced by mental stress can be modified by exercise stress management, and to evaluate the impact of these interventions on clinical outcomes. One hundred seven patients with coronary artery disease and ischemia documented during mental stress testing or ambulatory electrocardiographic monitoring were randomly assigned to a 4-month program of exercise or stress management training. Patients living at a distance from the facility formed a nonrandom, usual care comparison group. Myocardial ischemia was reassessed following treatment, and patients were contacted annually for as long as 5 years to document cardiac events, including death, nonfatal myocardial infarction, and cardiac revascularization procedures. Twenty-two patients (21%) experienced at least 1 cardiac event during a mean (+/- SD) follow-up period of 38 +/- 17 months. Stress management was associated with a relative risk of 0.26 compared with controls. The relative risk for the exercise group also was lower than that of controls, but the effect did not reach statistical significance. Stress management also was associated with reduced ischemia induced by mental stress and ambulatory ischemia. These data suggest that behavioral interventions offer additional benefit over and above usual medical care in cardiac patients with evidence of myocardial ischemia.

  17. Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

    International Nuclear Information System (INIS)

    Kuijpers, Dirkjan; Dijkman, Paul R.M. van; Janssen, Caroline H.C.; Vliegenthart, Rozemarijn; Zijlstra, Felix; Oudkerk, Matthijs

    2004-01-01

    The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) (P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event (P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy. (orig.)

  18. Myocardial Infarction as a Rare Cause of Otalgia

    Directory of Open Access Journals (Sweden)

    Riza Dundar

    2014-01-01

    Full Text Available Aim. To present a case referred to our clinic with severe right ear pain but without any abnormal finding during otological examination and diagnosed as myocardial infarction and also to draw attention to otalgia which can occur secondary to myocardial infarction. Case Report. An 87-year-old female admitted with right ear pain lasting for nearly 12 hours and sweating on the head and neck region. On otolaryngologic examination, any pathological finding was not encountered. Her electrocardiogram revealed findings consistent with myocardial infarction. Her troponin values were 0.175 ng/L at 1 hour, and 0.574 ng/L at 3 hours. The patient was diagnosed as non-ST MI, and her required initial therapies were performed. On cardiac angiography, very severe coronary artery stenosis was detected, and surgical treatment was recommended for the patient. The patient who rejected surgical treatment was discharged with prescription of medical treatment. Conclusion. Especially in elderly patients with complaints of ear pain but without any abnormal finding on otoscopic examination, cardiac pathologies should be conceived.

  19. Safety and efficacy of G-CSF in patients with ischemic heart failure: the CORNER (Cell Option For Recovery in the Non-Eligible Patients for Revascularization) study.

    Science.gov (United States)

    Leone, Antonio Maria; Giannico, Maria Benedetta; Bruno, Isabella; Giordano, Alessandro; Zaccone, Vincenzo; Perfetti, Matteo; Niccoli, Giampaolo; Porto, Italo; Burzotta, Francesco; Rebuzzi, Antonio Giuseppe; Biasucci, Luigi Marzio; Crea, Filippo

    2011-07-01

    Demonstration that the heart is not a post-mitotic organ has led to clinical trials trying to obtain myocardial repair even in patients with heart failure. To evaluate as a less invasive method for promoting cardiac repair. Thirteen patients with ischemic heart failure in NYHA and/or CCS classes ≥ 3 unsuitable for revascularization received G-CSF, as a compassionate use, in addition to optimal medical therapy. Symptoms and cardiac perfusion by gated-SPECT were assessed at baseline and at 4 month follow up. G-CSF was generally well tolerated. NYHA and CCS classes improved significantly from 3 (IR 2.5-3) to 2 (IR 1-2.5) (p = 0.012) and from 3 (IR 1-3) to 1 (IR 1-2) (p = 0.033). Heart failure severity symptoms according to the Minnesota Living with Heart Failure Questionnaire scores exhibited a non significant improvement from 52 ± 27 to 39 ± 26 (p = 0.15). At the Seattle Angina Questionnaire scores (ranging from 0 to 100, higher scores indicating better status), physical limitation improved from 39 ± 31 to 64 ± 29 (p = 0.03), angina stability from 42 ± 29 to 64 ± 28 (p = 0.05), angina frequency from 53 ± 33 to 73 ± 26 (p = 0.04), treatment satisfaction from 67 ± 29 to 83 ± 21 (p = 0.07), disease perception from 37 ± 29 to 66 ± 26 (p = 0.007). Quality of life assessed by a Visual Analogue Scale improved from 33 ± 24 to 64 ± 20 mm (p = 0.003). Stress and differential regional perfusion scores improved significantly from 1.78 ± 1.38 to 1.66 ± 1.38 (p = 0.05) and from 0.35 ± 0.68 to 0.23 ± 0.53 (p = 0.02) respectively. In patients with ischemic heart failure unsuitable for revascularization, G-CSF is associated to a significant improvement of symptoms, possibly reducing stress-induced ischemia. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  20. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI)

    DEFF Research Database (Denmark)

    Engstrøm, Thomas; Kelbæk, Henning; Helqvist, Steffen

    2015-01-01

    BACKGROUND: Patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease have a worse prognosis compared with individuals with single-vessel disease. We aimed to study the clinical outcome of patients with STEMI treated with fractional flow reserve (FFR...... electronically via a web-based system in permuted blocks of varying size by the clinician who did the primary PCI. All patients received best medical treatment. The primary endpoint was a composite of all-cause mortality, non-fatal reinfarction, and ischaemia-driven revascularization of lesions in non...

  1. A compare between myocardial topical negative pressure levels of -25 mmHg and -50 mmHg in a porcine model

    DEFF Research Database (Denmark)

    Lindstedt, Sandra; Paulsson, Per; Mokhtari, Arash

    2008-01-01

    Topical negative pressure (TNP), widely used in wound therapy, is known to stimulate wound edge blood flow, granulation tissue formation, angiogenesis, and revascularization. We have previously shown that application of a TNP of -50 mmHg to the myocardium significantly increases microvascular blood...... flow in the underlying tissue. We have also shown that a myocardial TNP levels between -75 mmHg and -150 mmHg do not induce microvascular blood flow changes in the underlying myocardium. The present study was designed to elucidate the difference between -25 mmHg and -50 mmHg TNP on microvascular flow...

