[Long term results of mitral balloon valvuloplasty]. / Resultados a largo plazo de la valvuloplastía mitral con balón.

BACKGROUND: Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up. AIM: To assess the late results of MBV. MATERIAL AND METHODS: A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis. RESULTS: The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04). CONCLUSIONS: MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.

[Rapid aspirin desensitization in patients with a history of aspirin hypersensitivity requiring coronary angioplasty. Report of four cases]. / Desensibilización rápida en pacientes con hipersensibilidad a aspirina sometidos a angioplastía coronaria. Reporte de cuatro casos.

Aspirin use is necessary after a coronary angioplasty. It should not be used in patients with a history of hypersensitivity. However, rapid desensitization protocols have been reported to allow its use in such patients. One of these protocols consists in the administration of progressive doses of aspirin, from 1 to 100 mg in a period of 5.5 hours, in a controlled environment. We report four male patients aged 45,49, 59 and 73 years with a history of aspirin hypersensitivity, who were subjected to a coronary angioplasty. In all, the rapid aspirin desensitization protocol was successfully applied, allowing the use of the drug after the intervention without problems.

Resultados a largo plazo de la valvuloplastía mitral con balón / Long term results of mitral balloon valvuloplasty

Background: Mitral balloon valvuloplasty (MBV) is the therapy of choice for the treatment of symptomatic mitral stenosis with suitable anatomy. Although its short and mid-term results are favorable, there is a paucity of information about long-term follow-up. Aim: To assess the late results of MBV. Material and Methods: A cohort of 225 patients aged 8 to 20 years who were subjected to a MBV from 1989 to 2001, was studied. All variables at the time of the procedure, short and long-term results and major events during follow-up (new mitral intervention and mortality) were recorded. Uni and multivariate analysis were used to assess prognosis. Results: The mean follow-up lapse was 13.5 years (range 8 to 20 years). During this period, 88 patients (39.1%) remained event-free and in acceptable functional capacity. Eight percent died, 8% required a second MBV and 43.5% required a surgical mitral valve replacement. A post-procedural area equal or greater to 1.9 cm² was associated with a greater likelihood of free-event survival (log rank test: p = 0.02/Cox proportional regression model: coefficient 0.54, p = 0.04). Conclusions: MBV is effective, although there is a high chance of new interventions in the long-term follow-up. A larger post-procedure mitral area is associated with a better prognosis.

Desensibilización rápida en pacientes con hipersensibilidad a aspirina sometidos a angioplastía coronaria: Reporte de cuatro casos / Rapid aspirin desensitization in patients with a history of aspirin hypersensitivity requiring coronary angioplasty: Report of four cases

Background: Aspirin use is necessary after a coronary angioplasty. It should not be used in patients with a history of hypersensitivity. However, rapid desensitization protocols have been reported to allow its use in such patients. One of these protocols consists in the administration of progressive doses of aspirin, from 1 to 100 mg in a period of 5.5 hours, in a controlled environment. We report four male patients aged 45,49, 59 and 73 years with a history of aspirin hypersensitivity, who were subjected to a coronary angioplasty. In all, the rapid aspirin desensitization protocol was successfully applied, allowing the use of the drug after the intervention without problems.

Mortalidad post infarto del miocardio en Chile: comparación de los registros de angioplastía primaria versus trombolisis / Mortality in myocardial Infarction in Chile: a comparison from the angioplasty and thrombolysis registries

Antecedentes: Desde el año 2005, se ha implementado en nuestro país un conjunto de políticas públicas para permitir un acceso universal al tratamiento trombolítico a los pacientes con infarto agudo del miocardio (IAM). Para evaluar sus resultados es importante establecer los estándares locales de las distintas opciones de reperfusión. Objetivos: 1) Comparar la mortalidad precoz y alejada de los pacientes con IAM sometidos a angioplastía primaria (angioplastía) versus los sometidos a trombolisis, en Chile. 2) Establecer los factores de riesgo de mortalidad en estos pacientes. Métodos: Utilizando los registros nacionales de angioplastía (RENAC) y de IAM (GEMI), seleccionamos a todos los pacientes con IAM tratados con angioplastía o trombolisis, durante los años 2003 y 2004. Entre ellos, comparamos mediante prueba de t de Student o chi-cuadrado, según correspondiera, sus características basales y su mortalidad hospitalaria, a 30 días, ya 12 y 24 meses. Además se hizo análisis de regresión logística multivariado para identificar los factores que independientemente se asociaron a mayor riesgo de mortalidad. Resultados: En el estudio se incluyeron 857 pacientes con IAM que recibieron trombolisis y 700 tratados con angioplastía. No hubo diferencias entre los grupos en cuanto a edad, sexo, incidencia de diabetes mellitus, hipertensión arterial, hiperlipidemia ni antecedentes de IAM previo. La mortalidad fue significativamente menor en los pacientes tratados con angioplastía (HR crudo: 0,65; 95 por ciento IC: 0,49-0,86, p=0,03). La diferencia fue evidente tanto para la mortalidad precoz como para la alejada. Así, alcanzó un 10,6 vs 6,3 por ciento (p <0,01), durante la hospitalización inicial, un 11,2 vs 8,1 por ciento a los 30 días (p <0,01), un 15,3vs 10,6 por ciento (p<0,01) a los 12 meses, y un 21,1 vs 11,7 por ciento a los 24 meses (p<0,001), para trombolisis y angioplastía respectivamente. Otros factores que independientemente se asociaron...

