RESUMO
Pacemaker lead infection is a rare condition, most often occurring when intervention is needed after pacemaker implantation. Diagnosis is by blood cultures and confirmation by transoesophageal echocardiography; transthoracic echocardiography is often inadequate. A literature review indicated the microorganism most responsible for late lead infection is Staphylococcus epidermidis (which can grow on plastic material). A retrospective analysis of patient files from the authors' institution (1993-97) yielded three patients with proven pacemaker lead endocarditis. The diagnosis of pacemaker endocarditis was by transoesophageal echocardiography. The endocarditis appeared after a long period and in two of the three patients there was S epidermidis infection. Thoracotomy with removal of the infected system was performed because of the large dimensions of the vegetations. A new pacemaker was implanted: in one patient with endocardial leads, in the other two with epicardial leads. All three patients recovered well and follow up was uneventful for at least one year.
Assuntos
Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico por imagem , Marca-Passo Artificial , Infecções Estafilocócicas/diagnóstico por imagem , Staphylococcus epidermidis , Adulto , Idoso , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Infecções Estafilocócicas/cirurgia , ToracotomiaRESUMO
Early recurrence of symptoms after successful coronary angioplasty is usually due to restenosis of the angioplasty site. Multilesion progression of atherosclerosis in the presence of patent prior dilated segments has not, to our knowledge, been reported as a cause of early recurrent angina after successful double coronary angioplasty. As both new lesions were also successfully dilated, this case demonstrates that multivessel coronary angioplasty is a repeatedly effective and patient-friendly procedure to treat symptomatic coronary atherosclerosis with rapid and unpredictable rate of progression.
Assuntos
Angina Pectoris/terapia , Angioplastia com Balão/efeitos adversos , Arteriosclerose/terapia , Angiografia Coronária , Humanos , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
Two cases of coronary occlusion and subsequent embolization during percutaneous coronary angioplasty (PTCA) are described. Prior to PTCA, angiographic evidence of intracoronary thrombus was present. Abrupt reclosure after dilation was treated by successful redilation. However, coronary embolization of thrombus debris occurred downstream in one patient and into an adjacent coronary branch in the second patient.