  2. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær

    2013-01-01

    Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined...... whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The development of new strategies to improve the quality of care for people with post-MI depression requires...... thorough understanding of the mechanisms that influence the prognosis as well as knowledge of the present care provided. The purpose of this PhD thesis is accordingly subdivided into four specific aims: 1. To estimate the prevalence of depression in people with MI after three months, and to estimate...

  3. Long-term survival after mitral valve surgery for post-myocardial infarction papillary muscle rupture

    NARCIS (Netherlands)

    Bouma, Wobbe; Wijdh-den Hamer, Inez J.; Koene, Bart M.; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E.; Jainandunsing, Jayant S.; van der Horst, Iwan C. C.; Gorman, Joseph H.; Gorman, Robert C.; Mariani, Massimo A.

    2015-01-01

    Background: Papillary muscle rupture (PMR) is a rare, but dramatic mechanical complication of myocardial infarction (MI), which can lead to rapid clinical deterioration and death. Immediate surgical intervention is considered the optimal and most rational treatment, despite high risks. In this study

  4. Outcome of Patients With Adenosine-Induced ST Segment Depression and Normal Myocardial Perfusion

    International Nuclear Information System (INIS)

    El-Refaei, S.; Selim, M.

    2011-01-01

    The aim of the present study was to determine the outcome of patients with normal MPS and adenosine-induced ST segment depression. A total of 1867 patients underwent adenosine Tc99m-tetrofosmin MPS in nuclear medicine unit in Saudi German Hospital, Saudi Arabia, between January 2004 and May 2008. Their ECGs were checked for ST segment depression during adenosine infusion. All patients with ≥ 1 mm horizontal or down-sloping ST segment depression or≥ 1.5 mm up-sloping ST segment depression were included in the study. Fifty-six patients met our inclusion criteria, of which 45 (80%) were females. During the follow-up period, a total of 15 of patients ended up doing coronary angiography, either for high clinical suspicion or following a second positive MPS performed 6-18 months after the first study. Seven of them were positive for coronary artery disease and were subsequently treated with revascularization procedure, and 8 returned either normal angiography or non-obstructive coronary artery disease. Male diabetic smoking patients were more prevalent and underwent revascularization. The patients were followed up for a mean of 22.8 ±7.8 months. No cardiac deaths or myocardial infarctions were reported. It could be concluded that adenosine-induced ST segment depression in patients with normal myocardial perfusion was a benign finding and did not increase the very low risk of cardiac events in those patients. However, male smokers and/or diabetics might need further investigation. This suggestion needs further evaluation

  5. The impact of moderate to severe renal insufficiency on patients with acute myocardial infarction.

    Science.gov (United States)

    Son, Jihyun; Hur, Seung-Ho; Kim, In Cheol; Cho, Yun-Kyeong; Park, Hyoung-Seob; Yoon, Hyuck-Jun; Kim, Hyungseop; Nam, Chang-Wook; Kim, Yoon-Nyun; Kim, Kwon-Bae

    2011-06-01

    Renal insufficiency (RI) has been reported to be associated with unfavorable clinical outcomes in patients undergoing percutaneous coronary interventions (PCI). However, little data is available regarding the impact of moderate to severe RI on clinical outcomes in patients with acute myocardial infarction (AMI) undergoing PCI. Between March 2003 and July 2007, 878 patients with AMI who underwent PCI were enrolled. Based on estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation, patients were divided into two groups: eGFR <60 mL/min·m(2) (moderate to severe RI, group A) and eGFR ≥60 mL/min·m(2) (normal to mild RI, group B). The primary endpoint was all-cause mortality at 1-year after successful PCI. The secondary endpoints were non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis (ST) and major adverse cardiac events (MACE) at 1-year. In group A, patients were more often male and older, with diabetes and hypertension. Compared to patients in group B, group A showed significantly higher incidences of all-cause mortality, cardiac mortality, non-fatal MI and MACE. The needs of TLR and TVR, and the incidence of ST were not significantly different between the two groups. Independent predictors of 1-year mortality were eGFR <60 mL/min·m(2), male gender, older age and a lower left ventricular ejection fraction. In patients with AMI, moderate to severe RI was associated with mortality and MACE at 1-year after successful PCI. In addition, eGFR <60 mL/min·m(2) was a strong independent predictor of 1-year mortality.

  6. Mechanical Thrombectomy using a solitaire stent in acute ischemic stroke; The relationship between the visible antegrade flow on first device deployment and final success in revascularization

    International Nuclear Information System (INIS)

    Lee, Sung Ho; Lee, Byung Hon; Hwang, Yoon Joon; Kim, Su Young; Lee, Ji Young; Hong, Keun Sik; Cho, Yong Jin

    2015-01-01

    The purpose of the study was to evaluate the relationship between the successful revascularization on the first Solitaire stent deployment and the successful revascularization on the final angiography in acute ischemic stroke. From February 2012 to April 2014, 24 patients who underwent Solitaire stent thrombectomy as the first thrombectomy method for treatment of acute ischemic strokes were retrospectively reviewed. When the first Solitaire stent was deployed, 9 patients showed revascularization (Group 1) and 15 patients did not show revascularization (Group 2). Revascularization immediately after the first Solitaire stent removal and on the final angiography were comparatively assessed between the 2 groups. Statistical analysis was performed by the Fisher exact test and Student's t-test. The rates of revascularization maintenance immediately after the first Solitaire stent removal were 89% in Group 1 and 27% in Group 2, respectively (p = 0.009), and the rates of final successful revascularization were 100% in Group 1 and 47% in Group 2, respectively (p = 0.009). There was a statistically significant difference between the 2 groups. Revascularization on the first Solitaire stent deployment can be a useful predictor in evaluating the success of final revascularization in the treatment of acute ischemic stroke.

