RESUMO
Transluminal coronary angioplasty (TCA) with pulsed excimer laser (CVX 300 Spectranetics) was performed in 89 patients (age 63.7 years); CCS I: 6; CCS II: 12; CCS III: 40; CCS IV: 31; instable: 58%. There was a previous history of myocardial infarction (MI) in 27 cases, TCA (9 restenoses) in 24 cases, 19 bypass graft procedures, 13 failures of TCA. The lesions (n = 90) affected the left main coronary artery: 1 case; the left anterior descending artery: 37 cases; the left circumflex: 8 cases; the right coronary: 28 cases and there were saphenous vein grafts in 16 cases. The lesions were classified B2 (ACC/AHA) in 56 cases and type C in 34 cases. There were 24 lesions > 10 mm, 15 > 20 mm; calcification in 49 cases; excentric in 65 cases; ostial in 9 cases; affecting bifurcations in 13 cases; affecting collateral vessels in 16 cases; chronic occlusions in 12 cases and restenoses of stents in 4 cases. Multifiber catheters: 1.4 mm (50), 1.7 mm (41) and 2 mm (3), were used to deliver energies of 43.3 mj/m2 (+/- 8.1 mj) with an average of 5.2 +/- 1.2 applications persite, and 2.7 +/- 1.1 passages. A balloon dilatation was performed after laser angioplasty in 96% of cases. The following results were observed: success of laser angioplasty (20% reduction of stenosis) in 95.5%, a successful procedure (residual stenosis less than 50% without major complications) in 95.5%, and a clinical success (no pathological Q wave or non-Q wave infarction, bypass graft, or repeat TCA): 92.1%. The following complications were observed: death = 0, non-Q wave infarction 2.2%, emergency bypass surgery in 1 case with Q wave infarction: 1.1%. The use of laser angioplasty may be proposed in the following indications: long, moderately calcified lesion, ostial lesions, complete occlusions, bypass graft disease, failure of angioplasty. In addition to these indications, we propose the treatment of restenosis on stents. The main disadvantage of the Excimer Laser is the poor cost/benefit ratio, given the relatively small number of indications.
Assuntos
Angioplastia Coronária com Balão , Angioplastia com Balão a Laser , Doença das Coronárias/cirurgia , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia com Balão a Laser/efeitos adversos , Angiografia Coronária , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva , Sistema de Registros , Fatores de Risco , Falha de Tratamento , Resultado do TratamentoRESUMO
The results of peripheral transluminal angioplasty are satisfactory in stenotic arteries but those observed in the recanalisation of occluded peripheral arteries are not so good. There would therefore seem to be a good therapeutic opportunity for laser between angioplasty and surgery for patients with symptomatic arterial occlusion. The authors report their experience with the Lastac laser in 12 patients with symptomatic superficial femoral arterial occlusion. This is a no-contact laser. All patients had surgical indications in case of failure to recanalise by laser, despite collateral circulation by the profunda artery which was inadequate on effort leading to claudication and a limited walking perimeter. After 1 initial failure, 11 successful procedures were performed. There were no perforations due to the Argon laser beam but 2 were observed with the guide wire which was rapidly sealed by the balloon catheter. A surgical haematoma at the percutaneous puncture point resulted in 1 reocclusion during the patient's hospital period so that the 11 technical successes became 10 clinical successes. At medium-term follow-up, one asymptomatic occlusion had occurred and one restenosis was successfully redilated. The advantages of a continuous Argon "Lastac" laser compared with a contact laser are its capacity for auto-control, its coaxial fibre placement and the absence of direct contact with the lesion. The coaxial fibre arrangement plays an important role in preventing vascular perforation. These factors enable it to be used with more safety in patients with arterial occlusion.
Assuntos
Angioplastia com Balão , Arteriopatias Oclusivas/terapia , Artéria Femoral , Terapia a Laser , Seguimentos , Humanos , RecidivaRESUMO
Out of 1400 percutaneous transluminal coronary angioplasties (PTCA), 23 (1.6 p. 100) were performed by the left percutaneous axillary approach because the bifemoral approach could not be used. There were 18 patients (17 men, 1 woman) with a mean age of 58 years. The coronary vessels dilated were the anterior interventricular artery (n = 4), the circumflex artery (n = 9) and the right coronary artery (n = 10), i.e. a total of 25 stenoses. The success rate in procedures was 83 p. 100 (19/23), and the primary success rate in patients was 83.3 p. 100 (15/18): Despite a good initial result, one patient developed inferior myocardial infarction as a result occlusion of a dominant distal circumflex artery, due to protamine administration immediately after the procedure. Another failure ascribable to the approach was due to selective catheterization being impossible. The mean duration of TCA was 38 min. In every cases the arterial introducer was withdrawn after neutralization with protamine. There were 4 cases of restenosis (25 p. 100) :3 were treated by a second PTCA using the percutaneous axillary approach and 1 by surgery. The method has the following disadvantages: (1) neutralization with protamine is mandatory (we had 1 case of occlusion with infarction after protamine in this series); (2) it is imperative to prevent the formation of a blood collection that would infiltrate the brachial plexus; for this purpose, the axillary cavity must be compressed effectively after PTCA and the puncture area must be watched for 24 to 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Angioplastia Coronária com Balão/métodos , Doença das Coronárias/terapia , Adulto , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protaminas/uso terapêutico , Fatores de TempoRESUMO
Endocavitary extraction of intracardiac fragments of intravenous catheters was attempted in 14 patients over a 7 year period. The fragments were recovered in 13 cases under local anaesthesia without complications. The average duration of the procedure was less than 15 minutes. The technique requires a pigtail catheter, a material which is usually readily available in all catheter laboratories. This simple procedure may prevent complications and enable some patients to avoid surgery.
