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ABSTRACT: Ischaemic hepatitis, although infrequent, should be considered as a cause of fulminant hepatitis in patients with congestive heart failure. Ischaemic hepatitis is characterized by a marked rise in transaminases occurring within 24-48 h of circulatory failure. Cardioversion of atrial fibrillation to sinus rhythm is associated with an increase in cardiac output in most patients; however, a transient reduction in cardiac output may occur in more than one-third of patients, and may therefore induce ischaemic hepatitis. This is the first report of fulminant ischaemic hepatitis as a complication of cardioversion of atrial fibrillation.
European Journal of Gastroenterology & Hepatology 01/2002; 13(12):1481-3. · 1.76 Impact Factor
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ABSTRACT: Nonstented bioprostheses have been associated with lower resting gradients than stented bioprostheses or mechanical valves. We compared the hemodynamic performance of nonstented bioprostheses and mechanical valves with normal native aortic valves at rest and exercise.
Dobutamine echocardiography was used to assess gradients and effective orifice area index at rest and exercise in patients with the Toronto stentless porcine valve (TSPV; n = 13; mean implant size 25.7 mm), Medtronic Freestyle (FR; n = 11; mean implant size 23.9 mm), Sorin Bicarbon (SOR; n = 11; mean implant size 24.5 mm), St. Jude Medical (SJM; n = 10; mean implant size 21.3 mm), and normal native aortic valves (NOR; n = 10).
All groups demonstrated a major rise in cardiac output at maximal dobutamine infusion. At rest and exercise, respectively, mean gradients were 5.48 +/- 1.1 mm Hg and 5.83 +/- 0.9 mm Hg for TSPV, 5.68 +/- 1.2 mm Hg and 7.50 +/- 1.7 mm Hg for FR, 10.29 +/- 1.4 mm Hg and 20.78 +/- 2.7 mm Hg for SJM, 5.26 +/- 0.8 mm Hg and 11.1 +/- 1.8 mm Hg for SOR, and 1.54 +/- 0.4 mm Hg and 2.18 +/- 0.7 mm Hg for NOR. In comparison with normal valves, both stentless groups showed no change in mean gradient at exercise, whereas both mechanical groups showed an increase in gradient at exercise (p < 0.04).
Stentless valves behave similarly to normal aortic valves in that there is almost no increase in gradient at exercise. Both mechanical valve groups showed increased gradients at exercise, suggesting that these valves obstruct blood flow. Our data add further evidence that stentless valves are hemodynamically superior to mechanical valves in the aortic position.
The Annals of Thoracic Surgery 10/2001; 72(4):1217-21. · 3.74 Impact Factor
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ABSTRACT: Surgical repair of atrial septal defect in adults reduces right ventricular and right atrial diameters and volumes, and improves left ventricular filling.
The American Journal of Cardiology 01/2001; 86(12):1395-7, A6. · 3.37 Impact Factor
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ABSTRACT: Angina pectoris usually occurs in patients with significant coronary artery disease during periods of increased coronary demand such as increased heart rate. Bradycardia is a rare and unusal cause of angina pectoris that should be considered during the evaluation of patients with agnia. This paper reports three cases of bradycardia-induced angina.
Clinical Cardiology 07/2000; 23(6):460-1. · 2.15 Impact Factor
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ABSTRACT: This study investigated the clinical and physiological significance of the dynamic left ventricle outflow gradient observed in some patients during dobutamine stress echocardiography.
Three hundred and ninety-four consecutive patients completed dobutamine stress echocardiography using Doppler echocardiography to assess the presence of myocardial ischaemia and left ventricular outflow gradient. The prevalence of left ventricular outflow gradient was evaluated and correlated with echocardiographic and clinical findings. Fifteen patients with left ventricular outflow gradient during dobutamine infusion underwent exercise echocardiography for appearance of left ventricular outflow gradient.
Sixty-nine of 394 (17.5%) patients developed a left ventricular outflow gradient of more than 36 mmHg. In nine of them (13%) the anterior mitral valve leaflet had a systolic anterior motion. In 60 of the 69 patients (87%) there was a dynamic obstruction at the level of the papillary muscles. The mean intracavitary gradient was 75.4 (range 36-175) mmHg. There was no correlation between the presence or absence of a dobutamine stress echocardiography-induced left ventricle outflow gradient and chest pain or shortness of breath. In patients who developed a left ventricular outflow gradient ischaemic wall motion abnormalities occurred at a significantly lower frequency during dobutamine stress echocardiography (2.9 vs 16.4% P<0.001). None of the 15 patients who underwent exercise echocardiography developed significant left ventricular outflow gradient.