  7. Mechanical Thrombectomy using a solitaire stent in acute ischemic stroke; The relationship between the visible antegrade flow on first device deployment and final success in revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Ho; Lee, Byung Hon; Hwang, Yoon Joon; Kim, Su Young; Lee, Ji Young; Hong, Keun Sik; Cho, Yong Jin [Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2015-05-15

    The purpose of the study was to evaluate the relationship between the successful revascularization on the first Solitaire stent deployment and the successful revascularization on the final angiography in acute ischemic stroke. From February 2012 to April 2014, 24 patients who underwent Solitaire stent thrombectomy as the first thrombectomy method for treatment of acute ischemic strokes were retrospectively reviewed. When the first Solitaire stent was deployed, 9 patients showed revascularization (Group 1) and 15 patients did not show revascularization (Group 2). Revascularization immediately after the first Solitaire stent removal and on the final angiography were comparatively assessed between the 2 groups. Statistical analysis was performed by the Fisher exact test and Student's t-test. The rates of revascularization maintenance immediately after the first Solitaire stent removal were 89% in Group 1 and 27% in Group 2, respectively (p = 0.009), and the rates of final successful revascularization were 100% in Group 1 and 47% in Group 2, respectively (p = 0.009). There was a statistically significant difference between the 2 groups. Revascularization on the first Solitaire stent deployment can be a useful predictor in evaluating the success of final revascularization in the treatment of acute ischemic stroke.

  8. Myocardial ischemia detection with single-phase CT perfusion in symptomatic patients using high-pitch helical image acquisition technique.

    Science.gov (United States)

    Bischoff, Bernhard; Deseive, Simon; Rampp, Martin; Todica, Andrei; Wermke, Marc; Martinoff, Stefan; Massberg, Steffen; Reiser, Maximilian F; Becker, Hans-Christoph; Hausleiter, Jörg

    2017-04-01

    Coronary CT angiography (CCTA) suffers from a reduced diagnostic accuracy in patients with heavily calcified coronary arteries or prior myocardial revascularisation due to artefacts caused by calcifications and stent material. CT myocardial perfusion imaging (CTMPI) yields high potential for the detection of myocardial ischemia and might help to overcome the above mentioned limitations. We analysed CT single-phase perfusion using high-pitch helical image acquisition technique in patients with prior myocardial revascularisation. Thirty-six patients with an indication for invasive coronary angiography (28 with coronary stents, 2 with coronary artery bypass grafts and 6 with both) were included in this prospective study at two study sites. All patients were examined on a 2nd generation dual-source CT system. Stress CT images were obtained using a prospectively ECG-triggered single-phase high-pitch helical image acquisition technique. During stress the tracer for myocardial perfusion (MP) SPECT imaging was administered. Rest CT images were acquired using prospectively ECG-triggered sequential CT. MP-SPECT imaging and invasive coronary angiography served as standard of reference. In this heavily diseased patient cohort CCTA alone showed a low overall diagnostic accuracy for detection of hemodynamically relevant coronary artery stenosis of only 31% on a per-patient base and 60% on a per-vessel base. Combining CCTA and CTMPI allowed for a significantly higher overall diagnostic accuracy of 78% on a per-patient base and 92% on a per-vessel base (p CT scans was 0.9 mSv, mean radiation dose for rest CT scans was 5.0 mSv. In symptomatic patients with known coronary artery disease and prior myocardial revascularization combining CCTA and CTMPI showed significantly higher diagnostic accuracy in detection of hemodynamically significant coronary artery stenosis when compared to CCTA alone.

  9. Artificial neural network retrained to detect myocardial ischemia using a Japanese multicenter database.

    Science.gov (United States)

    Nakajima, Kenichi; Okuda, Koichi; Watanabe, Satoru; Matsuo, Shinro; Kinuya, Seigo; Toth, Karin; Edenbrandt, Lars

    2018-03-07

    An artificial neural network (ANN) has been applied to detect myocardial perfusion defects and ischemia. The present study compares the diagnostic accuracy of a more recent ANN version (1.1) with the initial version 1.0. We examined 106 patients (age, 77 ± 10 years) with coronary angiographic findings, comprising multi-vessel disease (≥ 50% stenosis) (52%) or old myocardial infarction (27%), or who had undergone coronary revascularization (30%). The ANN versions 1.0 and 1.1 were trained in Sweden (n = 1051) and Japan (n = 1001), respectively, using 99m Tc-methoxyisobutylisonitrile myocardial perfusion images. The ANN probabilities (from 0.0 to 1.0) of stress defects and ischemia were calculated in candidate regions of abnormalities. The diagnostic accuracy was compared using receiver-operating characteristics (ROC) analysis and the calculated area under the ROC curve (AUC) using expert interpretation as the gold standard. Although the AUC for stress defects was 0.95 and 0.93 (p = 0.27) for versions 1.1 and 1.0, respectively, that for detecting ischemia was significantly improved in version 1.1 (p = 0.0055): AUC 0.96 for version 1.1 (sensitivity 87%, specificity 96%) vs. 0.89 for version 1.0 (sensitivity 78%, specificity 97%). The improvement in the AUC shown by version 1.1 was also significant for patients with neither coronary revascularization nor old myocardial infarction (p = 0.0093): AUC = 0.98 for version 1.1 (sensitivity 88%, specificity 100%) and 0.88 for version 1.0 (sensitivity 76%, specificity 100%). Intermediate ANN probability between 0.1 and 0.7 was more often calculated by version 1.1 compared with version 1.0, which contributed to the improved diagnostic accuracy. The diagnostic accuracy of the new version was also improved in patients with either single-vessel disease or no stenosis (n = 47; AUC, 0.81 vs. 0.66 vs. p = 0.0060) when coronary stenosis was used as a gold standard. The diagnostic ability of the

