RESUMEN
OBJECTIVES: This study aimed to compare gender-related differences in outcomes of patients undergoing TAVI over a long-term follow-up period. BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been considered the standard therapy for patients with inoperable or high-risk symptomatic aortic stenosis. The influence of gender-related differences in outcomes of patients undergoing TAVI is currently on debate. METHODS: From January 2008 to January 2015, 819 patients (49% men) underwent TAVI and were included in a multicenter Brazilian registry. Patients were followed-up and clinical outcomes were evaluated according to the updated Valve Academic Research Consortium-2 criteria. RESULTS: Mean follow-up was 497 ± 478 days. Compared with women, men had a lower rate of major or life-threatening bleeding (12.0% vs. 20.6%; HR = 0.57 [95CI% 0.40-0.81]; P = 0.001), and major vascular complications (6% vs. 11.7%; HR = 0.50 [95CI% 0.31-0.82]; P = 0.004). At 30 days, all-cause mortality was lower in men than in women (6.5% vs. 11.5%; P = 0.013), however, cumulative all-cause mortality was similar between groups (25.9% vs. 29.7%, men and women, respectively, HR = 0.92 [95CI% 0.71-1.19]; P = 0.52) over the entire follow-up period. By adjusted Cox regression model, renal function, diabetes, peripheral artery disease, and chronic obstructive pulmonary disease (COPD) remained independently predictors of all-cause mortality. CONCLUSIONS: In this large-scale study evaluating patients undergoing TAVI, 30-day mortality was higher among women than men driven by significant higher rates of major or life-threatening bleeding and major vascular complications. However, all-cause mortality on long-term follow-up was similar between groups. © 2016 Wiley Periodicals, Inc.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Válvula Aórtica , Cateterismo Cardíaco , Disparidades en el Estado de Salud , Implantación de Prótesis de Válvulas Cardíacas , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Brasil , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/mortalidad , Distribución de Chi-Cuadrado , Comorbilidad , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Hemodinámica , Hemorragia/etiología , Humanos , Estimación de Kaplan-Meier , Masculino , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/etiologíaRESUMEN
OBJECTIVE: To compare the 1-year outcomes of complete percutaneous approach versus surgical vascular approach for transfemoral transcatheter aortic valve implantation (TAVI), among "real-world" patients from the multi-center Brazilian TAVI registry. BACKGROUND: Vascular access still remains a major challenge for TAVI via transfemoral approach. Vascular access through complete percutaneous approaches or through open surgical vascular techniques seems to be acutely similar. However, the long-term outcomes of both techniques remain poorly described. METHODS: The study population comprised all patients treated via transfemoral route in the Brazilian TAVI registry, a "real-world", nation-based, multi-center study. Patients were divided according to the initial vascular access approach (percutaneous vs. surgical) and clinically followed-up for 1 year. The primary endpoint was the incidence of combined adverse events all-cause mortality, life-threatening bleeding, and/or major vascular complication at 1 year. RESULTS: A total of 402 patients from 18 centers comprised the study population (percutaneous approach in 182 patients; surgical cutdown approach 220 patients). The incidence of combined adverse events was not different in the percutaneous and the surgical groups at 30 days (17.6% vs. 16.3%; P = 0.8) and at 1 year (primary endpoint) (30.9% vs. 28.8%; P = 0.8). Also, the study groups overall were comparable regarding the incidence of each individual safety adverse events at 30 days and at 1 year. CONCLUSION: Total percutaneous techniques or surgical cutdown and closure may provide similar safety and effectiveness during the first year of follow-up in patients undergoing transfemoral TAVI.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Arteria Femoral/cirugía , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano de 80 o más Años , Brasil , Comorbilidad , Femenino , Humanos , Masculino , Sistema de Registros , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. OBJECTIVE: To assess TAVR's LC in Brazil over time. METHODS: We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. RESULTS: A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. CONCLUSION: A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.
Asunto(s)
Mortalidad Hospitalaria , Curva de Aprendizaje , Sistema de Registros , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Reemplazo de la Válvula Aórtica Transcatéter/estadística & datos numéricos , Brasil/epidemiología , Femenino , Masculino , Anciano de 80 o más Años , Anciano , Factores de Tiempo , Factores de Riesgo , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/mortalidad , Resultado del Tratamiento , Medición de RiesgoRESUMEN
BACKGROUND: Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated. OBJECTIVE: To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. METHODS: A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. RESULTS: Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). CONCLUSION: Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237).
