[The Registry for Angioplasty in Infarction (RAI): brief preliminary report on the main indicators and process of acute outcome]. / Registro per l'Angioplastica nell'Infarto (RAI): breve report preliminare dei principali indicatori di processo e di esito acuto. Conto di Tutti i Ricercatori del RAI.

BACKGROUND: Emergency coronary angioplasty can be the treatment of choice in selected patients with acute myocardial infarction in centers with adequate facilities and organization. METHODS: A multicenter observational study in patients with high-risk acute myocardial infarction was conducted to evaluate the quality of emergency angioplasty treatment according to process, acute and long-term outcome, and use of resources. RESULTS: The RAI registry included 345 patients with high-risk acute myocardial infarction who were admitted to six participating centers over a thirteen-month period. Emergency coronary angiography was performed in 261 patients (76%) and was followed by immediate angioplasty in 236 of them (68%). Mean door-to-procedure time was 58 +/- 47 min. Severe left ventricular failure was present at admission in 35 (13%) of the 261 patients with emergency coronary angiography; and 29 of them were in cardiogenic shock (11%). Overall, in-hospital mortality for patients with angioplasty was 7.6%; i.e., 43% and 3.7% for patients with and without shock, respectively. CONCLUSIONS: Despite logistical limitation, in centers with emergency angioplasty programs this treatment can be performed with favorable process and acute outcome characteristics in patients with high-risk myocardial infarction.

[Coronary angioplasty in unstable angina at rest. Influence of the degree of clinical instability on the immediate and long-term results]. / La angioplastica coronarica nella angina instabile a riposo. Influenza del grado di instabilità clinica sui risultati immediati e a distanza.

BACKGROUND: Coronary angioplasty in patients with unstable angina is associated with higher rate of complications and less favourable long term results in contrast to those patients with stable angina. OBJECTIVES: To establish whether temporary clinical stabilization of at least 48 hours prior to PTCA in patients with angina at rest carries an improvement in immediate and long term results. METHODS: A survey was carried out on 188 consecutive patients with recent onset angina at rest. Analysis included immediate results, complication rate, and 1 year follow up status. Patients were divided in 2 groups in accordance with Braunwald classification: i.e. on the basis of absence (Group II B, 90 patients) or presence (Group III B, 98 patients) of spontaneous angina at rest in the 48 hours prior of PTCA. Patients excluded were those with early postinfarction angina (15 days) and those with unstable angina following coronary restenoses after PTCA. RESULTS: The 2 groups were similar with regard to the main baseline clinical and angiographic characteristics, with the exception of intravenous administration of heparin and nitrates at the time of PTCA (47% in Group II B vs 85% in Group III B, p < 0.01) and the rate of intracoronary thrombus in the angiograms before dilatation (3% vs 15% respectively, p < 0.05). Complication rate was 2% in Group II B (2 acute myocardial infarction--AMI) and 4% in Group III B (1 death and 3 emergency By-pass operation) (p = n.s.). Clinical success was achieved in 93% of II B patients and 92% in Group III B (p = n.s.). During 12 months follow-up no significant difference in adverse events was found in either groups. There were no late deaths. Two patients in both groups experienced AMI. Thirtyone per cent of patients in Group II B and 34% in Group III B complained of recurrence of angina. The 12-months event free survival (the absence of AMI, repeat PTCA, by-pass operation and recurrence of angina) was 62% in both groups. CONCLUSIONS: In patients with unstable angina who underwent intensive pharmacological treatment including intravenous heparin and nitrates, the results of PTCA showed no negative influence of spontaneous angina which occurred in the 48 hours prior the procedure. To obtain complete clinical stabilization over a 48 hour waiting period would therefore appear to be no longer warranted.

Mobile right atrial mass biopsy guided by biplane transesophageal echocardiography.

Transesophageal echocardiography (TEE) has been successfully used in monitoring complex or high-risk interventions in the cardiac catheterisation laboratory. We report a case in which biplane TEE was used to facilitate the biopsy of a mobile right atrial mass.

Clinical and angiographic follow-up after coronary angioplasty in patients with two-vessel disease: influence of completeness and adequacy of revascularization on long-term outcome.