  10. Microvascular obstruction on delayed enhancement cardiac magnetic resonance imaging after acute myocardial infarction, compared with myocardial {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Hiroaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Department of Cardiology, Kainan Hospital, Yatomi (Japan); Isobe, Satoshi, E-mail: sisobe@med.nagoya-u.ac.jp [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Sakai, Shinichi [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Yamada, Takashi [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan); Watanabe, Naoki; Miura, Manabu [Department of Cardiology, Kainan Hospital, Yatomi (Japan); Uchida, Yasuhiro; Kanashiro, Masaaki; Ichimiya, Satoshi [Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi (Japan); Okumura, Takahiro; Murohara, Toyoaki [Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya (Japan)

    2015-08-15

    Highlights: • The percentage infarct size (%IS) was significantly greater in the microvascular obstruction (MO) group than in the non-MO group. • The percentage mismatch score (%MMS) on dual scintigraphy significantly correlated with the %IS and the percentage MO. • The %MMS was significantly greater in the non-MO group than in the MO group, and was an independent predictor for MO. - Abstract: Background: The hypo-enhanced regions within the hyper-enhanced infarct areas detected by cardiac magnetic resonance (CMR) imaging reflect microvascular obstruction (MO) after acute myocardial infarction (AMI). The combined myocardial thallium-201 ({sup 201}Tl)/iodine-123-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid ({sup 123}I-BMIPP) dual single-photon emission computed tomography (SPECT) is a useful tool for detecting myocardial reversibility after AMI. We evaluated whether MO could be an early predictor of irreversible myocardial damage in comparison with {sup 201}Tl and {sup 123}I-BMIPP dual SPECT findings in AMI patients. Methods: Sixty-two patients with initial AMI who successfully underwent coronary revascularization were enrolled. MO was defined by CMR imaging. Patients were divided into 2 groups as follows: MO group (n = 32) and non-MO group (n = 30). Scintigraphic defect scores were calculated using a 17-segment model with a 5-point scoring system. The mismatch score (MMS) was calculated as follows: the total sum of (Σ) {sup 123}I-BMIPP defect score minus Σ{sup 201}Tl defect score. The percentage mismatch score (%MMS) was calculated as follows: MMS/(Σ{sup 123}I-BMIPP score) × 100 (%). Results: The percentage infarct size (%IS) was significantly greater in the MO group than in the non-MO group (32.2 ± 13.8% vs. 18.3 ± 12.1%, p < 0.001). The %MMS significantly correlated with the %IS and the percentage MO (r = −0.26, p = 0.03; r = −0.45, p < 0.001, respectively). The %MMS was significantly greater in the non-MO group than in the MO group (45.4

  11. Prognostic value of normal exercise {sup 99m}Tc-MIBI myocardial perfusion SPECT: comparison with exercise electrocardiography and coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Woo; Lee, Jae Tae; Chun, Kyung Ah; Kang, Do Young; Kim, Dong Hwan; Cho, Yong Keun; Chae, Shung Chull; Lee, Kyu Bo [Kyungpook National Univ. College of Medicine, Taegu (Korea, Republic of)

    2000-06-01

    Myocardial perfusion scintigraphy is a useful technique to diagnose and to predict prognosis in patients with suspected or known coronary artery disease. The purpose of the present study is to evaluate the prognostic value of normal exercise {sup 99m}Tc-MIBI myocardial perfusion single photon emission computed tomography (SPECT) and to analyze results with regard to those of exercise electrocardiography or coronary angiography. We evaluated 301 patients (mean age 52{+-}10 years, 166 males and 135 females) with normal exercise {sup 99m}Tc-MIBI myocardial perfusion SPECT performed for suspected coronary artery disease. Subjects were evaluated for cardiac events and followed for 8-55 months (mean 19{+-}10 months) after imaging. During the follow-up period, there was no cardiac death but only one non-fatal myocardial infarction (event rate 0.21% per year). In addition, only one patient underwent coronary revascularization. There was no significant difference in cardiac event rate between patinets with positive (n=3D27) and negative (n=3D235) exercise electrocardiography (p:NS). There was no cardiac event in 17 patients who underwent coronary angiography (4 patients with >50% luminal narrowing, 2 patients with vasospasm and 11 patients with no significant lesion). Patients with normal exercise {sup 99m}Tc-MIBI myocardial perfusion SPECT has a very low risk for cardiac events regardless of exercise electrocardiographic and coronary angiographic findings.

  12. Successful Percutaneous Septal Alcohol Ablation After Surgical Myectomy

    Directory of Open Access Journals (Sweden)

    Mehmed Kulić

    2010-08-01

    Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is a primary, usually familial and genetically fixed myocardial hypertrophy, with dynamic left ventricular outflow tract obstruction. An alternative to surgical myectomy in the treatment of severe, drug refractory, HOCM is percutaneous transluminal septal myocardial ablation (PTSMA. We report a case of 24 year old female patient who had the first septal myectomy but because of progression of her disease, the percutaneous treatment of hypertrophic obstructive cardiomyopathy was performed. A year after the PTSMA the patient was without of symptoms.

  13. Long-term Outcomes of Drug-eluting versus Bare-metal stent for ST-elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Liping Wang

    2014-06-01

    Full Text Available Background: Long-term outcomes of drug-eluting stents (DES versus bare-metal stents (BMS in patients with ST-segment elevation myocardial infarction (STEMI remain uncertain. Objective: To investigate long-term outcomes of drug-eluting stents (DES versus bare-metal stents (BMS in patients with ST-segment elevation myocardial infarction (STEMI. Methods: We performed search of MEDLINE, EMBASE, the Cochrane library, and ISI Web of Science (until February 2013 for randomized trials comparing more than 12-month efficacy or safety of DES with BMS in patients with STEMI. Pooled estimate was presented with risk ratio (RR and its 95% confidence interval (CI using random-effects model. Results: Ten trials with 7,592 participants with STEMI were included. The overall results showed that there was no significant difference in the incidence of all-cause death and definite/probable stent thrombosis between DES and BMS at long-term follow-up. Patients receiving DES implantation appeared to have a lower 1-year incidence of recurrent myocardial infarction than those receiving BMS (RR = 0.75, 95% CI 0.56 to 1.00, p= 0.05. Moreover, the risk of target vessel revascularization (TVR after receiving DES was consistently lowered during long-term observation (all p< 0.01. In subgroup analysis, the use of everolimus-eluting stents (EES was associated with reduced risk of stent thrombosis in STEMI patients (RR = 0.37, p=0.02. Conclusions: DES did not increase the risk of stent thrombosis in patients with STEMI compared with BMS. Moreover, the use of DES did lower long-term risk of repeat revascularization and might decrease the occurrence of reinfarction.