FUNDAMENTO: São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. OBJETIVO: Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. MÉTODOS: Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. RESULTADOS: Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). CONCLUSÃO: Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta. (Arq Bras Cardiol. 2020; 115(2):229-237).
Asunto(s)
Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Anciano , Arterias , Brasil/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica , Estudios Prospectivos , Sistema de Registros , Infarto del Miocardio con Elevación del ST/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS: Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS: The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS: Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.
Asunto(s)
Lesión Renal Aguda/epidemiología , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Sistema de Registros , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Lesión Renal Aguda/etiología , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
Resumo Fundamento Dados robustos sobre a curva de aprendizagem (LC) da substituição da válvula aórtica transcateter (TAVR) são escassos nos países em desenvolvimento. Objetivo Avaliar a LC da TAVR no Brasil ao longo do tempo. Métodos Analisamos dados do registro brasileiro de TAVR de 2008 a 2023. Pacientes de cada centro foram numerados cronologicamente em número sequencial de caso (NSC). A LC foi realizada usando um spline cúbico restrito ajustado para o EuroSCORE-II e o uso de próteses de nova geração. Ainda, os desfechos hospitalares foram comparados entre grupos definidos de acordo com o nível de experiência, com base no NSC: 1º ao 40º caso (experiência inicial), 41º ao 80º caso (experiência básica), 81º ao 120º caso (experiência intermediária) e 121º caso em diante (experiência alta). Análises adicionais foram conduzidas de acordo com o número de casos tratados antes de 2014 (>40 e ≤40 procedimentos). O nível de significância adotado foi p <0,05. Resultados Foram incluídos 3194 pacientes de 25 centros. A idade média foi 80,7±8,1 anos e o EuroSCORE II médio foi 7±7,1. A análise da LC demonstrou uma queda na mortalidade hospitalar ajustada após o tratamento de 40 pacientes. Um patamar de nivelamento na curva foi observado após o caso 118. A mortalidade hospitalar entre os grupos foi 8,6%, 7,7%, 5,9%, e 3,7% para experiência inicial, básica, intermediária e alta, respectivamente (p<0,001). A experiência alta foi preditora independente de mortalidade mais baixa (OR 0,57, p=0,013 vs. experiência inicial). Centros com baixo volume de casos antes de 2014 não mostraram uma redução significativa na probabilidade de morte com o ganho de experiência, enquanto centros com alto volume de casos antes de 2014 apresentaram uma melhora contínua após o caso de número 10. Conclusão Observou-se um fenômeno de LC para a mortalidade hospitalar do TAVR no Brasil. Esse efeito foi mais pronunciado em centros que trataram seus 40 primeiros casos antes de 2014 que naqueles que o fizeram após 2014.
Abstract Background Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. Objective To assess TAVR's LC in Brazil over time. Methods We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. Results A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. Conclusion A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.
RESUMEN
Resumo Fundamento São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. Objetivo Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. Métodos Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. Resultados Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). Conclusão Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta. (Arq Bras Cardiol. 2020; 115(2):229-237)
Abstract Background Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated Objective To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy (Arq Bras Cardiol. 2020; 115(2):229-237)
Asunto(s)
Humanos , Masculino , Anciano , Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST/cirugía , Arterias , Brasil/epidemiología , Sistema de Registros , Estudios Prospectivos , Resultado del Tratamiento , Persona de Mediana Edad , Revascularización MiocárdicaRESUMEN
We report the case of a 16-year-old pregnant patient with severe aortic stenosis and pulmonary congestion clinically uncontrolled, in whom percutaneous balloon aortic valvuloplasty was used as the first choice of treatment in an emergency procedure. The clinical findings, pathophysiology, diagnostic features, and indications for percutaneous treatment are reported. Severe congenital aortic stenosis is rare in children and young individuals. Bicuspid aortic valve occurs in 3% to 6% of patients with congenital heart disease; when associated with commissural fusion, significant stenosis may be present in childhood. The association of severe congenital aortic stenosis and pregnancy is difficult to control clinically, carrying a high risk of maternal and fetal mortality, mainly when manifested with symptoms of pulmonary congestion 1,2.
