ABSTRACT
OBJECTIVE: To evaluate the diastolic function after regression of left ventricular hypertrophy, in mild to moderate hypertension treated with angiotensin converting enzyme(ACE) inhibitor and, if necessary, with a diuretic. METHODS: Ninety-eight hypertensive patients with left ventricular hypertrophy (LVH) and abnormal left ventricle diastolic function indexes received captopril (Capotena) 50 to 200 mg/day plus chlortalidone during 12 months to reach blood pressure control, defined as a diastolic blood pressure < or =90 and systolic blood pressure < or =140 mm Hg. Left ventricular (LV) mass index was calculated by M mode and two-dimensional echocardiography, and left ventricular diastolic function was assessed by transmitral pulsed Doppler ultrasound every 3 months. RESULTS: Sixty-three patients were women and 35 were men, mean age was 53.4 +/- 8.4 years (range 34-70). Thirty-six patients had mild (36.7%) and 62 (63.3%) moderate hypertension. Treatment reduced significantly both systolic pressure from 165 +/- 13 to 137 +/- 12.9 mm Hg (p<0.05) and diastolic pressure from 99 +/- 8.6 to 86 +/- 6.37 mm Hg (p<0.05). LV mass index decreased from 155.4 +/- 32.9 to 121.7 +/- 29.14 g/m2 (p<0.05). Late diastolic filling velocity (A wave) and the ratio of E/A waves improved (p<0.05), but early diastolic filling velocity (E wave) and isovolumetric relaxation time did not change with treatment. CONCLUSIONS: Some indexes of diastolic function improved after regression of left ventricular hypertrophy and good blood pressure control with captopril and chlortalidone.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Blood Pressure , Hypertension , Hypertrophy, Left Ventricular , Antihypertensive Agents , Blood Pressure/physiology , Captopril , Chlorthalidone , Diastole , Diastole/physiology , Hypertension , Hypertrophy, Left Ventricular , Prospective StudiesABSTRACT
Despite substantial advances in treatment, coronary atherosclerosis is a progressive disease, for this reason a second surgery is frequent. The left anterior small thoracotomy operation on a beating heart is an alternative with less morbidity and mortality than the conventional surgery. CASES REPORT: We report two cases of coronary surgery with limited access. The first corresponds to a 72-year-old man with diabetes, hypertension, dyslipidemia, obesity, with myocardial damage and bypass surgery to anterior descendent coronary artery and first diagonal coronary artery with saphenous vein graft performed 13 years ago. Due to unstable angina and positive test for myocardial ischemia, we performed bypass surgery of minimal access to the anterior descendent coronary artery and obtuse marginal coronary artery. The second case corresponds to a man with hypertension, diabetes, obesity, previous bypass surgery of two vessels performed 4 years ago, complicated with perioperative inferior myocardial infarction. Due to unstable angina and positive test for myocardial viability, we performed a re-do coronary artery bypass graft surgery to the left anterior descending artery and first diagonal coronary arteries through a minimal access incision. In both the clinical evolution was satisfactory, they were discharged 7 days after surgery and remain asymptomatic at one year of follow-up. CONCLUSION: The antero-lateral thoracotomy off-pump coronary bypass surgery is an alternative indicated in high risk patient with coronary revascularization.
Subject(s)
Aged , Humans , Male , Middle Aged , Coronary Artery Disease , Myocardial Revascularization/methods , Thoracotomy , Coronary Artery BypassABSTRACT
OBJECTIVE: To evaluate the risk factors related to bleeding in patients subjected to cardiac surgery using an extracorporeal circulation pump. MATERIAL AND METHODS: A study of cases and controls was designed performed in adults, matched by age and gender with indication of elective cardiac surgery using an extracorporeal circulation pump. Those patients with hepatic failure or blood coagulation disorders were excluded. Results were analyzed by Student t test, chi-square, and logistic regression analysis, considering p values significant at <0.05. RESULTS: The patients with functional class III or IV of the CCS presented more bleeding (p = 0.006), although there were no differences when comparing the ejection fraction in both. Obesity, dyslipidemia, and arterial hypertension were identified as risk factors. The coronary artery bypass graft, multivessels bypass surgery, and prolonged surgical times are associated to the complication (p < 0.05). According to the discriminant function analysis, the cardiopulmonary derivation time, weight, aortic clamp time, and heparin doses are the factors that better discriminate the possibility of hemorrhage. CONCLUSIONS: Heavy bleeding is related to ischemic patients, longer cardiac surgery time, overweight, and heparin doses during surgery.
Subject(s)
Female , Humans , Male , Middle Aged , Blood Loss, Surgical , Cardiopulmonary Bypass/adverse effects , Case-Control Studies , Risk Factors , Severity of Illness IndexABSTRACT
OBJECTIVE: To evaluate the utility of the cardiovascular magnetic resonance imaging (cMRI) for quantify the aortic area in adult patients with pure aortic stenosis (AS). METHOD: Comparative cross-sectional study, blinded, in patients with AS, without another valvular pathology associated. A transthoracic echocardiogram (TTE) and cMRI were performed, in all of them. Results were analyzed by Student t test and ji-square, considering significant values p < 0.05. Bayesian analysis and ROC curve, for the determination of the disease severity. RESULTS: No were significant differences with respect to quantification of the speed of transvalvular flow between both methods (TTE 4.593 +/- 0.9114 m/s vs. cMRI 4.233 +/- 0.6894 m/s, p = 0.080), nor the ejection fraction (TTE 54.27 +/-16.451 vs. cMRI 48.40 +/-17.332, p = 0.760). The cMRI seems to underestimate the maximum and medium gradients compared with the TTE, in 12.53 mm Hg and 10.07 mm Hg respectively. The sensitivity for the diagnosis of severe aortic stenosis is 90% with specificity 80%. CONCLUSIONS: The cMRI is a useful diagnostic method for the evaluation of patients with pure aortic valve stenosis, as good as TTE. cMRI can to be a diagnostic alternative in cases with limitations to TTE.