  14. Angiosome-targeted infrapopliteal endovascular revascularization for treatment of diabetic foot ulcers.

    Science.gov (United States)

    Söderström, Maria; Albäck, Anders; Biancari, Fausto; Lappalainen, Kimmo; Lepäntalo, Mauri; Venermo, Maarit

    2013-02-01

    Because of the prolonged healing time of diabetic foot ulcers, methods for identifying ways to expedite the ulcer healing process are needed. The angiosome concept delineates the body into three-dimensional blocks of tissue fed by specific source arteries. The aim of this study was to evaluate the benefit of infrapopliteal endovascular revascularization guided by an angiosome model of perfusion in the healing process of diabetic foot ulcers. A total of 250 consecutive legs with diabetic foot ulcers in 226 patients who had undergone infrapopliteal endovascular revascularization in a single center were evaluated. Patient records and periprocedural leg angiograms were reviewed. The legs were divided into two groups depending on whether direct arterial flow to the site of the foot ulcer based on the angiosome concept was achieved (direct group) or not achieved (indirect group). Ulcer healing time was compared between the two groups. A propensity score was used for adjustment of differences in pretreatment covariables in multivariate analysis and for 1:1 matching. Direct flow to the angiosome feeding the ulcer area was achieved in 121 legs (48%) compared with indirect revascularization in 129 legs. Foot ulcers treated with angiosome-targeted infrapopliteal percutaneous transluminal angioplasty healed better. The ulcer healing rate was mean (standard deviation) 72% (5%) at 12 months for the direct group compared with 45% (6%) for the indirect group (P ulcer healing rate than the indirect group (hazard ratio, 1.97; 95% confidence interval, 1.34-2.90; P = .001). Attaining a direct arterial flow based on the angiosome model of perfusion to the foot ulcer appears to be important for ulcer healing in diabetic patients. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  15. Concomitant unruptured intracranial aneurysms and carotid artery stenosis: an institutional review of patients undergoing carotid revascularization.

    Science.gov (United States)

    Borkon, Matthew J; Hoang, Han; Rockman, Caron; Mussa, Firas; Cayne, Neal S; Riles, Thomas; Jafar, Jafar J; Veith, Frank J; Adelman, Mark A; Maldonado, Thomas S

    2014-01-01

    The incidence of concomitant carotid artery stenosis and unruptured intracranial aneurysms (UIAs) has been reported at between 0.5% and 5%. In these patients, treatment strategies must balance the risk of ischemic stroke with the risk of aneurysmal rupture. Several studies have addressed the natural course of UIAs in the setting of carotid revascularization; however, the final recommendations are not uniform. The purpose of this study was to review our institutional experience with concomitant UIAs and carotid artery stenosis. We performed a retrospective review of all patients with carotid artery stenosis who underwent carotid artery endarterectomy (CEA) or carotid artery stenting (CAS) at our institution between 2003 and 2010. Only patients with preoperative imaging demonstrating intracranial circulation were included. Charts were reviewed for patients' demographic and clinical data, duration of follow-up, and aneurysm size and location. Patients were stratified into 2 groups: carotid artery stenosis with unruptured intracranial aneurysm (CS/UIA) and carotid artery stenosis without intracranial aneurysm (CS). Three hundred five patients met the inclusion criteria and had a total of 316 carotid procedures (CAS or CEA) performed. Eleven patients were found to have UIAs (3.61%) prior to carotid revascularization. Male and female prevalence was 2.59% and 5.26% (P = 0.22), respectively. Patients' demographics did not differ significantly between the 2 groups. The average aneurysm size was 3.25 ± 2.13 mm, and the most common location was the cavernous segment of the internal carotid artery. No patient in the study had aneurysm rupture, and the mean follow-up time was 26.5 months for the CS/UIA group. Concomitant carotid artery stenosis and UIAs is a rare entity. Carotid revascularization does not appear to increase the risk of rupture for small aneurysms (<10 mm) in the midterm. Although not statistically significant, there was a higher incidence of aneurysms found in

  16. Risk assessment after coronary angioplasty with SPECT myocardial perfusion studies

    International Nuclear Information System (INIS)

    Camilletti, Jorge A.; Erriest, Juan; Mele, Anibal A.

    2007-01-01

    The chest pain can be use for stratifying the risk of the patients after coronary angioplasty. Nevertheless this strategy has shown to have a low accuracy in the detection of restenosis and myocardial ischemia. Aims: To establish the usefulness of the SPECT studies in the risk stratification after the coronary angioplasty. Evaluate the incidence of silent ischemia or symptomatic, and its impact on the prognosis. Method: There were included 107 patients (p) submitted to a gated SPECT between the year of the coronary angioplasty. The analysis of the images was performed according to different scores (SSS, SRS, SDS). These data was correlated with the symptoms of the patients. We define group 1 (G1) as the asymptomatic without ischemia (n 59p), group 2 (G2) as silent ischemia (n = 28p) and group 3 (G3) as symptomatic with ischemia (n = 20p). A clinical follow-up was done in search of events (target vessel revascularization, unstable angina, AMI and death). Results: Significant differences were not observed in the clinical variables between the different groups. The SSS was lower in the G1 compare with G2 and G3 (p 0.0001) and was similar between the last two, p = NS (SSS: G1: 2.2 ± 4.9; G2: 7.6 ± 5.9; G3: 9.5 ± 6.8). The SDS was greater in G3 vs. G1 and G2, p = 0.0001, and greater in G2 vs. G1, p = 0.0001 (SDS: G1: 0; G2: 4.8 ± 3.5; G3: 7.2 ± 6.5). No differences where observed in the SRS between the three groups. In the follow-up the total percentage of events was lesser when compare the G1 with the G2 and G3 (G1: 3.3%; G2 and G3: 18.7%; p 0.02). The percentage of annual events of the G3 symptomatic with ischemia (11.03%) and G2 silent ischemia (4.04%) did not present differences (p 0.7). When the events of the G2 (4.04%) were compared with the G1 (1.24%) we observed a trend to major frequency of events in the G2 (p = 0.6). Conclusions: The presence of myocardial ischemia after coronary angioplasty is a determinant of the prognosis. Nevertheless, the extension

  17. Diabetes patients show different time-course of myocardial perfusion improvement after coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Lee, J. J.; Seok, J. W.; Eo, J. S.

