Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded.

Early results after synchronous carotid stent placement and coronary artery bypass graft in patients with asymptomatic carotid stenosis.

BACKGROUND: The optimal management of patients with combined carotid and coronary artery disease requiring cardiac surgery is still unknown. Staged carotid endarterectomy and carotid artery stenting (CAS), each followed by coronary artery bypass graft (CABG), are options frequently employed. However, for patients with severe carotid artery disease in urgent need of open cardiac revascularization, staged operations may not be the most appropriate alternative. The aim of this study was to describe our experience using a synchronous CAS-CABG method with minimal interprocedural time. We used this synchronous combination of procedures in patients with combined carotid and coronary artery disease admitted for urgent CABG. METHODS: Patients with concomitant severe carotid and coronary artery disease scheduled for synchronous CAS and urgent CABG between December 2006 and January 2010 were included in the study. All procedures were performed at a single center: the Cardiovascular Foundation of Colombia, in Floridablanca, Santander, Colombia. The study cohort was characterized according to demographic and clinical characteristics, which included degree of carotid stenosis, presence/absence of preoperative neurological symptoms, and cardiac operative risk profile. All patients underwent CAS under embolic protection devices and then CABG within the next 2 hours. Patients received aspirin pre- and postprocedure but were started on clopidogrel only after CABG. The primary end point of the study was the composite incidence rate of myocardial infarction, stroke, and death 30 days after CAS-CABG. RESULTS: Fifteen patients with concomitant severe carotid and coronary artery disease underwent synchronous CAS-CABG. Most patients (60%) were men, and mean (± standard deviation) age was 65.2 (± 8.4) years. Most patients (93%) were neurologically asymptomatic. The median (interquartile range) ejection fraction and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) for the cohort were 55% (36%-62%) and 9.7% (4.6%-14.8%), respectively. There were no deaths, major strokes, minor strokes, or myocardial infarctions during the procedure or within 30 days of CAS-CABG. One patient experienced neurological symptoms likely as a result of transient ischemic attack ipsilateral to the CAS procedure. None of the patients required cardiac or carotid reinterventions, and there were no cases of postoperative bleeding requiring reoperation. CONCLUSIONS: Synchronous CAS-CABG, when CABG is performed within the 2 hours of the CAS procedure, may be a viable alternative to the more generally accepted staged combination, particularly among patients for whom CABG cannot be postponed. We hope that this strategy will be further evaluated in larger prospective studies and adequately powered randomized clinical trials.

Catheter-based Therapy for Massive Pulmonary Embolism in an Elderly Woman with Chest Pain and Dyspnea: Case Report.

An 80-year-old woman presented with chest pain and dyspnea. The electrocardiogram (ECG) showed a known chronic complete left bundle branch block and elevated levels of high-sensitivity cardiac Troponin T. The first diagnosis was acute coronary syndrome, but a few hours later she developed shock and syncope; after resuscitation a coronary angiography was performed but it did not show any acute coronary obstruction. The echocardiogram showed McConnell's sign suggesting a massive pulmonary embolism; the pulmonary angiography showed large thrombi in both branches of pulmonary artery, so a catheter-based treatment was performed with thromboaspiration and rt-PA administration, and a significant improvement of blood pressure, clinical condition and right ventricle function was observed. In spite of bleeding at the puncture sites (femoral artery and vein), controlled by local compression, catheter-based therapy in massive pulmonary embolism was associated with survival and satisfactory outcome. A combined fragmentation/thromboaspiration and catheter-directed fibrinolysis strategy may be useful to reduce the embolic load, improve RV function, and reduce mortality.

A randomized trial of transfer for primary angioplasty versus on-site thrombolysis in patients with high-risk myocardial infarction: the Air Primary Angioplasty in Myocardial Infarction study.

