Serial assessment of arterial structure and function in patients with coarctation of the aorta undergoing stenting

Stenting for CoA has become an acceptable treatment modality in the last 20 years. However little is known about arterial changes after this procedure. To assess arterial structure and function including peripheral reactivity and stiffness and intima-media thickness (IMT) pre and post stenting for coarctation of the aorta (CoA). Twenty-one patients [median age: 15 years (8-39)] were studied at baseline, 1 day, 6 months and 1 year after stenting. Twenty-one healthy subjects (1:1 matched) were used as controls. Left ventricular (LV) mass, ejection fraction, flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) of left brachial artery, common carotid (CC) and right subclavian artery (RSCA) IMT and pulse wave velocity (PWV) were assessed by echocardiography and vascular ultrasound. CoA patients had higher LV indexed mass (p < 0.0001), impaired FMD (p < 0.0001) and NMD (p < 0.0001), increased PWV (p < 0.0001), carotid and RSCA IMT (both p < 0.0001). All procedures were successful and resulted in significant gradient reduction (p < 0.001). One year after stenting there was improvement in LV function (p = 0.034) and although there was significant reduction of LV mass (103.29 ± 24.77 vs...

Pleiotropic Effects With Equivalent Low-density Lipoprotein Cholesterol Reduction: Comparative Study Pleiotropic Effects With Equivalent Low-density

Background: Coadministration of any statin with ezetimibe is as effective as using high doses of the same statin in the reduction of low-density lipoprotein cholesterol (LDL-c). There may be other effects called pleiotropics. Objective: To compare the effectiveness of 2 different treatments that obtain equivalent LDL-c reductions (80 mg of simvastatin, once a day and coadministration of 10 mg of simvastatin and 10 mg of ezetimibe, once a day) over endothelial function and inflammation. Methods: Twenty-three randomized patients with hypercholesterolemia in a 2 3 2 crossover protocol were studied. Endothelial function was analyzed by ultrasound assessment of endothelial dependent flow-mediated vasodilation of the brachial artery, and inflammation was estimated by high-sensitivity C-reactive protein (hs-CRP). Results: LDL-c reduction was similar between the 2 treatments with simvastatin/ezetimibe and with simvastatin (P , 0.001); no difference between treatments was found (P = 0.968). Both treatments improved significantly the endothelial function [3.61% with simvastatin/

ezetimibe (P = 0.003) and 5.08% with simvastatin (P , 0.001)]; no difference was found between the 2 treatments (P = 0.291). hs-CRP had a 23% reduction with simvastatin/ezetimibe (P = 0.004) and a 30% reduction with simvastatin alone (P = 0.01), with no significant difference between the 2 treatments (P = 0.380).

Pleiotropic Effects With Equivalent Low-density Lipoprotein Cholesterol Reduction: Comparative StudyBetween Simvastatin and Simvastatin/Ezetimibe Coadministration

Background: Coadministration of any statin with ezetimibe is as effective as using high doses of the same statin in the reduction of low-density lipoprotein cholesterol (LDL-c). There may be othereffects called pleiotropics. Objective: To compare the effectiveness of 2 different treatments that obtain equivalent LDL-c reductions (80 mg of simvastatin, oncea day and coadministration of 10 mg of simvastatin and 10 mg of ezetimibe, once a day) over endothelial function and inflammation. Methods: Twenty-three randomized patients with hypercholesterolemia in a 2 3 2 crossover protocol were studied. Endothelial function was analyzed by ultrasound assessment of endothelialdependent flow-mediated vasodilation of the brachial artery, andinflammation was estimated by high-sensitivity C-reactive protein(hs-CRP). Results: LDL-c reduction was similar between the 2 treatments withsimvastatin/ezetimibe and with simvastatin (P , 0.001); no differencebetween treatments was found (P = 0.968). Both treatments improved significantly the endothelial function [3.61% with simvastatin/ ezetimibe (P = 0.003) and 5.08% with simvastatin (P , 0.001)]; no difference was found between the 2 treatments (P = 0.291). hs-CRP had a 23% reduction with simvastatin/ezetimibe (P = 0.004) and a 30% reduction with simvastatin alone (P = 0.01), with no significant difference between the 2 treatments (P = 0.380). Conclusion: The 2 forms of treatment presented similar pleiotropiceffects: improvement in endothelial function and decrease in hs-CRP levels.