    2005-01-01

    Diabetes mellitus is an independent risk factor of cardiovascular disease. Diabetes is known to cause microangiopathy. The microangiopathy is hardly detectable on the coronary angiography. Myocardial perfusion imaging shows the resultant perfusion status which reflects the microangiopathy. For patients who underwent revascularization, the microangiopathy could affect the myocardial perfusion improvement. Diabetes patients probably experience the different myocardial perfusion improvement as compared to the non-diabetes patients although they have similar angiographic findings. The aim of this study is to find out whether there is a time-course difference of perfusion improvement between the diabetes and non diabetes patients who showed patent angiographic findings after coronary artery grafting surgery (CABG). A total of 129 patients who underwent coronary artery bypass grafting surgery were enrolled in this study. Myocardial SPECTs performed at previous, short-term (3 month), and mid-term (1 year) to CABG. One-year follow up angiography was done 411±121 days after surgery. Graft patency was determined according to the FitzGibbon et al. Segments were assigned to vascular territories using a 20 segment model. The segments of excellent patency were included in this study. Time course differences of concerned segments were analyzed using RMANOVA. The number of segments enrolled was 764 of diabetes and 1083 of non-diabetes. At short-term follow up, reversibility score was 2.8±8.1% in diabetes and 0.3±7.5% in non-diabetes. At long-term follow up, reversibility score was 1.8±8.0% in diabetes and 0.1±7.3% in non-diabetes. The time-course of reversibility score was significantly different between the diabetes and non diabetes (p<0.001) Diabetic segments showed high residual reversibility score than non-diabetic segments after CABG although the angiographic finding was patent in both groups. This result is maybe attributable to microangiopathy induced by diabetes

  18. The value of myocardial perfusion imaging in differentiating between idiopathic dilated cardiomyopathy from the ischemic form

    International Nuclear Information System (INIS)

    Fad, A.; Emami, F.; Eftekhari, M.; Saghari, M.; Fallahi, B.; Beiki, D.; Tkavar, A.

    2004-01-01

    Introduction: differentiating between ischemic cardiomyopathy and idiopathic dilated cardiomyopathy is important as coronary revascularization can improve prognosis in the ischemic subgroup. Due to inherent problems of coronary angiography in patients with depressed ejection fraction introducing a noninvasive tool to diagnose those who will benefit from angiography seems to be rewarding. We examined usefulness of myocardial perfusion scan in this group of patients. Materials and methods: study was performed on 64 patients (62 male and 2 female) aged 57.1 ± 6.7 y (mean ± SD) all with dilation of the left ventricular cavity and ejection fraction less than 40 % by echocardiography. Myocardial perfusion scan was performed in stress and rest phases. All the patients had coronary angiography which was used as the gold standard test. On each set of images, heart was arbitrary divided into 17 segments and perfusion abnormality in each segment was scored by a 5 grade scoring system (0-4). Summed stress Score was used as the scan criteria to differentiate dilated ischemic from idiopathic cardiomyopathy. Scores more than 17 were considered ischemic, and less than that, idiopathic. Results were compared with angiography. Results: from total 40 cases of ischemic cardiomyopathy (proved by angiography) 39 were correctly diagnosed by scan and only one case was mis categorized as idiopathic dilated cardiomyopathy . All 24 cases of idiopathic dilated cardiomyopathy were correctly diagnosed by scintigraphy. Sensitivity, specificity, positive predictive value, and negative predictive value of myocardial perfusion imaging for discrimination between ischemic and idiopathic dilated cardiomyopathy were 97.5 %, 100 %, 100 %, and 96 % respectively. Conclusion: Considering excellent accuracy of myocardial perfusion scan with scoring system in discrimination of ischemic dilated cardiomyopathy from idiopathic cardiomyopathy, this noninvasive test could be considered the main diagnostic test

  19. The Society for Vascular Surgery's objective performance goals for lower extremity revascularization are not generalizable to many open surgical bypass patients encountered in contemporary surgical practice.

    Science.gov (United States)

    Saraidaridis, Julia T; Ergul, Emel; Patel, Virendra I; Stone, David H; Cambria, Richard P; Conrad, Mark F

    2015-08-01

    In 2009, the Society for Vascular Surgery (SVS) established objective performance goals (OPG) for lower extremity bypass (LEB) in patients with critical limb ischemia (CLI) based on pooled data from previously performed prospective studies in an effort to provide a benchmark and historical control for future trials. However, patients with a prosthetic conduit and end-stage renal disease were excluded from this cohort. In contemporary practice, many patients do not meet the criteria for SVS OPG inclusion, making generalization of the SVS OPG difficult. The goal of this study was to establish safety and efficacy measures for patients who were excluded from the original SVS OPG analysis. All patients who underwent LEB for CLI in the Vascular Study Group of New England (VSGNE) from 2003 to 2013 were identified. Patients were stratified into OPG-eligible and non-OPG-eligible cohorts. Outcomes included 30-day major adverse limb events, 30-day major adverse cardiovascular events, 1-year survival, and 1-year freedom from amputation. The SVS OPG methodology was used to create new performance goals for the non-OPG-eligible patients. We identified 3609 patients: 2360 OPG (65%) vs 1249 non-OPG (35%), and overall results were stratified as a function of OPG status. The 30-day major adverse limb event rate was 5.0% (5.5% non-OPG vs 4.4% OPG; P = .34), and the 30-day major adverse cardiovascular event rate was 7.3% (9.2% non-OPG vs 6.2% OPG; P = .001). At 1 year, survival was 84% (75.9% non-OPG vs 88.3% OPG; P < .001), and freedom from amputation was 86.9% (80.9% non-OPG vs 90.1% OPG; P < .001). The SVS OPG were attainable in New England for the population of patients who would have met SVS OPG study cohort inclusion criteria. However, 35% of the patients who underwent LEB for CLI in the last 10 years fell outside of these criteria by having end-stage renal disease or requiring a prosthetic conduit. We therefore suggest new benchmarks for these high-risk populations. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  20. Mortality after major amputation in diabetic patients with critical limb ischemia who did and did not undergo previous peripheral revascularization Data of a cohort study of 564 consecutive diabetic patients.