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Estenosis de la Válvula Aórtica/terapia , Cateterismo , Complicaciones Cardiovasculares del Embarazo/terapia , Adolescente , Estenosis de la Válvula Aórtica/congénito , Femenino , Humanos , Embarazo , Resultado del EmbarazoRESUMEN
Penetrating aortic atherosclerotic ulcer is an underdiagnosed condition that presents high rates of morbidity and mortality. We report two cases of patients with severe chest pain, with no ischemic features, who underwent chest angiotomography and showed an ulceration of the aortic wall, with contrast penetration into the middle layer. Due to the failure of the medical treatment, the patients underwent percutaneous aortic stent implantation with complete resolution of symptoms.
Asunto(s)
Enfermedades de la Aorta/cirugía , Procedimientos Endovasculares/métodos , Stents , Úlcera/cirugía , Anciano de 80 o más Años , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Obstructions of the upper venous system may be due to spontaneous thrombosis or the presence of hemodialysis or chemotherapy catheters, or even the presence of extrinsic compression due to intra-thoracic tumors. The use of endoprosthesis for the treatment of these obstructions has become common practice, and its indications include situations of risk for pulmonary embolism, superior vena cava syndrome, and loss of vascular access. Within this context, the use of intracardiac ultrasound may be useful in evaluating the extension and severity of the obstructive lesion, besides providing important information about the mural and intraluminal morphology of the venous system. The authors report the case of a patient with superior vena cava syndrome caused by thrombosis at the entry pathway of the right atrium, besides discussing the subject by means of literature review.
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Prótesis Vascular , Síndrome de la Vena Cava Superior/cirugía , Trombosis/complicaciones , Ultrasonografía Intervencional , Endosonografía , Femenino , Humanos , Persona de Mediana Edad , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Ultrasonografía Intervencional/métodosRESUMEN
OBJECTIVE: To determine the prevalence of renal artery stenosis (RAS) in patients who have undergone cineangiocoronariography. METHODS: Prospective study of cineangiocoronariography and aortography examinations conducted between January 2002 and February 2004 on 1,656 hypertensive and normotensive patients who underwent the examinations to confirm the diagnosis of obstructive coronary artery disease or valve disease. RESULTS: The average age of the 1,656 patients was 61.6 +/- 11.8 years. Eight hundred and ninety-one (53.8%) were male, 169 (10.2%) were diabetic and 1,054 (63.8%) presented obstructive coronary artery disease. Renal stenosis greater than 50% was observed in 228 (13.8%) patients, and 25 (1.5%) had bilateral stenosis. Obstructive coronary artery disease was defined as stenosis greater than or equal to 50% of the vessel lumen, in one, two or three main arteries, classified as single, double or triple vessels, respectively. Quantification was conducted using visual analysis of the angiography. Comparison of the groups with and without renal artery obstruction > or = 50%, revealed significant statistical differences in relation to gender, age, diabetes mellitus, blood pressure and left ventricular function. However, no statistical difference was noted in relation to the occurrence of coronary artery obstructions > or = 50%. Nevertheless, renal artery obstructions > or = 70%, revealed significant differences in relation to blood pressure, coronary artery obstructions > or = 50% and left ventricular function, which were all higher in the renal artery obstruction group. CONCLUSION: The prevalence of RAS found in our study was comparable to that reported by major medical literature case studies. RAS is associated with systemic hypertension (SH), end-stage renal disease (ESRD) and its sequelae, emphasizing how important it is that we are aware of possible candidates for angiographic diagnosis of this disease.
Asunto(s)
Enfermedad Coronaria/complicaciones , Hipertensión/complicaciones , Obstrucción de la Arteria Renal/epidemiología , Aortografía , Cateterismo Cardíaco , Cineangiografía , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obstrucción de la Arteria Renal/diagnóstico por imagenRESUMEN
We report the case of a female patient with obstructive lesions in the right and left carotid, right renal, left subclavian and left common iliac arteries which were percutaneously treated.
Asunto(s)
Angioplastia de Balón , Stents , Arteritis de Takayasu/terapia , Adulto , Femenino , Humanos , Indígenas Sudamericanos , Resultado del TratamientoRESUMEN
A úlcera aterosclerótica penetrante de aorta é uma patologia subdiagnosticada que apresenta altas taxas de morbimortalidade. Relatamos dois casos de pacientes com dor torácica intensa sem características isquêmicas que foram submetidos a angiotomografia de tórax e apresentaram ulceração na parede da aorta com penetração de contraste na camada média. Em razão da falha no tratamento clínico, foram submetidos a implante percutâneo de endoprótese aórtica com resolução completa dos sintomas.