Oclusão percutânea do canal arterial menor 3 mm com auxílio do biótomo / Bioptome - assisted technique for percutaneous occlusion of the patent ductus arteriosus > 3 mm

A oclusão percutânea do canal arterial de pequeno calibre com molas de Gianturco tem sido considerada como a primeira opção terapêutica na maioria dos centros do mundo. Entretanto, o emprego de molas para canais menor 3 mm está associado a maiores taxas de insucessos e complicações. Neste artigo, descrevemos os resultados da oclusão destes canais por meio da técnica anterógrada com o auxílio do biótomo, empregando-se principalemnte coils, 0,052 polegadas. De setembro de 2002 a agosto de 2006, 14 pacientes (2 do sexo masculino, mediana de idade e peso de 8 anos e 23,6 kg, respectivamente) foram submetidos ao procedimento. Treze pacientes possuiam canal arterial do tipo A e um do tipo C. O diâmetro mínimo variou de 3,1 a 5,2 mm (média igual 3,8 mais ou menos 0,6 mm). Sucesso no implante foi observado em 13 casos. Destes 2 necessitaram de implante de molas adicionais. no mesmo procedimento devido a fluxos residuais significativos. Cinco apresentaram oclusão completa imediata e 8 saíram da sala de cateterismo com fluxo residual discreto, difuso e de baixa velocidade. Não houve complicações relacionadas ao cateterismo. Durante o seguimento, os ecocardiogramas mostraram oclusão em 12 dos 13 pacientes. Nenhum apresentava distúrbios de fluxo na aorta ou na artéria pulmonar esquerda. Um paciente foi submetido a procedimento de reoclusão com implante de nova mola. A oclusão do PCA > 3 mm por meio da técnica de liberação controlada por biótomo por via anterógrada de molas de Gianturco (preferencialmente de 0,052 polegadas) é factível, de simples realização, de baixo custo, segura e eficaz.

Percutaneous occlusion of the small patent ductus arteriosus (PDA) with Gianturco coils is considered the first-line therapeutic option in most centers around the world. However, the use of coils to close ducti larger than 3 mm is associated with higher failure and complication rates. In this paper we report the outcomes of percutaneous occlusion of these larger PDAs employing the bioptome assisted anterograde technique mainly using 0.052" coils. From 9/2002 to 8/2006, 14 patients (2 male; median age 8 years and weight 23.6 kg) underwent the procedure. Thirteen patients had type A PDAs and one had a type C. Minimal diameter varied from 3.1 to 5.2 mm (mean = 3.8 ± 0.6 mm). Successful implantation was achieved in 13 cases. Of these, 2 required additional coils in the same procedure due to significant leaks. Five had immediate total occlusion and 8 left the catheterization laboratory with discrete, diffuse, low-velocity residual leaks. There were no complications related to the catheterization procedures. On follow-up, total occlusion was observed in 12 of the 13 patients at echocardiography and none had flow disturbances of the aorta or of the left pulmonary artery. A single patient required a re-occlusion procedure with implantation of an additional coil. Percutaneous occlusion of PDAs larger than 3 mm using the bioptome assisted anterograde technique mainly with 0.052" coils is feasible, easy to perform, cost effective, safe and efficacious.

One-month therapy with simvastatin restores endothelial function in hypercholesterolemic children and adolescents

Simvastatin has been shown to restore endothelial function in children with familial hypercolesterolemia after 28 weeks of treatment. The aim of this study was to evaluate 1-month simvastatin treatment effect on endothelial function in hypercholesterolemic children and adolescents. Eighteen hypercholesterolemic patients (HC group) and 18 healthy controls, aged 6–18 years, were studied with medical history, physical examination, full lipid profile,

serum apolipoprotein B (apo B), fibrinogen, hepatic transaminases, and creatine kinase concentrations. Flow-mediated dilatation (FMD) was performed by high-resolution ultrasound of the brachial artery. The HC group received simvastatin 10 mg/day for 1 month. Arterial diameter was measured by two experienced sonographers who were unaware of subjects’ conditions. At baseline, FMD was impaired in the HC group (mean, 5.27 ± 4.67%) compared to controls

(mean, 15.05 ± 5.97%) (p < 0.001). After treatment, we observed a significant reduction in total cholesterol (TC) (29%), low-density lipoprotein cholesterol (LDL-C); (37%), apo B concentrations (36%) and FMD restoration (mean, 12.94 ± 7.66%), with an absolute increase of 7.66 ± 8.58 (p = 0.001). These results show that children and adolescents with hypercholesterolemia present endothelial dysfunction, and simvastatin, in addition to significantly

reducing TC, LDL-C, and apo B concentrations, restores endothelial function with 1-month treatment.