OBJECTIVES: The Air Primary Angioplasty in Myocardial Infarction (PAMI) study was designed to determine the best reperfusion strategy for patients with high-risk acute myocardial infarction (AMI) at hospitals without percutaneous transluminal coronary angioplasty (PTCA) capability. BACKGROUND: Previous studies have suggested that high-risk patients have better outcomes with primary PTCA than with thrombolytic therapy. It is unknown whether this advantage would be lost if the patient had to be transferred for PTCA, and reperfusion was delayed. METHODS: Patients with high-risk AMI (age >70 years, anterior MI, Killip class II/III, heart rate >100 beats/min or systolic BP <100 mm Hg) who were eligible for thrombolytic therapy were randomized to either transfer for primary PTCA or on-site thrombolysis. RESULTS: One hundred thirty-eight patients were randomized before the study ended (71 to transfer for PTCA and 67 to thrombolysis). The time from arrival to treatment was delayed in the transfer group (155 vs. 51 min, p < 0.0001), largely due to the initiation of transfer (43 min) and transport time (26 min). Patients randomized to transfer had a reduced hospital stay (6.1 +/- 4.3 vs. 7.5 +/- 4.3 days, p = 0.015) and less ischemia (12.7% vs. 31.8%, p = 0.007). At 30 days, a 38% reduction in major adverse cardiac events was observed for the transfer group; however, because of the inability to recruit the necessary sample size, this did not achieve statistical significance (8.4% vs. 13.6%, p = 0.331). CONCLUSIONS: Patients with high-risk AMI at hospitals without a catheterization laboratory may have an improved outcome when transferred for primary PTCA versus on-site thrombolysis; however, this will require further study. The marked delay in the transfer process suggests a role for triaging patients directly to specialized heart-attack centers.

Transcatheter aortic valve implantation: safety and effectiveness of the treatment of degenerated aortic homograft.

INTRODUCTION AND OBJECTIVES: Percutaneous aortic valve implantation for patients with severe symptomatic aortic stenosis and a high surgical risk is currently well established. We report our experience in terms of safety and effectiveness of transcatheter aortic valve implantation in other clinical context like the degenerated aortic homografts. METHODS: We report our initial experience in four hospitals and five patients with degenerated aortic homograft and severe aortic regurgitation, refused for surgery for a heart team, that underwent percutaneous implantation of CoreValve(®) aortic prosthesis. RESULTS: We included three males and two females. The mean age was 70 (3.5) years. All patients were symptomatic in New York Heart Association class III or IV. Procedures were performed through one of the femoral arteries in all patients and under sedation in three patients. The implant was successfully carried out in all cases. There were no major complications during the procedure or admission and the valvular defect was solved in all cases. In-hospital and 30-days mortality was 0. All patients had clinical improvement during follow-up with a reduction in at less two grades in the New York Heart Association functional scale. CONCLUSIONS: In our experience the treatment of degenerated aortic homografts and aortic insufficiency with transcatheter aortic valve implantation showed to be safe and effective. The current challenge is to convey the good results of transcatheter aortic valve implantation in symptomatic aortic stenosis and high surgical risk to others disorders of the aortic valve. In the future, it is possible that transcatheter aortic valve implantation will expand its indications to majority of aortic valve disorders and patients with less surgical risk.

Arritmia como única forma de presentación de la miocarditis / Arrhythmia as the only presentation form of myocarditis / Arritmia como a única forma de apresentação de miocardite

