RESUMEN
INTRODUCTION AND OBJECTIVES: There is current controversy regarding the benefits of percutaneous recanalization (PCI) of chronic total coronary occlusions (CTO). Our aim was to determine acute and follow-up outcomes in our setting. METHODS: Two-year prospective registry of consecutive patients undergoing PCI of CTO in 24 centers. RESULTS: A total of 1000 PCIs of CTO were performed in 952 patients. Most were symptomatic (81.5%), with chronic ischemic heart disease (59.2%). Previous recanalization attempts had been made in 15%. The mean SYNTAX score was 19.5 ± 10.6 and J-score was > 2 in 17.3%. A retrograde procedure was performed in 92 patients (9.2%). The success rate was 74.9% and was higher in patients without previous attempts (82.2% vs 75.2%; P = .001), those with a J-score ≤ 2 (80.5% vs 69.5%; P = .002), and in intravascular ultrasound-guided PCI (89.9% vs 76.2%, P = .001), which was an independent predictor of success. In contrast, severe calcification, length > 20mm, and blunt proximal cap were independent predictors of failed recanalization. The rate of procedural complications was 7.1%, including perforation (3%), myocardial infarction (1.3%), and death (0.5%). At 1-year of follow-up, 88.2% of successfully revascularized patients showed clinical improvement (vs 34.8%, P < .001), which was associated with lower mortality. At 1-year of follow-up, the mortality rate was 1.5%. CONCLUSIONS: Compared with other national registries, patients in the Iberian registry undergoing PCI of a CTO showed similar complexity, success rate, and complications. Successful recanalization was strongly associated with functional improvement, which was related to lower mortality.
Asunto(s)
Oclusión Coronaria/cirugía , Revascularización Miocárdica/métodos , Anciano , Enfermedad Crónica , Oclusión Coronaria/mortalidad , Femenino , Humanos , Masculino , Isquemia Miocárdica/etiología , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/cirugía , Revascularización Miocárdica/estadística & datos numéricos , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/estadística & datos numéricos , Portugal/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Sistema de Registros , Reoperación/estadística & datos numéricos , España/epidemiología , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Ultrasonografía Intervencional/métodosRESUMEN
Percutaneous closure is nowadays considered the treatment of choice of ostium secundum atrial septal defects (ASD). However, transcatheter closure can be highly challenging when we face an ASD with complex morphological features. The combination of different imaging modalities can be very helpful. This case shows the great value of using both intracardiac and real time 3D transesophageal echocardiography for the percutaneous closure of a complex iatrogenic ASD after device embolization.
Asunto(s)
Cateterismo Cardíaco , Defectos del Tabique Interatrial/diagnóstico por imagen , Defectos del Tabique Interatrial/terapia , Dispositivo Oclusor Septal , Anciano , Cateterismo Cardíaco/métodos , Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica/métodos , Embolización Terapéutica/métodos , Femenino , Humanos , Resultado del Tratamiento , Ultrasonografía Intervencional/métodosAsunto(s)
Síndrome Coronario Agudo/etiología , Embolia/complicaciones , Endocarditis Bacteriana/complicaciones , Infecciones por Bacterias Grampositivas/complicaciones , Válvula Mitral/cirugía , Infecciones Relacionadas con Prótesis/complicaciones , Sepsis/complicaciones , Síndrome Coronario Agudo/diagnóstico , Anciano , Antibacterianos/uso terapéutico , Angiografía Coronaria , Quimioterapia Combinada , Ecocardiografía Transesofágica , Embolia/microbiología , Embolia/terapia , Endocarditis Bacteriana/diagnóstico , Enterococcus faecalis/aislamiento & purificación , Fibrinolíticos/uso terapéutico , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Terapia Trombolítica/métodosRESUMEN
The implantation of a stent in ostial lesions with Szabo technique is a simple, ingenious and useful way of treating these complex lesions. But in some circumstances the manipulation of the stent added to a calcified vessel could finish with complications. We present a case of stent dislodgement during Szabo technique in an ostial lesion placed in left anterior descending artery.
Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Angioplastia Coronaria con Balón/métodos , Enfermedades Cardiovasculares/cirugía , Falla de Prótesis , Stents , Enfermedades Cardiovasculares/diagnóstico por imagen , Angiografía Coronaria/instrumentación , Angiografía Coronaria/métodos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Frequently, both peripheral and coronary artery disease are present in the same patient. In patients with abdominal aortic occlusion (i.e., Leriche's syndrome) or femoroiliac occlusion, collateral circulation to the lower extremities can originate in branches of the abdominal aorta or even in the internal thoracic artery (depending on the level of the occlusion). It is important to identify the origin of this circulation during diagnostic procedures, especially in patients who may need to undergo coronary revascularization surgery since, in cases where the majority of the collateral circulation originates in the internal thoracic artery, using the artery as a coronary graft could lead to acute ischemia of the lower extremities. We present three patients with Leriche's syndrome in whom the internal thoracic artery was the origin of the collateral circulation to the ipsilateral femoral artery.
