Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
Add more filters










Database
Language
Publication year range
1.
Circulation ; 86(2): 458-62, 1992 Aug.
Article in English | MEDLINE | ID: mdl-1638715

ABSTRACT

BACKGROUND: Accelerated allograft atherosclerosis is the main cause of death of cardiac transplant recipients after the first year after transplantation. Because no medical therapy is known to prevent or retard graft atherosclerosis and transplantation is associated with a shortened allograft survival, alternative, palliative therapy with percutaneous transluminal coronary angioplasty (PTCA) has been attempted. Because no single medical center has performed angioplasty in a large number of cardiac transplant recipients, representatives of 11 medical centers retrospectively analyzed their complete experience of coronary angioplasty in cardiac transplant patients to determine the safety, efficacy, limitations, and long-term outcome of angioplasty in allograft coronary vascular disease. METHODS AND RESULTS: Thirty-five patients underwent 51 angioplasty procedures for 95 lesions 46 +/- 5 months (mean +/- SEM) after transplantation. The primary indications for angioplasty included angiographic coronary disease in 22 cases (43%) and noninvasive evidence of ischemia in 18 procedures (35%). Angiographic success, defined as less than or equal to 50% post-PTCA stenosis, occurred in 88 of 95 lesions (93%). Mean pre-PTCA stenosis was 83 +/- 1.1%; mean post-PTCA stenosis was 29 +/- 2.1% (p less than 0.0001). Periprocedural complications included myocardial infarction and late in-hospital death in one patient and three groin hematomas. Twenty-three of the 35 patients (66%) had no major adverse outcome such as death, retransplantation, or myocardial infarction at 13 +/- 3 months after angioplasty. Four patients died less than 6 months after angioplasty, and four died more than 6 months after angioplasty (range, 6-23 months). Two patients had retransplantation 2 months after PTCA, and one patients had retransplantation 18 months after angioplasty. CONCLUSIONS: Coronary angioplasty may be applied in selected cardiac transplant recipients with comparable success and complication rates to routine angioplasty. Whether angioplasty prolongs allografts survival remains to be determined by a prospective, controlled trial.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Artery Disease/therapy , Heart Transplantation/adverse effects , Coronary Angiography , Coronary Artery Disease/etiology , Coronary Artery Disease/mortality , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Time Factors
3.
J Thorac Cardiovasc Surg ; 100(1): 6-12, 1990 Jul.
Article in English | MEDLINE | ID: mdl-2366566

ABSTRACT

Although the etiology of allograft coronary artery disease, a major limiting factor in long-term survival after cardiac transplantation, is poorly understood, it is undoubtedly in part immune mediated and not detected by routine endomyocardial biopsy. Therefore it is possible that withdrawal of maintenance corticosteroids, although providing other short- and long-term benefits, could increase the prevalence of allograft coronary artery disease by permitting undetected immune-mediated vascular injury to occur. To assess whether corticosteroid-free maintenance immunosuppression increased the prevalence of allograft coronary artery disease, we reviewed serial angiograms of 102 patients (49% not receiving corticosteroid maintenance therapy) who underwent heart transplantation after March 7, 1985. Multiple variables including serum cholesterol, recipient and donor age, sex, blood pressure, rejection frequency and severity, early rejection prophylaxis protocol (polyclonal versus monoclonal T-cell agents), and corticosteroid use were examined in relation to allograft coronary artery disease by univariate and multivariate analyses. Allograft coronary artery disease was identified in 21 patients (seven severe, four moderate, and 10 mild). The prevalence by Kaplan-Meier life-table analysis was 17% at 1 year and 25% at 2 years. No further allograft coronary artery disease was detected among patients undergoing angiography at three years. Increased allograft coronary artery disease was not noted in patients withdrawn from maintenance corticosteroids when compared with their corticosteroid-requiring counterparts. In fact, with each 1 gm increment in cumulative corticosteroid use, a slightly increased risk (1.04, p less than 0.05) of allograft coronary artery disease was noted (Cox regression model). None of the other variables correlated with the prevalence of allograft coronary artery disease. Thus withdrawal of maintenance corticosteroids is not associated with an increased risk of early allograft coronary artery disease and minimization of corticosteroids may lead to a decreased long-term incidence of coronary artery disease in cardiac transplant recipients.