Introducción. Las arritmias ventriculares se presentan, en algunos pacientes, como único signo clínico de miocarditis, siendo ésta no incluida como probabilidad etiológica. La dificultad de la caracterización clínica de esta forma de presentación en esta patología no permite iniciar el tratamiento oportuno. Objetivo. Analizar la evolución clínica y el tratamiento de pacientes con arritmias, como única manifestación clínica de miocarditis. Materiales y método. Estudio descriptivo, observacional, transversal, retrospectivo de diecinueve pacientes con diagnóstico de miocarditis, asistidos en nuestra institución, entre los años 2000 y 2009. Se seleccionaron siete pacientes (35%), que presentaron arritmias ventriculares como única forma de manifestación clínica. La edad media de estos pacientes fue de 18 ± 7 años, cinco hombres y dos mujeres. Todos tuvieron biopsia endomiocárdica positiva para miocarditis. Se examinaron las historias clínicas a fin de observar el tipo de arritmia, la función ventricular, la respuesta al tratamiento recibido y la evolución clínica a corto y largo plazo. Para el análisis estadístico, se empleó el programa estadístico InfoStat/Profesional versión 2009p. Resultados. Todos los pacientes presentaron extrasístoles ventriculares frecuentes, 3 (43%) taquicardia ventricular no sostenida y 4 (57%) taquicardia ventricular sostenida, de éstos, 1 paciente padeció además fibrilación ventricular. La función ventricular fue normal en todos los pacientes (fracción de eyección: 62 ± 8,08%). Seis pacientes (86%) fueron tratados con inmunosupresores (corticoides y azatioprina), de los cuales 5 (72%) evolucionaron con extrasístoles ventriculares aisladas. Sólo un paciente continuó con taquicardia ventricular sostenida, que requirió implante de cardiodesfibrilador y ablación por radiofrecuencia. No hubo óbitos, en un seguimiento de 6 ± 3 años. Conclusiones. De los pacientes tratados con inmunosupresores se logró reducir la inflamación y controlar las arritmias. Se evidenció una buena evolución de los pacientes a corto y largo plazo.

Background. Ventricular arrhythmias occur in some patients as the only clinical sign of myocarditis; still it is not included as an etiological probability. The complexity of its clinical characterization does not allow an appropriate treatment. Aim.To analyze clinical evolution and treatment in those patients with arrhythmia as the only clinical manifestation of myocarditis. Materials and method. Descriptive, observational, transversal, retrospective study, enrolling nineteen patients diagnosed with myocarditis, attended in our institution within the period 2000-2009. Seven patients (35%) who presented ventricular arrhythmia as the only clinical manifestation were selected. Their mean age was 18 ± 7 years old, five men and two women. All of them underwent endomyocardial biopsy, resulting positive for myocarditis. Clinical histories were analyzed in order to examine arrhythmia type, ventricular function, response to received treatment, and clinical long and short-term evolution. Statistical analysis was performed with statistical program InfoStat/Profesional version 2009p. Results. All patients presented frequent ventricular extrasystoles; 3 (43%) non sustained ventricular tachycardia; 4 (57%) sustained ventricular tachycardia, and 1 of these patients had ventricular fibrillation. Ventricular function was normal in all patients (ejection fraction 62 ± 8,08%). Six patients (86%) received immunosupressors (corticoids y azatioprin), of which 5 (72%) evolved with isolated ventricular extrasystoles. Only one patient continued with sustained ventricular tachycardia, requiring defibrillator implantation and radiofrequency ablation. There were no deaths in a follow up of 6 ± 3 years. Conclusions. Immunosuppressive therapy allowed reducing inflammation and controlling arrhythmias. Patients showed a good short and long term evolution.

Introdução. As arritmias ventriculares ocorrem em alguns pacientes, como o único sinal clínico de miocardite, ainda não incluída como de probabilidade de diagnóstico. A dificuldade da caracterização clínica da doença não permite o tratamento adequado para controlá-lo. Objetivo. Analisar a evolução clínica e tratamento de pacientes com arritmias, como a única manifestação clínica da miocardite. Materiais e métodos. Estúdio descritivo, observacional, transversal, retrospectivo, com dezenove pacientes com diagnóstico de miocardite, atendidos em nossa instituição entre os anos 2000 e 2009. Foram selecionados sete pacientes (35%) com arritmia ventricular como única forma de manifestação clínica. A idade média desses pacientes foi de 18± 7 anos, cinco homens e duas mulheres. Todos foram submetidos à biópsia endomiocárdica, resultando positivo para miocardite. As histórias clínicas foram analisadas a fim de avaliar o tipo de arritmia, função ventricular, a resposta ao tratamento recebido e evolução clínica a longo e curto prazo. A análise estatística foi realizada com o programa estatístico InfoStat/Profesional versão 2009p. Resultados. Todos os pacientes apresentaram extra-sístoles ventriculares freqüentes, 3 (43%) taquicardia ventricular não sustentada; 4 (57%) taquicardia ventricular sustentada, e um destes pacientes também sofreu fibrilação ventricular. A função ventricular era normal em todos os pacientes (fração de ejeção de 62 ± 8,08%). Seis pacientes (86%) receberam imunossupressores (corticóides e azatioprina), dos quais 5 (72%) evoluíram com extra-sístoles ventriculares isoladas. Apenas um paciente continuou com taquicardia ventricular sustentada, necessitando de implante de desfibrilador e ablação por radiofreqüência. Não houve mortes em um seguimento de 6 ± 3 anos. Conclusões. A terapia imunossupressora permitiu reduzir a inflamação e controlar arritmias. Os pacientes apresentaram boa evolução a curto e longo prazo.