Penet rat ing aor t ic atherosclerot ic ulcer i s an underdiagnosed condition that presents high rates of morbidity and mortality. We report two cases of patients with severe chest pain, with no ischemic features, who underwent chest angiotomography and showed an ulceration of the aortic wall, with contrast penetration into the middle layer. Due to the failure of the medical treatment, the patients underwent percutaneous aortic stent implantation with complete resolution of symptoms.
La úlcera aterosclerótica penetrante de aorta es una patología subdiagnosticada que presenta altas tasas de morbimortalidad. Referimos dos casos de pacientes con dolor torácico intenso sin características isquémicas que se sometieron a una angiotomografía de tórax y presentaron ulceración en la pared de la aorta con penetración de contraste en la capa media. En razón de la falta en el tratamiento clínico, se sometieron a implantación percutánea de endoprótesis aórtica con resolución completa de los síntomas.
Asunto(s)
Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Aorta/cirugía , Procedimientos Endovasculares/métodos , Stents , Úlcera/cirugía , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodosRESUMEN
Introdução: Aproximadamente 90 por cento dos pacientes submetidos a cirurgia de revascularização do miocárdio (CRM) recebem enxerto de artéria torácica interna esquerda. A ocorrência de estenose da artéria subclávia esquerda pode resultar em falência do enxerto por limitação de fluxo coronário. A prevalência de estenose da artéia subclávia esquerda em pacientes com aterosclerose coronária grave, considerados candidatos a CRM, não é conhecida. Objetivo: Determinar a prevalência e a eficácia da avaliação clínica para diagnóstico a estenose da artéria subclávia esquerda em candidatos a CRM. Método: Em um registro multicêntrico, realizou-se angiografia seletiva da artéria subclávia esquerda em pacientes com indicação de CRM na ocasião da cinecoronariografia. Estenoses maiores ou iguais a 50 por cento antes da origem da artéria torácica interna foram considerdas significativas. Resultados: Dos 205 pacientes estudados, 16 (7,8 por cento) apresentavam estenose significativa da artéria subclávia esquerda. A medida da pressão arterial não-invasiva diferencial entre...
Background: Approximately 90% of the patients submitted to coronary artery bypass graft surgery (CABG) receive a left internal thoracic artery (LITA) graft. Stenosis of the left subclavian artery can result in graft failure due to restricted coronary flow. The prevalence of stenosis of the left subclavian artery in patients with severe coronary atherosclerosis, deemed candidates to CABG, is not known. Objective: To assess the prevalence of stenosis of left subclavian artery in CABG candidates, as well as the diagnostic effectiveness of clinical evaluation. Methods: In a multicenter registry, selective angiography of the left subclavian artery was carried out in patients considered candidates to CABG during coronary cineangiography. Stenoses ≥ 50% proximal to the origin of the LITA were considered significant. Results: A total of 205 patients were included. Significant stenosis of the left subclavian artery was observed in 16 (7.8%) patients. Noninvasive differential arterial blood pressure measurement ≥ 10 mmHg between both arms showed low sensitivity (37.5%) and low positive predictive value (13.3%) for stenosis identification. No clinical predictors of significant stenosis were identified by univariate analysis. Conclusion: Stenosis of the left subclavian artery is not uncommon in CABG candidates. Noninvasive blood pressure gradient between both arms has low diagnostic accuracy. Therefore, in patients candidates to CABG, selective angiography of the left subclavian artery should be considered, because of the risk of reduced flow and coronary-subclavian steal syndrome in patients with non-diagnosed stenosis of the subclavian artery who receive a LITA graft.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Aterosclerosis/complicaciones , Aterosclerosis/diagnóstico , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico , Síndrome del Robo de la Subclavia/complicaciones , Síndrome del Robo de la Subclavia/diagnóstico , Angiografía/métodos , Angiografía , Arteria Subclavia/anomalías , PrevalenciaRESUMEN
Neste artigo os autores discutem a importância epidemiológica da doença oclusiva das carótidas, destacando a apresentação clínica e os principais métodos para o seu diagnóstico, invasivos ou não. Além disso, discutem os principais estudos disponíveis na literatura comparando os resultados da endarterectomia carotídea aos das intervenções percutâneas.
