RESUMO
Two 38 and 53-year old male patients with unstable angina, whose hemodynamic study showed an isolated stenosis of the left coronary artery ostium, were submitted to a surgical angioplasty of the left main coronary artery (LMCA) with saphenous vein patch. At the end of the operation, the patients presented intermitent myocardial isquemia. One of them led to abrupt cardiogenic shock which reversed completely. The postoperative hemodynamic study demonstrated excellent left main coronary artery patency and normal left ventricular of LMCA has been proposed as an alternative technique to the treatment of ostial lesions, the surgical team should be prepared to face severe operative morbidity. The LMCA spasm has been considered as a possible etiology of that event.
Assuntos
Angioplastia/efeitos adversos , Vasos Coronários/cirurgia , Isquemia Miocárdica/etiologia , Adulto , Angiografia Coronária , Ponte de Artéria Coronária , Humanos , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/etiologia , Função Ventricular EsquerdaAssuntos
Pressão Sanguínea/fisiologia , Hipertensão/epidemiologia , Consumo de Bebidas Alcoólicas , Brasil/epidemiologia , Doenças Cardiovasculares/mortalidade , Medicina Baseada em Evidências , Feminino , Humanos , Hipertensão/prevenção & controle , Estilo de Vida , Masculino , Metanálise como Assunto , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Cloreto de Sódio na Dieta/administração & dosagemRESUMO
BACKGROUND: Considering the controversial results published in the literature concerning associations between human leukocyte antigens (HLA) and rheumatic fever (RF), the purpose of the present study was to investigate by means of cosegregation analysis the participation of HLA genes in susceptibility to RF. METHODS AND RESULTS: The sample reported here was composed of 51 affected and 66 healthy individuals belonging to 22 genetically informative families. The comparison (chi 2 goodness-of-fit test) of the observed numbers of identical-by-descent (IBD) HLA haplotypes among all affected individuals (siblings, cousins, and uncle/nephew and grandparent/grandchild type of pairs) with the expected ones under the assumption of independent segregation of HLA alleles and the presumptive RF susceptibility gene gave a value of P = .088. Since the number of subjects studied was relatively small and the rejection level obtained was near the usual .05 significance level, we calculated the expected HLA IBD scores in the 13 pairs of affected sibs of our sample for all possible frequencies of the presumptive RF susceptibility gene. This analysis allowed clear rejection of a recessive mode, considering susceptibility gene frequencies lower than 20%, whereas the observed values fitted very well a dominant mode of inheritance, with penetrance (K) values varying between 0.5 and 0.9 and a frequency of the susceptibility gene of at least 1%. CONCLUSIONS: The present data support the hypothesis of an RF susceptibility gene within or very near the HLA complex.
Assuntos
Antígenos HLA/genética , Febre Reumática/genética , Adulto , Brasil/epidemiologia , Suscetibilidade a Doenças , Feminino , Genes MHC Classe I , Genes MHC da Classe II , Ligação Genética , Marcadores Genéticos , Haplótipos/genética , Humanos , Masculino , Febre Reumática/epidemiologia , Cardiopatia Reumática/epidemiologiaRESUMO
Dois pacientes do sexo masculino (38 e 53 anos) com angina estável, com estudo hemodinâmico revelando grave lesão de óstio de tronco de coronária esquerda (TCE), foram submetidos a angioplastia cirúrgica do TCE com patch de veia safena. Ao final da operação os pacientes apresentaram isquemia miocárdica intermitente, um deles com choque cardiogênico e, em ambos, reversão completa do quadro. O estudo hemodinâmico pós-operatório revelou adequada ampliação do TCE com função ventricular esquerda preservada nos dois pacientes. Embora a angioplastia cirúrgica do TCE seja uma alternativa técnica para os doentes com lesöes ostiais, chamamos a atenção para esta grave morbidade operatória, tendo como uma das possíveis causas o espasmo do TCE.