[Cellular protection in acute myocardial infarction with ST-segment elevation]. / Protección celular en el infarto agudo de miocardio con supradesnivel del segmento ST.

About half of the patients with acute myocardial infarction who undergo successful fibrinolytic treatment or primary percutaneous coronary artery rechanneling continue to have abnormal microcirculatory blood flow. Various medications have been designed to protect the myocardial cell and have been investigated in human beings as coadjuvants to rechanneling procedures. Overall, they can be divided into: a) medications that act on the inflammatory response triggered by ischemia/reperfusion, such as anti-CD11/CD18 antibodies and anti-complement, and b) medications that enhance metabolic tolerance, such as glucose-insulin-potassium solution and inhibitors of the Na+/H+ ion exchange system. Despite the importance of the problem, the results so far obtained have been inconclusive and it was concluded that new studies are needed. Some of these studies have already been undertaken in attempt to find a satisfactory response to the question.

Implante percutáneo de válvula aórtica: seguridad y eficacia del tratamiento del homoinjerto aórtico disfuncionante / Transcatheter aortic valve implantation: safety and effectiveness of the treatment of degenerated aortic homograft

Introducción y objetivos. El implante percutáneo de válvula aórtica, como tratamiento de la estenosis aórtica severa con elevado riesgo quirúrgico, está actualmente bien establecido. Pretendemos comunicar la experiencia en términos de seguridad y eficacia del implante percutáneo de válvula aórtica, sobre una serie de homoinjertos aórticos disfuncionantes. Métodos. Presentamos la experiencia inicial acumulada en cuatro centros, sobre 5 pacientes portadores de un homoinjerto aórtico degenerado, todos con insuficiencia aórtica severa y rechazados para cirugía por un equipo multidisciplinario, sometidos a implante de una prótesis aórtica CoreValve®. Resultados. Se incluyó a 3 varones y 2 mujeres, con una media de edad de 70±3,5 años, severamente sintomáticos en clase funcional III o IV de la New York Heart Association. El procedimiento se llevó a cabo por vía femoral en todos los casos, y mediante sedación en 4 pacientes. El implante se realizó con éxito en todos los casos. Ningún paciente presentó complicaciones mayores durante el procedimiento o el ingreso, y en todos ellos se resolvió la deficiencia valvular. No hubo mortalidad hospitalaria ni durante el seguimiento. Todos los pacientes presentaron mejoría clínica en el seguimiento, con una disminución de al menos 2 grados en la escala de la New York Heart Association. Conclusiones. En nuestra experiencia, el tratamiento de homoinjerto disfuncionante e insuficiencia aórtica se ha demostrado seguro y eficaz. El reto actual es trasladar los buenos resultados del implante percutáneo de válvula aórtica en la estenosis aórtica severa degenerativa del anciano a pacientes con alto riesgo quirúrgico y otras afecciones de la aorta. Es posible que en el futuro el implante percutáneo de válvula aórtica abarque cada vez mayor número de enfermedades aórticas y pacientes de menor riesgo quirúrgica (AU)