To assess the influence of the degree of revascularization on long-term results with angioplasty in multivessel disease, 151 consecutive patients with double-vessel disease and successful angioplasty in at least one vessel were prospectively followed up for a mean of 14 months (range 6 to 30 months) with clinical evaluation, an exercise stress test, and routine angiography. Patients were divided into three groups according to completeness and adequacy of revascularization: group 1--complete revascularization (no residual stenosis > or = 70%, 51 patients); group 2--incomplete but functionally adequate revascularization (residual stenosis > or = 70% in a vessel < 2 mm in diameter or supplying akinetic or dyskinetic segments of the left ventricle, 56 patients); group 3--incomplete and inadequate revascularization (residual stenosis > or = 70% in a vessel > or = 2 mm in diameter supplying normal or hypokinetic segments, 45 patients). There were no late deaths; one myocardial infarction occurred in group 1 patients, three in group 2, and two in group 3 patients (p = NS). Recurrence of angina was lower in group 1 (13 of 51 or 26%) and group 2 (16 of 56 or 28%) compared with group 3 (23 of 45 or 51%, p < 0.01). A positive stress test for ischemia was present in 20 patients (39%) of group 1, in 30 (54%) of group 2, and in 26 patients (58%) of group 3.(ABSTRACT TRUNCATED AT 250 WORDS)

[Aortic dissection: an incidence study based on hospital cases]. / Dissecazione aortica: studio dell'incidenza basato su una casistica ospedaliera.

To ascertain the incidence of aortic dissection, we retrospectively studied the data base of our hospital (Ospedale di Treviso-ULSS n 10). The population in the Treviso area is well defined as a geographic settlement and was sufficiently stable from a demographic point of view in the period examined (1976-1988). Patients were selected on the basis of established aortic dissection diagnosed by angiography, surgical inspection or autopsy. One hundred eighty-seven patients were included: 126 of them lived in the hospital-referring area (mean annual population of 239824 people in the study period). The calculated incidence of aortic dissection was 40.4 new cases/million inhabitants/year. This figure is consistently higher than that reported in the literature. The outcome of the study is discussed and data are compared with those of previously published papers.

Transesophageal echocardiographic findings in partial and complete papillary muscle rupture complicating acute myocardial infarction.

Papillary muscle rupture occurred in two patients with recent inferior myocardial infarction. In one case with partial rupture transesophageal echocardiography in the standard four-chamber view did not visualize the rupture and in the second case with complete rupture it provided incomplete diagnostic information. A not previously described transgastric longitudinal scanning of the left ventricle provided complete delineation of the lesion and it was of great value in the diagnosis and management of this potentially lethal complication. Both patients were operated upon and had a favourable outcome.

Coronary angioplasty in single-vessel complex lesions: short- and long-term outcome and factors predicting acute coronary occlusion.

Percutaneous transluminal coronary angioplasty (PTCA) of complex coronary lesions (plaque ulceration and/or thrombus) has an increased risk of procedural complications. To assess the influence of these angiographic features on immediate and long-term results of PTCA, we prospectively compared the success rate, incidence of procedural complications, and restenosis rate in two groups of patients selected on the basis of the presence (study group = 30 patients) or absence (control group = 200 patients) of complex morphology at the time of angioplasty. The two groups were similar with regard to extent of coronary artery disease and site of coronary stenosis. Patients in the study group had a higher incidence of periprocedural acute coronary occlusion (47% vs 6%; p less than 0.01), which in 78% of the cases was successfully treated with repeat angioplasty and intracoronary thrombolysis. Univariate correlates of this complication were Canadian Cardiovascular Society class IV (57% vs 19%; p less than 0.05) and recent (less than 30 days) onset of worsening of symptoms (71% vs 31%; p less than 0.05). The incidence of acute myocardial infarction was slightly higher in the study group (6.7% vs 2%; p = NS), and the success rate with redilatation was the same (90%). Clinical and angiographic follow-up data were obtained from all patients in whom the procedure was successful; the restenosis rate was 55% in the study group compared with 36% in the control group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Type A aortic dissection: the role of angiography in identifying morphologic features in comparison with autopsy and surgical findings]. / Dissecazione aortica di tipo A: ruolo della angiografia nella valutazione delle caratteristiche morfologiche; confronto con i reperti anatomici e chirurgici.

