Immediate and Follow‐Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First Procedure

Background: The widespread use of percutaneous mitral commissurotomy (PMC) has led to an increase in restenosis cases. The data regarding follow‐up results of repeat PMC are quite limited. The aim of this retrospective analysis is to evaluate the immediate and midterm results of the second PMC, in patients with symptomatic mitral restenosis after a succesful first procedure. Methods: Twenty patients (95% female, mean age 37 ± 4 years) who have undergone a second PMC, 6.3 ± 2.5 years after a first successful intervention built the study group. All were in sinus rhythm, with a mean Wilkins score of 8.5 ± 1.2. Results: The valve area increased from 1.2 ± 0.2 to 1.9 ± 0.2 cm² and mean gradient decreased from 10.5 ± 3.4 to 6.1 ± 1.1 mmHg. There were no complications except for a transient embolic event without sequela (5%) and two cases (10%) of severe mitral regurgitation. The immediate success rate was 90%. The mean follow‐up was 70 ± 29 months (36–156 months). The 5‐year restenosis and intervention (repeat PMC or valve replacement) rates were 9.1 ± 5.2% and 3.6 ± 3.3%, respectively. The intervention free 5‐year survival in good functional capacity (New York Heart Association [NYHA] I–II) was 95.1 ± 5.5% and restenosis and intervention free 5‐year survival with good functional capacity was 89.7 ± 6.8%. Conclusions: Although from a limited number of selected patients, these findings indicate that repeat PMC is a safe and effective method, with follow‐up results similar to a first intervention and should be considered as the first therapeutic option in suitable patients. (Echocardiography 2010;27:765‐769)     

Characterization of Mechanical Effects and β-Adrenoceptor Binding of Prenalterol in Rat Myocardium

Abstract: The partial β-agonist prenalterol has been found to differ from the full agonist isoprenaline in some aspects of its cardiac action. We therefore studied in rat myocardium whether prenalterol elicited the same qualitative changes of the contraction-relaxation cycle as was previously found for isoprenaline. We also measured binding of prenalterol to β-adrenoceptors. Prenalterol augmented relaxation more than contraction and thus evoked the same qualitative changes of the contraction-relaxation cycle as did isoprenaline. However, the response developed slowlier than that to isoprenaline, and the effect on relaxation followed a more protracted time course than the effect on contraction. Prenalterol bound non-selectively to β₁- and β₂-adrenoceptors in both heart and lung broken cell preparations. pK_d for binding to β-adrenoceptors and pD₂ values for functional effects in heart were similar, i.e. prenalterol had to occupy half the amount of β-adrenoceptors in order to evoke half-maximal functional effects. The non-selective α-blocker phentolamine potentiated the effects of prenalterol on contraction, but did not change the equilibrium binding of prenalterol to cardiac β-adrenoceptors. Phentolamine did not change the potency and efficacy of isoprenaline. Thus, although prenalterol qualitatively evoked the same response as isoprenaline, it also exhibited some properties which differed.     

Live three-dimensional right parasternal and supraclavicular transthoracic echocardiographic examination

In the present study, we describe the usefulness of the recently developed technique of live three-dimensional transthoracic echocardiography in the assessment of normal cardiac structures and adjacent vessels using the right parasternal and supraclavicular approaches. Examples of some abnormalities diagnosed from these approaches are also illustrated.     

Spontaneous splenic rupture complicating thrombolytic therapy in acute myocardial infarction

A 64-year-old woman with the diagnosis of acute anterior infarction was treated with streptokinase, i.v. heparin, and aspirin. After 20 hours of hospitalization she developed hypotension and a fall in hematocrit level with acute onset of severe abdominal pain. After genitourinary and gastrointestinal bleeding, pulmonary embolism and reinfarction had been ruled out, however, abdominal ultrasonography revealed intraabdominal hemorrhage and the patient was given three units of blood transfusion. Abdominal laparotomy and laparoscopy were not performed as the patient's clinical status stabilized on the 3rd day and hemodynamics did not deteriorate thereafter. Abdominal computerized tomography in the second week revealed a splenic rupture.     