Introduction and objectives. Percutaneous aortic valve implantation for patients with severe symptomatic aortic stenosis and a high surgical risk is currently well established. We report our experience in terms of safety and effectiveness of transcatheter aortic valve implantation in other clinical context like the degenerated aortic homografts. Methods. We report our initial experience in four hospitals and five patients with degenerated aortic homograft and severe aortic regurgitation, refused for surgery for a heart team, that underwent percutaneous implantation of CoreValve® aortic prosthesis. Results. We included three males and two females. The mean age was 70 (3.5) years. All patients were symptomatic in New York Heart Association class III or IV. Procedures were performed through one of the femoral arteries in all patients and under sedation in three patients. The implant was successfully carried out in all cases. There were no major complications during the procedure or admission and the valvular defect was solved in all cases. In-hospital and 30-days mortality was 0. All patients had clinical improvement during follow-up with a reduction in at less two grades in the New York Heart Association functional scale. Conclusions. In our experience the treatment of degenerated aortic homografts and aortic insufficiency with transcatheter aortic valve implantation showed to be safe and effective. The current challenge is to convey the good results of transcatheter aortic valve implantation in symptomatic aortic stenosis and high surgical risk to others disorders of the aortic valve. In the future, it is possible that transcatheter aortic valve implantation will expand its indications to majority of aortic valve disorders and patients with less surgical risk (AU)

Tratamiento de aorta abdominal e ilíacas con técnica endovascular / Treatment of abdominal aorta and iliac arteries with endovascular technique

Antecedentes: desde 1991 la técnica endovascular se ha aplicado con éxito en el manejo de los aneurismas de aorta infrarrenal, y se ha perfeccionado de manera tal que rápidamente se ha convertido en una alternativa para pacientes de alto riesgo para la cirugía convencional. Objetivo: describir los resultados institucionales en el manejo de las patologías de aorta abdominal e ilíacas mediante técnica endovascular desde 2003 a 2005.Diseño-Método: estudio descriptivo, longitudinal, retrospectivo, en el que se analizaron las historias clínicas de los pacientes sometidos a procedimiento endovascular de aorta abdominal e ilíacas. El análisis se realizó en Stata 8,0 S/E...

Antecedents: since 1991 endovascular technique has been successfully used in the management of infra-renal aortic aneurysms and it has been improved in such a way that it has quickly turned into an alternative for patients considered having high risk for conventional surgery. Objective: describe the institutional results in the management of abdominal aortic pathologies through endovascular technique from 2003 to 2005. Design-Method: descriptive, longitudinal, retrospective study in which clinical histories of patients that underwent an endovascular procedure of abdominal aorta and iliac arteries were analyzed. The analysis was performed in Stata 8,0 S/E. Results: 9 patients received exclusively treatment for abdominal aortic and iliac lesions. All were male individuals with mean age 68.9 ± 8.1 years. 6 patients had diagnosis of infra-renal aortic aneurysm and the other 3 had anastomotic aneurysms. Requirement of endoprosthesis was evidenced in an average of 1.9 ± 0.8. Femoro-femoral bypass surgery was performed as simultaneous procedure in 4 of the 9 patients. 77.8% of patients had no complications. Mortality due to the procedure was 22% (2 patients) and it is important to notice that only these 2 patients had complications. Conclusions: exclusion of aortic and iliac aneurysms with modular endoprosthesis is being widely implemented as a valid treatment option, with excellent results that avoid the risks of conventional surgery and its associated morbidity.

Experiencia en el manejo endovascular para el tratamiento de la aorta torácica / Experience in endovascular management for thoracic aorta treatment

Antecedentes: el tratamiento endovascular ofrece la posibilidad de cubrir el origen de la disección y evitar que progrese hasta aneurisma de la aorta, y con ello demuestra una reducción en la mortalidad hasta del 16 porciento.Objetivo: evaluar los resultados quirúrgicos en términos de morbi-mortalidad de los pacientes sometidos a manejo endovascular de las lesiones de la aorta torácica en la Fundación Cardiovascular de Colombia desde 2003 hasta 2005. Diseño–método: estudio longitudinal tipo descriptivo retrospectivo, en el que se evaluaron las historias clínicas de todos los pacientes sometidos a manejo endovascular de patología toracoabdominal; en éste sólo se incluyeron los pacientes con procedimientos de la aorta torácica, desde 2003 hasta 2005. El análisis de los datos se realizó en Stata/SE 8,0...