To evaluate the reliability of cineangiography in identifying some morphologic characteristics of type A aortic dissection, the angiograms of 36 consecutive patients were retrospectively revised and compared with the surgical of necropsy findings. The following features were examined: site and extension of intimal tear (s); extension of the wall dissection; coronary and brachiocephalic arteries involvement; coexisting anuloaortic ectasia; aortic valve state. The angiographic diagnosis of site and extension of the intimal tear was correct in 97 (35/36) and 100% of cases respectively. In one case the presence of an intimal tear at the level of the aortic arch was missed because of the superimposition of the innominate artery. The extension of the wall dissection was correctly identified in 24 out of 25 patients. In one case the presence of distal false lumen thrombosis made the correct diagnosis impossible. The brachiocephalic arteries involvement was always correctly stated while the coronary involvement was suspected in 6 and confirmed in 5 (1 false positive). Anuloectasia was suspected in 12 and confirmed in 10 (2 false positives). In our experience the most challenging diagnosed were the presence of aortic arch tears and the aortic arch and coronary arteries involvement in the dissection. This study confirms that many morphologic features of type A aortic dissection can be adequately assessed by cineangiography.

[Cardiac rhythm disorder in infection caused by cytomegalovirus in patients with kidney transplant]. / Turbe del ritmo cardiaco in corso di infezione da citomegalovirus nei trapianti di rene.

A higher incidence of arrhythmias was observed in 16 renal allograft recipients infected with Cytomegalovirus (CMV), as compared to 26 patients who were transplanted during the same period and did not contract the infection (43.7% vs. 3.8%; p less than 0.01). There was a highly significant difference in the incidence of sinus tachycardia (37.5% infected vs. 0% not infected; p less than 0.005), while the incidences of atrial fibrillation and ventricular ectopic beats were not significantly different. The arrhythmias always appeared in the early phases of the infection and disappeared after a certain period, lasting from one week to months. It is proposed that arrhythmias arising during CMV infection may be due to a myocardial CMV involvement.

[Pulmonary atresia with interventricular communication. Review of concepts]. / Atresia pulmonar con comunicación interventricular. Revisión de conceptos.

The purpose of this paper is to clarify the definition and anatomic characteristics of pulmonary atresia with ventricular septal defect. This complex congenital cardiac malformation produces great controversy in the literature. We analyze some embryological aspects, the right ventricular outflow tract anatomy and pulmonary arterial pattern with the various patterns of collateral blood supply. A good understanding of these anatomic characteristics is of great importance in the hemodynamic and angiographic diagnostic procedures and in the planning of surgical correction. The differential diagnosis with other congenital heart diseases with single outlet from the heart is discussed.

Atresia pulmonar con comunicacion interventricular: Revision de conceptos. / Pulmonary atresia with ventricular septal defect: review of concepts

Este trabajo se propone hacer mas clara la definicion y las caracteristicas anatomicas de la atresia pulmonar con comunicacion interventricular. El concepto de esta compleja malformacion congenita del corazon es muy controvertido en la literatura.Nosotros analizamos algunos aspectos embriologicos, la anatomia del tracto de salida del ventriculo derecho y la distribucion del arbol arterial pulmonar con las varias posibilidades de circulacion colateral. El conocimiento de estas caracteristicas anatomicas es importante tanto para el diagnostico como para el planteamiento quirurgico. Ademas se discute el diagnostico diferencial entre esta cardiopatia y otras cardiopatias congenitas con unica via de salida del corazon a traves de la aorta

[Segmental echocardiographic analysis of congenital cardiopathies]. / Análisis ecocardiográfico segmentario de las cardiopatías congénitas.

The usefulness of M mode and two-dimensional echocardiography in the segmental localization of the cardiac chambers in congenital heart disease was studied. Nineteen patients with congenital heart disease and various possibilities of conexion of the different segments of the heart were diagnosed by angiocardiography and in some cases by surgical treatment. The echocardiographic diagnosis in these cases was based in the analysis of the spatial position of the heart chambers, atrio-ventricular, aortic and pulmonary valves. The results obtained are presented and the differential diagnosis is discussed. We conclude that in the majority of these patients with complex congenital heart disease, the diagnosis can be suggested by echocardiography, or at least, this procedure can guide us to program the angiocardiographic studies.