RESUMO
We present our preliminary clinical experience with the initial and repetitive administration of the novel inotropic agent levosimendan in a cohort of 20 patients with end-stage heart failure who were acutely decompensated or whose symptoms were refractory to the usual pharmacological treatments thus necessitating hospitalization. Repetitive levosimendan infusions were administered to 9 patients (minimum 2, maximum 8 pulses). The effects of this therapy on the symptomatic status, vital signs, hemodynamic performance and clinical outcomes are discussed.
Assuntos
Canais de Cálcio Tipo L/administração & dosagem , Cardiotônicos/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Hidrazonas/administração & dosagem , Piridazinas/administração & dosagem , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , Baixo Débito Cardíaco/tratamento farmacológico , Baixo Débito Cardíaco/mortalidade , Baixo Débito Cardíaco/fisiopatologia , Cardiotônicos/uso terapêutico , Diástole/efeitos dos fármacos , Dobutamina/uso terapêutico , Dopamina/uso terapêutico , Quimioterapia Combinada , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Grécia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Hematócrito , Hemoglobinas/efeitos dos fármacos , Hemoglobinas/metabolismo , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacos , Potássio/sangue , Índice de Gravidade de Doença , Simendana , Estimulação Química , Análise de Sobrevida , Sístole/efeitos dos fármacos , Resultado do Tratamento , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
INTRODUCTION: The transseptal Inoue (IN) and to a lesser extend retrograde non-transseptal (RNT) techniques are established procedures for percutaneous mitral balloon valvuloplasty (PBMV) in patients with mitral stenosis. However, a head to head comparison of these two techniques, especially from a single center, has not yet been reported. METHODS: Seventy-two consecutive patients (n = 35 IN and n = 37 RNT) underwent PMBV in our clinic from October 1993 to December 1999. All baseline and procedural characteristics were compared, as well as immediate and long-term outcomes (mean follow-up, 42 12 months) of the patients. RESULTS: Baseline characteristics were similar in the two groups. A successful immediate result was achieved in 91% of IN patients and 89% of RNT patients. After the PMBV, mitral valve area (MVA) increased from 1.04 0.16 cm2 to 1.6 0.3 cm2 and from 1.06 0.23 cm2 to 1.55 0.3 cm2 in the IN group and RNT group, respectively (p = NS). There was a higher percentage of mild mitral regurgitation (MR) after the RNT technique (p = 0.03). Mean fluoroscopy time was 31 16 minutes in the IN group and 39 11 minutes in the RNT group (p = 0.02). After discharge, major adverse cardiac events (MACE: mitral valve replacement, repeat PMBV) occurred in 3 patients (8%) patients in the IN group and 5 patients (13.5%) in the RNT group (p = NS). Follow-up echocardiographic evaluation revealed no significant changes regarding MVA in either group. CONCLUSIONS: The IN and RNT techniques are comparable regarding the achieved MVA, with slightly more frequent MR post-RNT PBMV. IN requires significantly less fluoroscopy time. MACE and event-free survival rates at follow-up were similar in the two groups.