Manejo endovascular de la aorta torácica / Endovascular treatment of thoracic aorta

En comparación con el tratamiento convencional, la terapia endovascular en aneurisma de aorta torácica, presenta los mejores resultados, por lo que se convierte en el tratamiento de elección para la patología de aorta torácica descendente endovascular, por su baja morbimortalidad perioperatoria. El tratamiento quirúrgico por vía retroperitoneal y/o endovascular para aneurisma de aorta abdominal infrarrenal, resulta ser especialmente seguro en pacientes octogenarios o con alta morbilidad. Esta cohorte institucional presenta resultados perioperatorios y en el seguimiento, similares a los reportados en la literatura mundial.

Compared with the conventional treatment, endovascular therapy in thoracic aortic aneurysm shows the best results, being the election treatment for the pathology of the descending thoracic aorta, due to its low peri-operative morbid-mortality. Surgical treatment by retro-peritoneal route and/or endovascular for infra-renal abdominal aortic aneurysm is especially safe in octogenarian patients or in those with a high mortality rate. This institutional cohort show peri-operative and follow-up results similar to those reported in the world literature.

Arteria carótida y placa carótida un órgano / Carotid artery and plaque. Carotid: an organ

En estos momentos es posible hacer recomendaciones sobre las indicaciones de la endarterectomía carotídea, basadas en los ensayos clínicos publicados y en la revisión de grandes series quirúrgicas. Las indicaciones para la cirugía dependerán del grado de estenosis y de la morfología de la placa, así como del estado clínico del paciente y de la morbi-mortalidad del equipo quirúrgico. Este al igual que otros estudios con grandes series de casos, evidencia que la endarterectomía carotídea y/o el manejo endovascular, realizado por equipos expertos, es un procedimiento seguro en pacientes con indicación quirúrgica.

It is now possible to recommend indications for aortic endarterectomy, based on published clinical essays and revision of large surgical series. Surgery indications will depend on the stenosis degree and the plaque morphology, as well as on the patient's clinical state and the morbid-mortality in this surgical team. As other studies with large case series, evidences that carotid endarterectomy and/or endovascular management, when realized by expert teams, is a safe procedure in patients with surgical indication.

Endarterectomía carotídea en pacientes sintomáticos y asintomáticos: resultados de morbi-mortalidad desde 1998 hasta 2005 / Carotid endarterectomy in symptomatic and asymptomatic patients: morbid-mortality results from 1998 to 2005

Antecedentes: el accidente cerebrovascular es la tercera causa de muerte y probablemente la causa más importante de discapacidad a largo plazo. La tasa de mortalidad está entre 15% y 35% con el primer ataque y se eleva a 65% para los accidentes cerebrovasculares subsiguientes. Los resultados a largo y mediano plazo avalan esta técnica quirúrgica para el tratamiento de la enfermedad carotídea, al demostrar altos perfiles de seguridad. Objetivo: determinar los resultados de morbilidad y mortalidad quirúrgica y a 3, 6 y 12 meses de seguimiento, en los pacientes sometidos a endarterectomía carotídea desde 1998 hasta septiembre de 2005. Diseño-método: se evaluaron las historias clínicas de los pacientes sometidos a endarterectomía carotídea, desde 1998 hasta septiembre de 2005. Resultados: se realizaron 42 procedimientos desde 1998 hasta septiembre de 2005; el 57% de los pacientes eran hombres, con edad promedio de 68,8 ± 9,9 años. Los antecedentes de importancia fueron: hipertensión arterial (82%), tabaquismo (61%) y dislipidemia (50%). El 82% de los pacientes mostraban síntomas de enfermedad carotídea. Once pacientes tuvieron lesión de carótida derecha, 16 de carótida izquierda y 15 lesión bilateral, con un promedio de obstrucción de 85 ± 11,4%. La mortalidad fue de 4,7% y no estaba relacionada con el procedimiento quirúrgico. A septiembre de 2005 el 57% de los pacientes egresados estaban libres de síntomas. Conclusiones: la mortalidad para este grupo de pacientes es comparable con los resultados publicados en todo el mundo. La seguridad del procedimiento avala esta técnica quirúrgica como la primera opción en el manejo de la patología carotídea.

