[Percutaneous transluminal angioplasty of the vena cava inferior]. / Angioplastía transluminal percutánea de la vena cava inferior.

We describe a 65-years-old female, with percutaneous balloon angioplasty (PBA) of inferior vena cava. The patient had massive calcification of the right atrium, the tricuspid anulus as well as obstruction of the tricuspid valve (percutaneous tricuspid valvuloplasty was performed 2.5 years before). The only predisposing factor for calcification was, a cerebral-right atrial shunt (cerebral cysticercosis) for 32 years. PBA was performed. We discuss some events that occurred after dilatation. We describe the technique in this uncommon case. We conclude that percutaneous balloon angioplasty is another alternative to surgical repair in inferior vena cava obstruction.

[Percutaneous mitral commissurotomy with an Inoue catheter in congenital mitral stenosis]. / Comisurotomía mitral percutánea con catéter de Inoue en estenosis mitral congénita.

We describe a 3-years-old boy, with congenital mitral stenosis, who underwent percutaneous transvenous mitral commissurotomy (PTMC) with Inoue balloon. The mitral gradient decreased from 24 to 4 mmHg, the mitral valvular area (MVA) increased from 1.2 to 1.6 cm2 without modification in mitral regurgitation. One year later the recatheterization showed decreased pulmonary pressures, and a 7.5 mmHg mitral valvular gradient without mitral insufficiency. MVA by echo is 1.8 cm2 with mild regurgitation. As far as we know there is no experience with Inoue balloon in children. We conclude that PTMC with Inoue balloon could be an attractive alternative in some patients with congenital mitral stenosis.

[Residual shunts after application of the Rushkind occlusion system in closure of persistent ductus arteriosus. Insertion of a second device]. / Fuga residual postcolocación de oclusor de Rashkind para cierre del conducto arterioso persistente via percutánea. Colocación de un segundo dispositivo.

From May 1991 to August 1994, we performed transcatheter closure of patent ductus arteriosus with Rashkind umbrella system in 25 patients. In one, the device had embolism, to the right pulmonary artery and was operated 24 hs afterwards without complications. Seven had residual shunts, two had subsequent surgery, two are being followed (one for mild and one for moderate residual shunt). In the other three cases we inserted a second device. We used a 12 mm device in two cases and a 17 mm device in the other. Two cases had total occlusion 24 hrs after and in one had mild residual shunt without clinical repercussion. There were no complications. All had electrocardiographic and clinical improvement, take no medication, and their cardiomegaly had decreased (Cardiac index pre 61 vs post 54%). In conclusion the insertion of a second device is safe and effective alternative for residual shunt after first Rashkind occluder.

[Transcatheter closure of patent ductus arteriosus with Rashkind's occluder. Experience during 3.7 years]. / Cierre transcateterismo del conducto arterioso (CTCA) con oclusor de Rashkind. Experiencia de 3.7 años.

Thirty eight transcatheter umbrella closure (TUC) of a persistently patent ductus arteriosus using the Rashkind umbrella occluder (USCI), were attempted in thirty four patients. Mean age 8.5 +/- 9.0 years (range 1.5 to 31). Internal diameter of ductus arteriosus (DA) average 4.0 +/- 1.5 mm (range 2 to 9 mm). Successful implantation was achieved in 36 procedures (94.7%). Complete closure immediately postimplantation was achieved in 15 (45.4%), 12 (36.3%) had trivial and 6 (18.1%) severe residual shunt. In four cases we implanted successfully a second device. At the follow-up (average 24 months) in 31 patients, 87.0% (n = 27) had complete closure and 96.7% (n = 30) did not need another intervention. Device embolization to distal left pulmonary artery occurred in two cases (5.2%), one was retrieved by surgery and in the other case it was allowed to remain. No mortality was observed. This results confirm the efficacy, with low morbidity and no mortality of TUC, especially in those with smaller PDA (< 4 mm).

[Intravascular ultrasound. Initial experience and review of the literature]. / Ultrasonido intravascular. Experiencia inicial y revisión de la literatura.

UNLABELLED: From February 1995 to February 1996, 52 patients underwent intravascular ultrasound (IVUS) imaging: three with aortic coarctation (AoCo), one with persistent ductus arteriosus (PDA), 5 with rheumatic heart disease (RHD) and normal coronary arteries by angiography, one with muscular bridge in anterior descending artery, 20 with percutaneous transluminal coronary angioplasty PTCA (Group I), one of them with eximer laser and 22 stents (Group II). In patients with AoCo was possible to observe obstruction mechanism and the effect of dilation. In patient with PDA we measured the diameter of ductus. In patients with RHD we found early atherosclerosis in four cases, no detected by angiography. In Group I, we found soft plaque in 8, fibrous/mixed in 7 and calcified plaque with the calcium located superficially near the lumen in 5, concentric in 6 and 14 eccentric plaques. In this group the objective was observational in most of the cases, except when the imaging was characteristic of mayor dissection or small final lumen. In 10 cases we observed fracture or dissection of the plaque, in some with small flaps into the lumen. In the last two cases, IVUS was used to optimize results after PTCA in one, in the other we postponed the procedure because the characteristics of the lesion (severe superficial calcification). The patient who underwent eximer laser, IVUS demonstrated irregular and small lumen and was followed by PTCA. In Group II, IVUS was used to optimize deployment of stents. We did not have any case with subacute thrombosis. COMPLICATIONS: Only four cases had angina with ischemic ECG changes during the procedure, but reverted after catheter pullback and intracoronary nitroglycerin. In summary, IVUS gives information about mechanism of obstruction, its complications and results of PTCA. Also detect early atherosclerotic disease not observed by angiography. Optimize deployment of stents and avoids cumarinic anticoagulation in most of the patients. Rational selection of device or deferral of the procedure is possible if we know the characteristics of the plaque before intervention. Utility in other cardiovascular diseases is limited at this time. It's a safe procedure, the morbidity is low and in our experience, without mortality. In the future this new technology will bring useful information in other types of coronary arteries diseases.

[Stents: experience at the Cardiology Hospital of the 21st century National Medical Center]. / Stents: Experiencia en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI.

UNLABELLED: From february 1995 to february 1997 we implanted 157 stents in 105 patients. Age ranged from 38 to 81 years (mean 58), there were 83 males and 22 females. In 62.8% cases we implanted one stent and in 39 (37.2%) cases 2 to 6. Eighty three were Palmaz/Schatz (P/S), 27 ACT-ONE, 18 Wiktor (W), 9 Gianturco Rubin (GR), 8 Wallstent, 6 XT-Bard and 6 microstent. Indication were de novo in 23.8%, 87.5% post failure PTCA and in 13.3% late PTCA restenosis. Implant was successful al 96.1% of the patients. The first 32 patients received oral anticoagulation, the last 72 received aspirin and ticlopidine only. COMPLICATIONS: 4.7% acute thrombosis, 0.9% sub-acute thrombosis, three of them (2.5%) developed myocardial infarction, 0.9% emergency surgical treatment, 2.8% vascular complications and death in 2.8%. During follow-up (1 to 18 months, mean 7.7) we repeated angiography and 35 patients two to 14 months (m = 5.6), 12 of them had restenosis, during dilation two cases had dissection of the main left coronary artery and were send to surgery, the others were dilated without complications. One case had restenosis of the stent with obstructive lesions in other vessels and was send to elective surgery. The reminded patients are symptom free and had negative stress test. We conclude that this technology is an excellent alternative to percutaneous myocardial revascularization. Larger trials with long term follow-up is necessary to determine the true incidence of restenosis with the different types of stents.