In this article, the authors discuss the epidemiological importance of carotid o cclusivedisease, highlighting the clinical presentation and the main methods for its diagnosis, both invasive and non-invasive. Additionally, the authors discuss the chief studies available in the literature, comparing the results of carotid endarterectomy to percutaneous interventions.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico , Endarterectomía Carotidea/métodos , Endarterectomía Carotidea , Estenosis Carotídea/cirugía , Estenosis Carotídea/terapiaRESUMEN
As obstruções do sistema venoso superior podem ocorrer por trombose espontânea ou na presença de cateteres de hemodiálise ou quimioterapia, e mesmo na presença de compressão extrínseca por tumores intratorácicos. O uso de endopróteses para o tratamento dessas obstruções vem se tornando prática comum e sua indicação inclui situações de risco de embolia pulmonar, síndrome da veia cava superior e perda do acesso vascular. Nesse contexto, o uso do ultra-som intracardíaco pode ser útil na avaliação da extensão e da gravidade da obstrução, além de fornecer informações morfológicas murais e intramurais do sistema venoso. Relatamos o caso de uma paciente com síndrome da veia cava superior por trombose da via de entrada do átrio direito, submetida a implante de endoprótese monitorado por ultra-som intracardíaco, além de discutir o tema por meio de revisão da literatura.
Obstructions of the upper venous system may be due to spontaneous thrombosis or the presence of hemodialysis or chemotherapy catheters, or even the presence of extrinsic compression due to intra-thoracic tumors. The use of endoprosthesis for the treatment of these obstructions has become common practice, and its indications include situations of risk for pulmonary embolism, superior vena cava syndrome, and loss of vascular access. Within this context, the use of intracardiac ultrasound may be useful in evaluating the extension and severity of the obstructive lesion, besides providing important information about the mural and intraluminal morphology of the venous system. The authors report the case of a patient with superior vena cava syndrome caused by thrombosis at the entry pathway of the right atrium, besides discussing the subject by means of literature review.
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Femenino , Humanos , Persona de Mediana Edad , Prótesis Vascular , Síndrome de la Vena Cava Superior/cirugía , Trombosis/complicaciones , Ultrasonografía Intervencional , Endosonografía , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior , Ultrasonografía Intervencional/métodosRESUMEN
OBJETIVO: Determinar a prevalência de estenose da artéria renal (EAR) em pacientes submetidos a cineangiocoronariografia. MÉTODOS: Estudo prospectivo, considerando 1.656 cinean-giocoronariografias seguidas de aortografia, entre janeiro/2002 e fevereiro/2004, de pacientes encaminhados à cineangiocoronariografia diagnóstica com história ou não de hipertensão arterial sistêmica (HAS). RESULTADOS: Dos 1.656 pacientes, a idade média foi de 61,6 ± 11,8 anos, 53,8 por cento eram do sexo masculino, 10,2 por cento eram diabéticos, 63,8 por cento apresentavam coronariopatia obstrutiva. A presença de EAR maior que 50 por cento foi observada em 228 (13,8 por cento) pacientes, e em 25 (1,5 por cento) destes, ocorreu bilateralmente. A coronariopatia obstrutiva foi definida como estenose que causa redução do lúmen do vaso em 50 por cento ou mais, em um, dois ou três vasos principais, denominados uniarterial, biarterial ou triarterial, respectivamente.A quantificação era realizada através da análise visual da angiografia. Comparando os grupos com e sem EAR > 50 por cento, observou-se diferença estatisticamente significativa quanto a gênero, idade, ocorrência de diabete melito, PA e função ventricular esquerda. Não houve diferença significativa, no entanto, quanto à ocorrência de obstrução coronariana > 50 por cento. Quando, porém, a EAR considerada é > 70 por cento, observa-se diferença significativa quanto a PA, associação à obstrução coronariana > 50 por cento e à disfunção ventricular esquerda, maiores no grupo com EAR. CONCLUSÃO: A prevalência de EAR neste estudo foi comparável àquela das grandes casuísticas da literatura e, em razão de sua importância pela associação com HAS e doença renal terminal (DRT) e suas seqüelas, devemos estar atentos para seu diagnóstico angiográfico.