Antecedents: cerebrovascular disease is the third cause of death and probably the most common cause of significant long term disability. Mortality rate with first stroke is between 15% and 35% and goes up to 65% with subsequent strokes. Results at long and middle term endorse carotid endarterectomy for carotid artery disease treatment by demonstrating high safety profiles. Objective: to determine the surgical morbidity and mortality results at 3, 6 and 12 months of follow-up in patients submitted to carotid endarterectomy from 1998 to 2005. Design-Method: clinical histories of patients submitted to carotid endarterectomy from 1998 to September 2005 were evaluated. Results: 42 procedures were realized since 1998 until September 2005. 57% of the patients were men with mean age 68.8 ± 9.9 years. Important antecedents were arterial hypertension (82%), cigarette smoking (61) and dyslipidemia (50%). 82% showed symptoms of carotid disease. 11 patients had right carotid lesion and in 15 the lesion was bilateral, with mean obstruction of 85 ± 11.4%. Mortality was 4.7% and was not related to the surgical procedure. At September 2005, 57% of the discharged patients were asymptomatic. Conclusions: mortality for this group of patients is comparable to the worldwide published results. Procedure safety guarantees this surgical technique as the first option in this carotid pathology management.

Prevención de reestenosis post implante de stents coronarios / The restenosis prevention post coronary stent implantation

Los stent coronarios fueron grandes optimizadores de la angioplastia coronaria con balón. Los estudios stress, benestent 1 y 2 evidenciaron reducciones importantes en las tasas de reestenosis coronaria. El proceso de reestenosis fue afectado por los stents en el sentido de reducir el retroceso elástico precoz y el remodelamiento negativo, pero el proceso de hiperplasia neoíntimal sólo no fue modificado sino que exagerado. En el sentido de minimizar la hiperplasia debemos establecer formas de reducir la injuria durante el implante del stent, reducir el proceso inflamatorio, inhibir la migración y proliferación celular y favorecer el proceso de endotelización del stent. Varias opciones farmacológicas han sido discutidas y presentaremos los resultados con dichas drogas tales como: actinomocina, tacrolimus, taxol y sirolimus

Protección celular en el infarto agudo de miocardio con supradesnivel del segmento ST / Cellular protection in acute myocardial infarction with st-segment elevation

De los pacientes con infarto agudo de miocardio sometidos con éxito a terapéuticas de recanalización con fibrinolíticos o intervención coronaria percutánea primaria, aproximadamente la mitad de ellos permanecen con alteración del flujo sanguíneo en la microcirculación. Para proteger a la célula del sufrimiento, se han investigado en humanos diferentes medicamentos, como coadyuvantes a las terapéuticas de recanalización. De una manera global pueden ser divididos en: a) aquellos que actúan en la respuesta inflamatoria desencadenada por el proceso de isquemia/reperfusión, como los anticuerpos anti-CD11/CD18 y anticomplemento, y b) aquellos que actúan aumentando la tolerancia metabólica, como la solución glucosa-insulina-potasio y los inhibidores del sistema de intercambio Na+/H+. A pesar de la importancia del problema, se llegó a la conclusión de que las terapias utilizadas hasta el momento presentan resultados conflictivos. Por ello, es preciso que se lleven a cabo nuevos estudios, algunos de ellos ya en desarrollo, con el fin de obtener una respuesta definitiva sobre el tema (AU)

About half of the patients with acute myocardial infarction who undergo successful fibrinolytic treatment or primary percutaneous coronary artery rechanneling continue to have abnormal microcirculatory blood flow. Various medications have been designed to protect the myocardial cell and have been investigated in human beings as coadjuvants to rechanneling procedures. Overall, they can be divided into: a) medications that act on the inflammatory response triggered by ischemia/reperfusion, such as anti-CD11/CD18 antibodies and anti-complement, and b) medications that enhance metabolic tolerance, such as glucose-insulin-potassium solution and inhibitors of the Na+/H+ ion exchange system. Despite the importance of the problem, the results so far obtained have been inconclusive and it was concluded that new studies are needed. Some of these studies have already been undertaken in attempt to find a satisfactory response to the question (AU)