Asunto(s)
Arteriopatías Oclusivas/complicaciones , Circulación Colateral , Arteria Femoral , Síndrome de Leriche/complicaciones , Síndrome de Leriche/cirugía , Arterias Mamarias/anatomía & histología , Cuidados Preoperatorios , Anciano , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Los aneurismas coronarios son una patología infrecuente (0,5-3 por ciento de incidencia). Suelen asociarse con estenosis coronarias y la aterosclerosis es la etiología más frecuente. Nuestro paciente debutó con muerte súbita. Posteriormente presentó taponamiento cardíaco y a las 24 horas desarrolló un IAM inferior. La coronariografía mostró una gran dilatación esferoidal (4,5 × 5 cm) en la coronaria derecha proximal. Se trató con resección del aneurisma y puente aortocoronario. La evolución suele ser asintomática. La rotura o la muerte súbita son formas raras de presentación. La actitud conservadora es el tratamiento más comúnmente aplicado. La indicación quirúrgica dependerá de la presencia de estenosis coronarias asociadas o de la existencia de complicaciones.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Aneurisma Coronario/cirugía , Síncope Vasovagal , Taponamiento Cardíaco , Enfermedad de la Arteria CoronariaRESUMEN
INTRODUCTION AND OBJECTIVES: It has been clearly demonstrated that abciximab is useful in percutaneous coronary interventions. However, it is not known if intracoronary administration of the initial abciximab bolus improves outcome. Moreover, there may be safety concerns. METHODS: The study was a single-center prospective randomized trial that included all patients undergoing coronary angioplasty involving the use of abciximab. Patients were randomized to either intracoronary or intravenous administration of the abciximab bolus. The primary endpoint was the incidence of major adverse cardiac events (i.e., death, myocardial infarction, or the need for revascularization); secondary endpoints were hemorrhagic complications and the troponin-I level. RESULTS: The study included 137 patients; 72 received an intracoronary abciximab bolus and 65, an intravenous bolus. Clinical characteristics and baseline angiographic findings were similar in the two groups. All patients underwent coronary stent implantation. No difference was observed between the intracoronary bolus group and the intravenous bolus group in type of stent used (drug eluting stent 47.2% vs 50.8%, respectively), total stent length, or final TIMI flow grade (3 vs 2.97, respectively). The intervention success rates were also similar (98.5% vs. 99%, respectively). No complication associated with the administration route was reported. However, the level of the myocardial injury marker troponin I increased significantly in the intravenous bolus group. Clinical follow-up at 1 year did not reveal any difference in the incidence of major adverse cardiac events: 8.5% in the intracoronary bolus group versus 6.2% in the intravenous bolus group. CONCLUSIONS: Intracoronary administration of an abciximab bolus did not appear to be less safe or effective than intravenous administration. Less post-procedural myocardial damage was observed in the intracoronary bolus group.
Asunto(s)
Angioplastia Coronaria con Balón , Anticuerpos Monoclonales/administración & dosificación , Fragmentos Fab de Inmunoglobulinas/administración & dosificación , Inhibidores de Agregación Plaquetaria/administración & dosificación , Stents , Abciximab , Angiografía Coronaria , Vasos Coronarios , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intraarteriales , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: To analyze retrospectively the usefulness of cardiovascular magnetic resonance imaging in the assessment of patients with clinically suspected arrhythmogenic right ventricular dysplasia. MATERIAL AND METHOD: We reviewed retrospectively findings from 46 consecutive patients (mean age, 42+/-19 years; 25 male) who were referred for investigation to rule out right ventricular dysplasia. Abnormal findings were classified according to the general diagnostic criteria established by the European Society of Cardiology. RESULTS: Evaluable images were available for all patients. Abnormal right ventricular findings were reported in 24 patients (52%), but only 5 were given a definite diagnosis of right ventricular dysplasia. Fatty infiltration was observed in 9 patients; it was an isolated finding in 6 but was associated with right ventricular contractile dysfunction in 3. These latter patients belonged to the group with confirmed dysplasia. None of the 22 patients (48%) with normal findings on magnetic resonance imaging was given a diagnosis of dysplasia. CONCLUSIONS: Cardiovascular magnetic resonance imaging enabled the right ventricle to be assessed in all patients. In those with clinically suspected dysplasia, normal findings ruled out the diagnosis. However, only 21% of those with abnormal findings on magnetic resonance imaging were finally given a confirmed diagnosis of dysplasia. Fatty infiltration of the right ventricular wall does not imply dysplasia unless it is associated with other abnormalities in right ventricular morphology or contractility. Cardiovascular magnetic resonance imaging is useful in the work-up of patients with clinically suspected arrhythmogenic right ventricular dysplasia.