Showing papers by "José Luis Zamorano published in 1992"

Comparison of results of percutaneous mitral valvuloplasty in patients with large (>6 cm) versus those with smaller left atria

Abstract: To determine whether the presence of an aneurysmatic (severely enlarged) left atrium (>60 mm on echocardiography) influences results of percutaneous mitral valvuloplasty (PMV), the clinical, echocardiographic and hemodynamic characteristics and the results of this technique were compared in 46 consecutive patients with aneurysmatic left atrium (group I) and 125 consecutive patients without such echocardiographic finding (group II). Left atrial size was 70.5 ± 8 vs 50.1 ± 6 mm (p < 0.005) in groups I and II, respectively. Patients in group I were older (57 ± 12 vs 48 ± 12 years, p < 0.025), more symptomatic (New York Heart Association functional class ≥III or IV: 67 vs 42%, p < 0.05), and had atrial fibrillation more frequently (91 vs 44%, p < 0.001). The echocardiographic score (8.9 ± 1.9 vs 7.5 ± 2, p < 0.005) and the incidence of mild mitral regurgitation on angiography before PMV (54 vs 30%, p < 0.01) was also higher in group I patients. Hemodynamic parameters before PMV were similar in both groups, but after the procedure, final mitral valve area (1.61 ± 0.5 vs 1.95 ± 0.4 cm2, p < 0.05) and the absolute increase in mitral area (0.81 ± 0.3 vs 1.02 ± 0.3 cm2, p < 0.05) were lower and mean pulmonary artery pressure (35 ± 10 vs 28 ± 9 mm Hg, p < 0.025) was higher in group I. More difficulties in crossing the interatrial septum (9 vs 0%, p < 0.01) were also found in group I. PMV success (mitral valve area increase ≥50% without complications) tended to be lower (83 vs 94%, p < 0.1) and dilatation failure higher (11 vs 1%, p < 0.01) in group I, but the incidence of major complications was similar in both groups. An optimal result (final mitral valve area ≥1.5 cm2) was found more frequently (88 vs 61%, p < 0.05) in group II patients. In addition, on multivariate analysis, an aneurysmatic left atrium was an independent predictor of PMV suboptimal results. In conclusion, patients with mitral stenosis and aneurysmatic left atrium may successfully undergo PMV, but they have more severe mitral valve disease and experience technically difficult procedures, dilatation failure and suboptimal results more often than patients with smaller left atria.

Nuclear magnetic resonance spectroscopy of excised human hearts.

Abstract: Background —Phosphorus nuclear magnetic resonance spectroscopy has been proposed as a method of studying the metabolism of the myocardium in patients. Little is known about 31 P nuclear magnetic resonance spectroscopy of diseased human hearts. Methods —Two donor hearts meeting the requirements for heart transplantation and 11 diseased hearts were removed during a transplantation procedure and were studied in a horizontal 2·35 T superconducting magnet. Spectra were obtained at 0°C about 30 minutes after the excision. The areas of the inorganic phosphate peak (Pi) and of the phosphocreatine peak (PCr) were summed and expressed as a ratio with respect to the area of the β ATP peak. Results —The ratio (Pi + Pcr)/β ATP was found to be significantly lower in five hearts with a myocardial infarct (0·77 (0·18)) than in hearts with dilated cardiomyopathy (1·25 (0·29)) and in normal hearts (1·69 (0·11)). The area of the phosphodiester peak was expressed as a ratio with respect to the area of the β ATP peak: no differences were found between the three groups. Conclusions —These results suggest that the phosphocreatine concentration is lower in ischaemic heart disease than in dilated cardiomyopathy and that the phosphodiester peak is probably not useful in distinguishing between these two types of heart disease.

Transluminal percutaneous coronary angioplasty of the left coronary artery

Abstract: This paper describes our preliminary experience with left main coronary angioplasty in 8 patients (9 procedures). In 6 patients the left main coronary artery was "protected" either by previous by-pass surgery (4 patients) or by collateral vessels from the right coronary artery (2 patients). Three patients had a total occlusion of the left main coronary artery and 2 of them had a recent or acute myocardial infarction and the coronary angiogram suggested a thrombotic occlusion of the infarct-related artery. Three patients were not considered surgical candidates and an additional patient, who was in cardiogenic shock, required an emergency coronary angioplasty as "rescue" procedure. A successful dilatation was achieved in 6 patients (including a patient with successful deployment of a Palmaz-Schatz stent) but, unfortunately, one them eventually died 7 days later from a femoral sepsis related to the procedure. However in the 2 remaining patients--with a total occlusion of the left main coronary artery in relation with a myocardial infarction--the dilatation procedures were unsuccessful. One patient underwent a successful repeat coronary angioplasty for restenosis of left main coronary artery. Our preliminary experience confirms previous reports suggesting the value of coronary angioplasty in patients with left main coronary artery disease providing a careful selection of possible candidates is performed prior to the procedure.