[Effect of myocardial revascularization on asymptomatic ischemic episodes]. / Efeito da cirurgia de revascularização miocárdica sobre os episódios isquêmicos assintomáticos.

PURPOSE: To evaluate the effect of coronary artery bypass graft surgery (CABG) on ischemic asymptomatic episodes (IAE). METHODS: Twenty eight males (means age 57.3 +/- 9.6 years) with stable angina and no microcirculation abnormalities, who presented with IAE after medication withdrawal, were studied using ambulatory electrocardiography monitoring. Presence of IEA was analyzed before and 4 months after CABG according to its frequency and heart rate (HR) response. CAGB was considered complete in 75% of the cases. RESULTS: The number or IAE was reduced from 162 (9 symptomatic) in the preoperative period to 4 after surgery (p < 0.05). In two patients with IAE in the postoperative period, coronariography confirmed obstruction of aortocoronary grafts. Analysis of HR at the beginning and peak of IAE suggested as mechanisms both reduced blood flow and increased oxygen consumption by the myocardium. CONCLUSION: CABC eliminated IAE regardless of HR. When IAE is present after surgery, graft occlusion should be suspected.

Efeito da cirurgia de revascularizaçäo miocárdica sobre os episódios isquêmicos assintomáticos / Effect of coronary artery bypass graft surgery on ischemic asymptomatic episodes

OBJETIVO - Avaliar o efeito da cirurgia de revascularizaçäo miocárdica (CRM) sobre episódios isquêmicos assintomáticos (EIA). MÉTODOS - Foram estudados 28 homens, com angina estável (idade média 57,3ñ9,6) anos sem condiçöes relacionadas a alteraçöes de microcirculaçäo e que, após retirada da medicaçäo, apresentaram EIA à eletrocardiografia ambulatorial (ECGA). No pré-operatório e 4 meses após a cirurgia foram analisados os comportamentos dos EIA, segundo sua freqüência, e o de suas freqüências cardíacas (FC). A revascularizaçäo miocárdica foi completa em 75 'por cento' dos casos. RESULTADOS - O número dos EIA foi reduzido de 162 (9 sintomáticos) no pré-operatório para, apenas, 4 no pós-operatório (p<0,05). Nos dois pacientes com EIA no operatório, estudo cinecoronariográfico confirmou obstruçäo de enxertos aortocoronários. A análise das FC no início e pico dos EIA sugeriram envolvimento de mecanismo de reduçÝo de oferta e aumento de consumo de oxigênio pelo miocárdio. CONCLUSÄO - A CRM eliminou os episódio isquêmicos relacionados ou näo ao aumento da FC. Quando os EIA encontram-se presentes após CRM, devemos considerar a possibilidade de oclusäo de enxerto.

[Clinical profile of aged patients with severe aortic stenosis]. / Perfíl clínico de idosos portadores de estenose aórtica severa.

PURPOSE: To evaluate clinical symptoms and echocardiographic findings in elderly patients with severe aortic stenosis and possible gender differences. METHODS: We studied 54 patients, 24 (44.5%) males and 30 (55.5%) females aged 80.7 +/- 5.2 years with severe aortic stenosis. The following variables were analyzed: presence of clinical manifestations (dyspnea, angina, and syncope) and echocardiographic indices (left ventricular [LV] dimensions, ejection fraction [EF], and mass index). RESULTS: Dyspnea was the most frequent symptom with overall prevalence of 44%. EF was lower than 50% in only 2 patients. There were no gender differences in the prevalence of any of the clinical manifestations. Male patients had higher LV volumes (p < 0.05) and lower EF (p = 0.03). CONCLUSION: The data showing dyspnea as the most common clinical manifestation; EF > 50%; lower LV volumes and greater EF in female patients suggest that the adaptive mechanisms to this condition may be different between the two sexes.