    Science.gov (United States)

    Faglia, Ezio; Clerici, Giacomo; Caminiti, Maurizio; Curci, Vincenzo; Clerissi, Jacques; Losa, Sergio; Casini, Andrea; Morabito, Alberto

    2010-01-01

    To evaluate the survival after major lower limb amputation, at a level either below (BKA) or above (AKA) the knee, in diabetic patients admitted to hospital because of critical limb ischemia (CLI). From January 1999 to December 2003, 564 diabetic patients were consecutively admitted to our Foot Center because of CLI and followed up until December 2005. A revascularization procedure was performed in 537 patients (95.2%): in 420 with peripheral angioplasty, in 117 with peripheral bypass graft. Neither endoluminal nor surgical revascularization was practicable in 27 (4.8%) patients. Major amputation was performed in a total of 55 (9.8%) patients. Among the clinical and demographic variables evaluated, age was significantly lower (67.3+/-10.1 vs. 76.7+/-10.4, Pdiabetes was higher (17.1+/-11.1 vs. 13.4+/-10.0, P=.013), and current smoking was more frequent (38.5% vs. 25.0%, Pdiabetic patients with CLI. Copyright 2010 Elsevier Inc. All rights reserved.

  1. Surgical treatment of post-infarct left ventricular pseudoaneurysm with on-pump beating heart technique.

    Science.gov (United States)

    Korkmaz, Kemal; Lafçi, Gökhan; Gedik, Hikmet Selçuk; Budak, Ali Baran; Yener, Ali Ümit; Ecevit, Ata Niyazi; Yalçinkaya, Adnan; Kadiroğullari, Ersin; Çağli, Kerim

    2014-01-01

    Left ventricular pseudo-aneurysms develop when cardiac rupture is contained by pericardial adhesions or scar tissue due to myocardial infarction, surgery, trauma or infection. Left ventricular pseudo-aneurysms are uncommon, difficult to diagnose and prone to cardiac rupture. Urgent surgical repair is recommended. Here we report on a case of a large left ventricular pseudo-aneurysm on the anterolateral wall due to a previous anterior myocardial infarction, and its successful repair using the on-pump beating-heart technique.

  2. Myocardial scintigraphy in the diagnosis of myocardial contusion

    Energy Technology Data Exchange (ETDEWEB)

    Terashima, Masayoshi; Shinoda, Mitsutaka; Iwama, Hiroshi; Hirama, Hisao; Hoshino, Toshiaki; Urabe, Shinpei [Central Aizu General Hospital, Fukushima (Japan); Meguro, Taiichiroh

    1996-04-01

    To assess the clinical value of a new fatty acid imaging tracer, {sup 123}I-{beta}-methyl iodophenyl pentadecanoic acid (BMIPP), I-BMIPP and thallium-201 (Tl) dual imaging was performed at rest in fifteen patients with mild blunt chest trauma (mean AIS thoracic 1.4{+-}0.51, mean ISS 6.47{+-}3.50, mean RTS 7.69{+-}0.43). All patients were prospectively evaluated on the basis of serial electrocardiograms (ECG) and cardiac enzyme studies (total CPK). Tl and BMIPP dual scintigrams were performed within 10 days following admission. SPECT images were divided into seven segments, and the segmental images were visually scored according to tracer uptake on a 3 (severely decreased tracer uptake) to 0 (normal) scale. Nine patients had scintigraphic defects and were considered to have a myocardial contusion. ECG findings, AIS, ISS, and CPK levels failed to distinguish between scintigraphically positive patients and scintigraphically negative patients. Five of the 14 hypoperfused segments on BMIPP imaging, showed normal Tl uptake, one showed lower BMIPP uptake than Tl, and the remaining eight showed similar distribution of both tracers. The mismatch between tracer uptake on BMIPP images and Tl images was thought to reflect impaired myocardial fatty acid metabolism. Thus, mild blunt chest trauma results in a higher frequency of traumatic myocardial injury than previously recognized, and BMIPP is a promising radio-pharmaceutical for evaluating impaired myocardial fatty acid metabolism in patients with myocardial contusion. (author).

  3. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    International Nuclear Information System (INIS)

    Lim, Seok Tae; Lee, Dong Soo; Kang, Won Jon; Chung, June Key; Lee, Myung Chul

    1999-01-01

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7±10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6±5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery

  4. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seok Tae; Lee, Dong Soo; Kang, Won Jon; Chung, June Key; Lee, Myung Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-02-01

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7{+-}10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6{+-}5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

  5. Myocardial Perfusion Tomoscintigraphy With 99mTc MIBI (SPECT MPS 99mTc MIBI) In The Assessment Of Myocardial Viability

    International Nuclear Information System (INIS)