Assuntos
Cateterismo/efeitos adversos , Corpos Estranhos/terapia , Coração , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Feminino , Migração de Corpo Estranho , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Sistema de Condução Cardíaco/efeitos dos fármacos , Mexiletina/farmacologia , Propilaminas/farmacologia , Adulto , Idoso , Arritmias Cardíacas/tratamento farmacológico , Fascículo Atrioventricular/efeitos dos fármacos , Feminino , Humanos , Infusões Parenterais , Masculino , Mexiletina/administração & dosagem , Mexiletina/uso terapêutico , Pessoa de Meia-Idade , Ramos Subendocárdicos/efeitos dos fármacosRESUMO
13 patients with chronic obstructive pulmonary disease (COPD) were studied for left ventricular function immediately after acute decompensation. Parameters of right and left ventricular function were measured. Mean pulmonary wedge pressure (Paw) was elevated (11.9 mm Hg) but there was no correlation between Paw and left ventricular end-diastolic pressure (LVEDP). The indices of left ventricular contractility were in the normal range. In 4 patients, LVEDP was too high. A correlation was established between RVEDP and LVEDP. Left ventricular compliance, as studied by the index of Diamond and Forrester, was abnormal. Two conclusions are discussed: (1) in COPD, Paw cannot indicate left ventricular dysfunction; (2) alteration of left ventricular compliance is possibly related to an elevation of RVEDP.
Assuntos
Coração/fisiopatologia , Pneumopatias Obstrutivas/fisiopatologia , Idoso , Dióxido de Carbono/sangue , Complacência (Medida de Distensibilidade) , Ventrículos do Coração/fisiopatologia , Humanos , Pneumopatias Obstrutivas/sangue , Pessoa de Meia-Idade , Oxigênio/sangueAssuntos
Aorta/cirurgia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Próteses Valvulares Cardíacas/mortalidade , Humanos , Hipotermia Induzida , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Estenose da Valva Mitral/mortalidadeRESUMO
In a series of 103 consecutive surgical patients, the normal and pathological echocardiographic appearances of the tricuspid valve were analysed and compared with the anatomical findings. It was possible to define the nature of the lesions by echocardiography, which was superior to angiography in this field. The right ventricular index (right ventricular dimension body surface area) correlated well with the mean pulmonary artery pressure (r = 0.75; p less than 0.001). The index may be useful in the long term follow-up of post-operative patients.
Assuntos
Ecocardiografia , Insuficiência da Valva Tricúspide/diagnóstico , Adolescente , Adulto , Angiografia , Pressão Sanguínea , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiologiaRESUMO
The authors report their experience of 21 revision operations for malfunction of the Beall Surgitool 104 prosthesis used in the mitral position. The incidence and uniformity of the disorders found in the prostheses suggest that these changes are produced inevitably usually during the fourth year. The disc becomes kinked, the mountings eroded, and the teflon ring torn. The clinical features are the onset of heart failure, anaemia, or a thrombo-embolic episode. These three findings may occur individually or in association. The authors do not advise systematic revision surgery, but conclude that close follow-up is essential in the case of all patients who have had a Beall prosthesis. Early signs of failure should be revealed by clinical examination, the level of LDH, and by phonocardiogram and echocardiogram studies. Leaving aside thrombo-embolic episodes and severe anaemia which themselves constitute indications for revision surgery, the decision to replace the damaged prosthesis should be taken as soon as the first signs of cardiac failure are detected.
Assuntos
Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Anemia Hemolítica/etiologia , Valva Aórtica/cirurgia , Humanos , Tromboembolia/etiologia , Fatores de Tempo , Valva Tricúspide/cirurgiaAssuntos
Aneurisma Aórtico/diagnóstico , Dissecção Aórtica/diagnóstico , Ecocardiografia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors present a case of a continuous right lateral sternal murmur which led to the discovery of a systemic-to-pulmonary fistula at the origin of the internal mammary artery. The fact that the patient had a right pulmonary abscess with pyopneumothorax drained several years previously has led them to discuss the possible etiology of this fistula. The murmur disappeared after surgical treatment.