Subject(s)
Coronary Disease/diagnostic imaging , Heart Transplantation , Immunosuppressive Agents/administration & dosage , Adrenal Cortex Hormones/administration & dosage , Adult , Coronary Angiography , Coronary Disease/etiology , Female , Graft Rejection , Heart Transplantation/mortality , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
4.
Br Heart J ; 62(2): 154-6, 1989 Aug.
Article in English | MEDLINE | ID: mdl-2765327

ABSTRACT

A 29 year old woman had a myocardial infarction three weeks post partum. Coronary angiography was performed six days later. No abnormalities were seen initially, but re-injection of the left coronary artery resulted in a dissection that extended through the anterior descending and circumflex branches and a reinfarction. This case suggests that myocardial infarctions occurring in patients with angiographically normal coronary arteries may be caused by dissections that heal by the time of catheterisation.


Subject(s)
Myocardial Infarction/etiology , Puerperal Disorders/etiology , Adult , Aortic Dissection/complications , Coronary Angiography , Female , Humans , Myocardial Infarction/diagnostic imaging , Pregnancy
5.
Am Heart J ; 117(3): 680-3, 1989 Mar.
Article in English | MEDLINE | ID: mdl-2919541

ABSTRACT

A technique for performing retrograde catheterization of the left atrium followed by double balloon mitral valvuloplasty without transseptal catheterization is described. Three patients have undergone double balloon mitral valvuloplasty by means of this technique, all with marked improvement in postdilatation mitral valve areas. The technique avoids iatrogenic atrial septal defects and is less difficult to perform than transseptal catheterization.


Subject(s)
Cardiac Catheterization/methods , Catheterization/methods , Mitral Valve Stenosis/therapy , Adult , Aged , Calcinosis/therapy , Echocardiography , Female , Hemodynamics , Humans
6.
Am Heart J ; 117(1): 11-7, 1989 Jan.
Article in English | MEDLINE | ID: mdl-2911964

ABSTRACT

Three different techniques for percutaneous balloon aortic valvuloplasty h have been described: retrograde single balloon, retrograde double balloon, and antegrade techniques. This report describes our experience using the three techniques in twenty-five consecutive procedures. All techniques resulted in a significant decrease in transvalvular pressure gradient and an increase in calculated aortic valve area, without significant difference among the three. There was no increase in the degree of aortic regurgitation after valvuloplasty by any of the techniques. Vascular complications occurred only with the retrograde double balloon technique. Cardiac tamponade during balloon inflation occurred with both the retrograde single and double balloon techniques. Three deaths occurred; two during the antegrade technique and one after the retrograde double balloon technique. Thus, balloon aortic valvuloplasty can be effectively performed using any of the three techniques. However, the differing techniques have inherent advantages in specific situations, as well as potential complications.


Subject(s)
Aortic Valve Stenosis/therapy , Balloon Occlusion , Catheterization/methods , Aged , Aged, 80 and over , Aortic Valve/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Aortography , Blood Pressure , Catheterization/adverse effects , Echocardiography, Doppler , Female , Humans , Male
7.
Clin Obstet Gynecol ; 31(4): 955-62, 1988 Dec.
Article in English | MEDLINE | ID: mdl-3067936

ABSTRACT

Coronary heart disease should not be considered a male dominated disease. The incidence of clinical CHD lags by several years in women, but it remains a leading cause of death and disability in the adult female. Risk factors for the development of coronary atherosclerosis are essentially the same for both sexes. Management strategies are usually similar regardless of gender.


Subject(s)
Coronary Disease , Coronary Disease/diagnosis , Coronary Disease/etiology , Coronary Disease/therapy , Female , Humans , Risk Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...