Identification of mildly oxidized low-density lipoprotein (electronegative LDL) and its auto-antibodies IgG in children and adolescents hypercholesterolemic offsprings

Oxidative modification of low-density lipoproteins (LDL) is an essential step in atherogenesis, generating minimally oxidized LDL, also called electronegative LDL [LDL(−)], which has chemotactic, cytotoxic and immunogenic properties.Methods and results: Serum LDL(−) and anti-LDL(−) auto-antibodies (IgG) were evaluated in 28 children and adolescents with familial hypercholesterolemia (FH) antecedents, with or without early coronary artery disease in first-degree relatives (eCAD), hypercholesterolemic (hc) or normocholesterolemic (nc) versus a control group of normocholesterolemic children without pathologic antecedents (C). ELISAmethod was used for detection of LDL(−) and anti-LDL(−) IgG. LDL(−) serum levels did not differ among the four groups (FH-eCADhc 41.4±24.9 g/dl; FH-hc 38.3±11.2 g/dl; FH-nc 47.3±17.0 g/dl and C 44.2±28.8 g/dl, p = 0.659). However, IgG anti-LDL(−) auto-antibodies were significantly higher in the control group in comparison to the FH groups with or without eCAD, independent of hypercholesterolemia or normocholesterolemia (FH-eCAD-hc 0.825±0.289 g/dl; FH-hc 0.667±0.307 g/dl; FH-nc 0.763±0.204 g/dl and C 1.105±0.233 g/dl, p = 0.006). When the auto-antibodies of groups with FH, with or without eCAD and with or without hypercholesterolemiawere compared, no differences were found (p = 0.509).Conclusion: These results showed that FH and/or eCAD children and adolescents have lower titers of auto-antibodies anti-LDL(−) than children from normal families, independent of serum LDL-cholesterol or serum LDL(−).

Efeito de um mês de tratamento com sinvastatina sobre a função endotelial de crianças e adolescentes com hipercolesterolemia / One-moth simvastatin therapy effect on endothelial function of children and adolescents with hypercholesterolemia

Objetivo: Esse estudo foi desenhado para avaliar se um mês de tratamento c sinvastatina 10 mg/dia melhora a função endotelial de crianças e adolescentes c hipercolesterolemia. Métodos: Estudo de corte, cego, controlado, com terapia aberta de curto-prazo. Foram estudados 18 crianças e adolescentes hipercolesterolêmico (grupo HC), com idade entre seis e 18 anos e 18 controles saudáveis com idade entre seis e 17 anos. Todos foram investigados com histórico médico, exame físico, PE lipídico completo, apolipoproteína B, fibrinogênio, transaminases hepáticas e creatino-fosfoquinase. Os critérios de inclusão foram: colesterol total > 199 mg/dl e LI colesterol > 129 mg/dl para o grupo HC; colesterol total  199 mg/dl; LDL-colesterol  129 mg/dl e história familiar negativa de hipercolesterolemia e doença arterial coronária prematura em parentes de primeiro grau, para o grupo controle. Foram excluído obesos, hipertensos, diabéticos, pacientes com síndrome nefrótica, insuficiência renal e doenças sistêmicas agudas ou crônicas, tabagistas, etilistas ou usuários de drogas ilícitas e pacientes com trigliceridemia  250 mg/dl. A avaliação da função endotelial obtida mensurando-se a dilatação fluxo-mediada por ultra-sonografia de alta resolução em todos os participantes ao ingresso no estudo e, no grupo HC, também ao final do tratamento. Todas as crianças do grupo HC receberam sinvastatina 10mg/dia durai um mês. Os diâmetros arteriais foram medidos por um único observador, de forma cega...

Novas técnicas percutâneas para perfuraçäo da valva pulmonar na atresia pulmonar com septo interventricular íntegro / New percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum

We report new percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum, in 3 newborns who had this birth defect. There was mild to moderate hypoplastic right ventricle, a patent infundibulum, and no coronary-cavitary communications. We succeeded in all cases, and no complications related to the procedure occurred. The new coaxial radiofrequency system was easy to handle, which simplified the procedure. Two patients required an additional source of pulmonary flow (Blalock-Taussig shunt) in the first week after catheterization. All patients had a satisfactory short-term clinical evolution and will undergo recatheterization within 1 year to define the next therapeutic strategy. We conclude that this technique may be safely and efficiently performed, especially when the new coaxial radiofrequency system is used, and it may become the initial treatment of choice in select neonates with pulmonary atresia and intact ventricular septum