    Pop Gjorcheva, Daniela

    2002-03-01

    Prognosis of the patients with severe coronary artery disease is highly dependent on the degree of left ventricular dysfunction. Impaired contractile performance at rest is not necessarily due to Irreversible tissue damage but may relate to the 'hibernating' myocardium which has been defined as potentially reversible, chronic contractile dysfunction during prolonged, painless ischemia. Recovery of function may occur after successful revascularization only in the presence of substantial amount of viable myocardium. The development of highly precise and predictable diagnostic methods for the identification of viable myocardium and postoperative functional improvement is crucial for reasonable preoperative selection of the patients. Detection of hibernated myocardium Is a real diagnostic challenge when FDG-Fl8 PET, as the most accurate method for myocardial viability assessment is not available and Tl 201, as already established myocardial viability marker is not routinely used. Interest for the 99mTc labeled complexes, most often 99mTc MIBI, as proved myocardial perfusion but not yet viability tracer is constantly increasing, supported by the widespread availability of this radioisotope, its better imaging and radio dosimetric properties when compared to Ti 201. The aim of this study was to evaluate the diagnostic value of different SPECT MIBI Tc99m myocardial perfusion scintigraphy (MPS) modalities performed at rest and after nitrate administration, in the detection of myocardial viability (MV) arid to compare it with rest-redistribution TI 201 MPS (R-Red) and with the control SPECT MPS Tc99m MIBI study after revascularization. In a prospective study, 176 patients (34-77yrs, 25 female, 151 male), with angiographically proved coronary artery disease, most of them with previous myocardial infarction (143/176p (81%),>6 months) and LV dysfunction (110/176p (62%), EF G-MPS 41+/-16%) underwent ECG Gated SPECT MPS Tc 99m MIBI at rest and after s.l. administration of 0,5 mg

  6. Thallium-201 exercise myocardial imaging to evaluate myocardial perfusion after coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Hirzel, H.O.; Nuesch, K.; Sialer, G.; Horst, W.; Krayenbuehl, H.P.

    1980-01-01

    To assess the usefulness of thallium-201 exercise scintigraphy in evaluating myocardial perfusion after coronary artery bypass surgery, imaging was performed after submaximal bicycle ergometry and at rest in 54 patients before and within 24 +- 10 (SD) weeks after operation. Scintigraphy identified 8 out of 20 patients who were symptom free after operation and showed normal exercise electrocardiograms as still having exercise-induced ischaemia and thus as having not truly benefited from the surgical intervention. In contrast, improvement in perfusion was documented in 17 out of 31 patients despite further complaints of chest pain and persistence of a pathological exercise electrocardiogram in 6 of them. Bypass graft patency rate paralleled the scintigraphic findings in the 35 patients who were restudied arteriographically. It was concluded that thallium-201 exercise scintigraphy is a useful technique to document changes in regional perfusion after surgery and is definitely superior to the clinical evaluation of patients including the exercise electrocardiogram. (author)

  7. Troponin I Levels and Postoperative Myocardial Infarction following Renal Transplantation

    Science.gov (United States)

    Shroff, G.R.; Akkina, S.K.; Miedema, M.D.; Madlon-Kay, R.; Herzog, C.A.; Kasiske, B.L.

    2012-01-01

    Background The relationship of routine postoperative troponin I (TnI) monitoring in kidney transplant recipients and in-hospital myocardial infarction (MI) is not known. Methods This observational study evaluated the prevalence of abnormal postoperative TnI (Ortho Clinical Diagnostics assay) in 376 consecutive kidney or kidney/pancreas transplant recipients. In-hospital MI was adjudicated using the universal definition. Rates of death and coronary revascularizations at 1 year were studied. Logistic regression analysis was performed to identify independent predictors of abnormal TnI. Results Ninety-five (25%) recipients had abnormal TnI (>0.04 ng/ml) following transplantation. Abnormal TnI levels were more common in older (mean age: 52.2 ± 13.4 vs. 48.3 ± 13.2 years, p = 0.01), diabetic (57.9 vs. 45.6%, p = 0.04), and prior coronary artery disease (31.6 vs. 20.3%, p = 0.02) patients. In-hospital MI occurred in 6 patients (1.6%). All subsequent in-hospital cardiovascular events occurred in the abnormal postoperative TnI group; most in those with TnI levels >1 ng/ml. Previous coronary artery disease was the only independent predictor of a postoperative TnI level >1 ng/ml in multivariate analysis (odds ratio 4.61, 95% confidence interval 1.49–14.32). At 1 year there was no significant difference in death (3.2 vs. 1.8%, p = 0.42) and borderline significant difference in coronary revascularization (5.3 vs. 1.4%, p = 0.049) in abnormal versus normal TnI groups. Conclusions In-hospital MI was infrequent, but abnormal TnI highly prevalent following renal transplantation. Normal TnI levels following renal transplantation had a high negative predictive value in excluding patients likely to develop subsequent postoperative MI. The role of a higher TnI cut-off for screening for postoperative MI in high-risk subgroups deserves future prospective evaluation. PMID:22286592

  8. Rationale and design of the DEAR-OLD trial: Randomized evaluation of routinely Deferred versus EARly invasive strategy in elderly patients of 75 years or OLDer with non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Leng, Wen-Xiu; Yang, Jingang; Li, Wei; Wang, Yang; Yang, Yue-Jin

    2018-02-01

    Comparing with conservative strategy, early invasive approach has been shown to be beneficial for initially stabilized patients with non-ST-elevation myocardial infarction (NSTEMI). However, concerns of increased risk of bleeding and other complications associated with early revascularization in patients aged ≥75 years persist. A routinely deferred invasive strategy aiming to facilitate revascularization after stabilizing the culprit lesion predominates across China. The aim was to compare efficacy and safety of deferred invasive strategy versus guideline-recommended early invasive strategy in initially stabilized Chinese patients aged ≥75 years with NSTEMI. Twenty qualified centers from 10 different provinces throughout mainland China will contribute to the study. Eligible patients will be central randomized to a routine deferred invasive approach or an early invasive approach (coronary angiography >72 hours or evaluating efficacy and safety of routinely deferred invasive strategy compared with early invasive strategy in Chinese elderly patients with NSTEMI. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Sex-related Impact on Clinical Outcome of Everolimus-eluting Versus Bare-metal Stents in ST-segment Myocardial Infarction. Insights From the EXAMINATION Trial.