Left ventricular outflow gradient occurs occasionally during dobutamine stress echocardiography examination. Its presence is of no physiological or clinical significance.
European Heart Journal 03/1999; 20(5):386-92. · 10.48 Impact Factor
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ABSTRACT: The diagnostic value of 12-lead electrocardiography during dobutamine stress echocardiography (DSE) is not well documented.
We reviewed the records of 116 patients referred for DSE and coronary angiography, 52 of whom were excluded because of abnormal ST segment or inadequate DSE. Of the analyzed 65 patients, 42 had angiographic evidence of significant coronary disease, 41 had evidence of ischemia according to the echocardiographic criteria, and 30 had ST changes during the study. DSE had sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 88%, 81%, 90%, and 78%, respectively. Twelve-lead electrocardiography had sensitivity, specificity, PPV, and NPV of 52%, 64%, 72%, and 41%, respectively. NPV increased to 92% in patients with negative DSE and negative ST changes. PPV increased to 95% if both DSE and 12-lead electrocardiographic ischemic changes were observed.
Twelve-lead electrocardiography has an incremental diagnostic value when used during DSE.
American Heart Journal 01/1999; 136(6):1061-4. · 4.65 Impact Factor
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American Heart Journal 12/1996; 132(5):1058-60. · 4.65 Impact Factor
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ABSTRACT: Pharmacologic testing with dobutamine or dipyridamole in conjunction with echocardiography has become an accepted method for diagnosis of coronary artery disease (CAD). The sensitivity of dobutamine echo ranges from 68 to 86%, and of dipyridamole from 53 to 69% for diagnosis of CAD. Our purpose was to investigate whether the addition of dipyridamole to dobutamine, which may improve the test sensitivity, is safe. Ten patients with low probability of CAD underwent dobutamine echo; 5 were control patients and 5 patients had low dose dipyridamole added at the maximal dose of dobutamine. Four of the latter patients had severe hypotension, while no hypotension was observed in control patients. Our findings suggest that this combination of dobutamine and dipyridamole can be hazardous and should not be used in patients with suspected CAD.
Israel journal of medical sciences 12/1996; 32(11):1105-7.
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ABSTRACT: While aortic valve prostheses are known to perform well at rest, few studies have examined them under stress. We compared stress hemodynamics of mechanical valves and nonstented porcine valves in the aortic position to that of normal native aortic valves.
Dobutamine echocardiography was used to assess mean and peak gradients and effective orifice area index (EOAI) at rest and exercise in patients with the Toronto Stentless Porcine Valve (SPV) (n = 13, mean implant size 25.7 mm), Sorin Bicarbon mechanical valve (SOR) (n = 11, mean implant size 24.5 mm), and patients with normal native aortic valves (NOR) (n = 10). Dobutamine infusion was started at 5 micron/kg per minute, and increased by increments of 5 micron/kg per minute until the target heart rate was achieved or until a maximal dose of 40 micron/kg per minute.
At rest and exercise, respectively, cardiac output (L/min) was 5.2 and 10.4 for Toronto SPV; 7.4 and 13.5 for SOR; and 4.6 and 11.2 for NOR. Measured EOAI (cm2) was 1.1+/-0.2 and 1.15+/-0.2 for TORONTO SPV; 1.60+/-0.3 and 1.58+/-0.3 for SOR; and 1.45+/-0.2 and 1.46+/-0.2 for NOR. Mean gradients (mmHg) were 5.48+/-1.1 and 5.83+/-0.9 for TORONTO SPV; 5.26+/-0.8 and 11.3+/-1.8 for SOR; and 1.54+/-0.4 and 2.18+/-0.7 for NOR. Peak gradients (mmHg) were 11.9+/-2.0 and 21.0+/-3.7 for TORONTO SPV; 10.79+/-1.7 and 25.9+/-3.4 for SOR; and 2.38+/-0.9 and 6.1+/-2.3 for NOR.
Although the mechanical group (SOR) had larger measured EOAI, the greater increase in gradients with exercise in this group suggests that the TORONTO SPV is less obstructive to flow.
Journal of Cardiac Surgery 13(5):412-6. · 0.87 Impact Factor