Predictors and importance of congestive heart failure in patients with acute inferior myocardial infarction

Inferior myocardial infarction (MI) is considered to have a more favorable prognosis than anterior wall MI but includes high risk groups with increased mortality and morbidity. It is well known that congestive heart failure (CHF) complicating acute MI has poor prognosis. In this study we assessed the clinical and prognostic significance of CHF and the predictive value of the baseline demographic and clinical variables for CHF in patients with acute inferior MI. A total of 350 patients with acute inferior MI were included. In group A there were 26 patients (7.4%) with CHF, and in group B there were 324 patients (92.6%) without this complication. Baseline clinical and demographic characteristics and in-hospital complications of the groups were assessed. In group A patients were older (67.6±9.5 vs 53.7±10.9 years, p<0.0001) and there were more female patients (50% vs 15%, p<0.00001) compared to group B. The prevalence of diabetes mellitus (58% vs 16%) and precordial ST segment depression on admission ECG (81% vs 50%) were significantly higher in group A compared to group B (p<0.00001 and p=0.002 consecutively). In group A there was a higher rate of righ ventricular (25% vs 23%), posterior (26% vs 24%) and posterolateral myocardial infarction (19% vs 14%), but the differences were not statistically different. In group A patients had significantly higher rate of second- or third-degree AV block (46% vs 8%, p<0.00001), cardiogenic shock (35% vs 1%, p<0.00001) and mortality (46% vs 3%, p<0.00001) compared to group B. In a multivariate regression analysis diabetes mellitus (p=0.0003) and precordial ST segment depression on admission ECG (p=0.002) were found as the independent predictors of in-hospital CHF in patients with acute inferior MI. CHF and ST segment depression on admission ECG were found as the independent predictors of in-hospital mortality (p<0.00001, p=0.04 consecutively). Patients with CHF complicating acute inferior MI have more unfavorable demographic and clinical characteristics on admission, higher rate of in-hospital complications and mortality. History of diabetes mellitus and precordial ST segment depression on admission ECG have an independent predictive value for CHF in this particular group of patients.     

Enoxaparin for the Treatment of Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: the ENO-INT Study

AIM. To assess safety and efficacy of enoxaparin in patients with UA/NSTEMI in an open-label, multi-centre, non-comparative study and to compare the results with data from large-scale randomized trials ESSENCE and TIMI-11B. METHODS: Patients hospitalized with a diagnosis of recent UA/NSTEMI were treated with 1 mg/kg enoxaparin every 12 hours for 2-8 days. The composite endpoint of the study was death, myocardial infarction (MI) or recurrent angina at day 15 (or hospital discharge). Minor and major bleedings were recorded. RESULTS: A total of 1902 patients were enrolled in 109 centers across 24 countries, of which 1901 received at least one injection of enoxaparin and 1785 (93.8%) completed the study (follow-up). Throughout the study (day 180) 21.4% of patients underwent at least one revascularization, of which 4.4% were urgent. The incidence of the composite efficacy endpoint was 16.3% after 15 days and 27.9% on day 180, which was comparable with the enoxaparin arm of the ESSENCE/TIMI 11B studies, and lower than the incidence found in the UFH arm of those studies. At day 15 or hospital discharge the occurrence of major and minor haemorrhages was 1.1 and 6.6%, respectively, which was lower than in ESSENCE/TIMI 11B. More bleeding complications (major and minor) were noted in patients aged 相似文献   

Lack of Functional Influence by Prenalterol through α1-Adrenoceptors in Rat Myocardium

Abstract: Some of the cardiac properties of the partial β-agonist prenalterol may indicate a contribution from α₁-adrenergic stimulation. We therefore studied whether prenalterol interacted with α₁-adrenoceptors in rat myocardium. Combination with propranolol did not reveal an α₁-adrenergic inotropic effect of prenalterol in papillary muscles. Neither did prenalterol block the α₁-adrenergic response to phenylephrine. In myocardial cells, prenalterol inhibited ³H-prazosin binding to α₁-adrenoceptors only at very high concentrations. Prenalterol thus exhibited no functionally important interactions with α₁-adrenoceptors in myocardium, and its properties cannot be accounted for in terms of contribution from α₁-adrenergic effects.     

Differentiation of cardiac chronotropic and inotropic effects of β-adrenoceptor agonists

Summary The relative inotropic and chronotropic activity of -adrenoceptor agonists was studied in the noradrenaline-depleted, anaesthetized cat. Terbutaline, a selective ₂-adrenoceptor agonist, gave at a certain dose a more pronounced chronotropic than inotropic response, while a new ₁-selective adrenoceptor agonist (–)-H 80/62 produced the same degree of chronotropic and inotropic stimulation. The results indicate that there is some difference between the -adrenoceptors in the sinus node mediating chronotropic stimulation and -adrenoceptors in the ventricular myocardium mediating stimulation of the contractile force. It has been shown that there are both ₁- and ₂-adrenoceptors in the heart (Carlsson et al., 1972). In the light of this finding it is hypothetized that there are differences in the relative distribution of ₁- and ₂-adrenoceptors in the sinus node and in the myocardium. Although ₁ is the predominant type of -adrenoceptor in both regions, the ₁: ₂ concentration ratio seems to be higher in the myo-cardium, than in the sinus node.