OBJECTIVE: To determine the prevalence of renal artery stenosis (RAS) in patients who have undergone cineangiocoronariography. METHODS: Prospective study of cineangiocoronariography and aortography examinations conducted between January 2002 and February 2004 on 1,656 hypertensive and normotensive patients who underwent the examinations to confirm the diagnosis of obstructive coronary artery disease or valve disease. RESULTS: The average age of the 1,656 patients was 61.6 ± 11.8 years. Eight hundred and ninety-one (53.8 percent) were male, 169 (10.2 percent) were diabetic and 1,054 (63.8 percent) presented obstructive coronary artery disease. Renal stenosis greater than 50 percent was observed in 228 (13.8 percent) patients, and 25 (1.5 percent) had bilateral stenosis. Obstructive coronary artery disease was defined as stenosis greater than or equal to 50 percent of the vessel lumen, in one, two or three main arteries, classified as single, double or triple vessels, respectively. Quantification was conducted using visual analysis of the angiography. Comparison of the groups with and without renal artery obstruction > 50 percent, revealed significant statistical differences in relation to gender, age, diabetes mellitus, blood pressure and left ventricular function. However, no statistical difference was noted in relation to the occurrence of coronary artery obstructions > 50 percent. Nevertheless, renal artery obstructions > 70 percent, revealed significant differences in relation to blood pressure, coronary artery obstructions > 50 percent and left ventricular function, which were all higher in the renal artery obstruction group. CONCLUSION: The prevalence of RAS found in our study was comparable to that reported by major medical literature case studies. RAS is associated with systemic hypertension (SH), end-stage renal disease (ESRD) and its sequelae, emphasizing how important it is that we are aware of possible candidates for angiographic diagnosis of this disease.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Enfermedad Coronaria/complicaciones , Hipertensión/complicaciones , Obstrucción de la Arteria Renal/complicaciones , Aortografía , Cateterismo Cardíaco , Cineangiografía , Angiografía Coronaria , Enfermedad Coronaria , Métodos Epidemiológicos , Obstrucción de la Arteria Renal/epidemiología , Obstrucción de la Arteria RenalRESUMEN
Reportamos o caso de uma paciente com lesões obstrutivas nas artérias carótidas direita e esquerda, renal direita, subclávia esquerda, e ilíaca comum esquerda, tratadas percutaneamente.
We report the case of a female patient with obstructive lesions in the right and left carotid, right renal, left subclavian and left common iliac arteries which were percutaneously treated.
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Humanos , Femenino , Adulto , Angioplastia de Balón , Stents , Arteritis de Takayasu , Indígenas Sudamericanos , Resultado del TratamientoRESUMEN
Relatamos um caso em que a valvoplastia aórtica percutânea foi utilizada como primeira escolha, em procedimento de urgência, para o tratamento de estenose aórtica grave em paciente gestante de 16 anos, com congestão pulmonar sem controle clínico. Descrevem-se o quadro clínico, a fisiopatologia, os aspectos diagnósticos e indicações do tratamento percutâneo. A estenose valvar aórtica congênita, quando grave, é rara em crianças e jovens. A valva aórtica bicúspide ocorre em 3 por cento a 6 por cento com doença cardíaca congênita e, quando relacionada com fusão comissural, pode haver estenose importante já na infância. A associação de estenose aórtica congênita grave com gestação é de difícil controle clínico e alto risco de mortalidade materna e fetal, principalmente quando se manifesta com sintomas de congestão pulmonar.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Estenosis de la Válvula Aórtica , Complicaciones Cardiovasculares del Embarazo , Estenosis de la Válvula Aórtica , Resultado del EmbarazoRESUMEN
Pesquisou-se a prevalência de indicador de alcoolismo em 169 pacientes (80 mulheres e 89 homens) internados em enfermarias de Medicina Interna da Irmandade da Santa Casa de Misericórdia de Porto Alegre, RS, durante os meses de junho e julho de 1993, usando o questionário CAGE. Dezessete mulheres (21,25 por cento) e quarenta e oito homens (53,93 por cento) foram considerados positivos para o teste CAGE. Conclui-se que o alcoolismo é frequente neste grupo de pacientes, mas que estes resultados näo podem ser extrapolados para a populaçäo geral e nem para outros grupos de pacientes tanto ambulatoriais quanto internados