Background: From 2005, thrombolysis has been made available as a public health policy to treat acute myocardial infarction (AMI) in Chile. A comparison with results obtained locally with primary PTCA is relevant Aim: to compare early and late mortality in AMI between thrombolysis and PTCA treatments and to determine risk factors associated to mortality Methods: Data from national registries of PTCA (RENAC) and trombolysis (GEMI) of patients treated from 2003 through 2004 were analyzed. Early (<30day) and late (12 and 24 months) mortality was compared between groups. Logistic regression analysis was used to identify independent risk factors for mortality. Results: 857 patients received thrombolysis and 700 were treated by PTCA. Age, sex, prevalence of diabetes, hypertension, dyslipidemia and prior AMI were similar in both groups. PTCA was associated to lower mortality rates compared to thrombolysis (crude HR 0.65, 95 percent C. I. 0.49-0.86, p= 0.03). Early, 12month and 24month mortality rates for thrombolysis and PTCA treated patients were 10.6 vs. 6.3 percent, , 15.3 vs. 10.6 percent and 21.1 vs. 11.7 percent, respectively (p<0.01). Increased age, female gender and presence of diabetes were independently associated to mortality, overall. Conclusion: Primary PTCA was associated to lower early and late mortality rates compared to thrombolysis in Chilean registry data.

Resultados alejados de la angioplastía coronaria en Chile en elRegistro Nacional de Angioplastía Coronaria (RENAC) 2001-2002 / Long-term results of coronary angioplasty in Chile according to the National Registry of Angioplasty (RENAC)

Introducción: En el año 2004 publicamos los resultados intrahospitalarios del primer registro chileno de angioplastía coronaria (AC), RENAC. Sin embargo, la información nacional sobre los resultados alejados de la AC en Chile hasta la fecha ha sido escasa y parcelar. Objetivo: Evaluar los resultados alejados de la angioplastía coronaria en pacientes sin infarto agudo de miocardio (IAM) en el país. Pacientes y métodos: Seis de los 10 centros participantes en el RENAC entre junio de 2001 y octubre de 2002 efectúan seguimiento clínico alejado de sus pacientes. Resultados: De un total de 892 pacientes sin IAM sometidos a AC y dados de alta vivos, se obtuvo seguimiento clínico en 744 (83,3 por ciento) y en 772 (86,5 por ciento) sólo de su estado vital. La mayoría había presentado un síndrome coronario agudo y en el 88,7 por ciento fueron sometidos a angioplastía de un vaso. El 84,8 por ciento de las 936 lesiones fueron tratadas con stents. Se obtuvo éxito angiográfico en el 97,2 por ciento de las lesiones y clínico en un 97,6 por ciento de los pacientes. Al cabo de un seguimiento promedio de 21 meses, la mortalidad cardíaca fue de 0,9 por ciento y la total de 1,7 por ciento. Se efectuó una nueva revascularización del vaso tratado en el 5,5 por ciento de los pacientes. La sobrevida libre de eventos isquémicos mayores fue de 90,0 por ciento. Conclusiones: Los resultados extrahospitalarios de pacientes sin IAM y sometidos a AC en Chile muestran una baja mortalidad cardíaca, una baja frecuencia de revascularización del vaso tratado y una alta sobrevida libre de eventos isquémicos.

Background: In 2004 we published the in-hospital results of the first Chilean coronary angioplasty registry (RENAC). To date the long-term results of coronary angioplasty in Chile is scant. Aim: To assess the long-term results of coronary angioplasty in patients without acute myocardial infarction in Chile. Patients and Methods: Six out of 10 participating centers in RENAC between June 2001 and October 2002, providedclinical follow-up of their patients. Results: A total of 892 patients without acute myocardial infarction underwent angioplasty and were discharged alive. In 744 (83,3 percent) patients clinical follow-up was obtained and in 772 (86,5 percent) only vital status could be ascertained. Most patients underwent one vessel angioplasty (88,7 percent) for an acute coronary syndrome. Stent implantation was performed in 84,8 percent of the 936 treated coronary lesions. Angiographic success was obtained in 97,2 percent of lesions and clinical success in 97,6 percent of patients. After an average follow-up of 21 months, cardiac and all cause mortality were 0,9 and 1,7 percent. Target vessel revascularization was performed in 5,5 percent and survival free of cardiac ischemic events was 90,0 percent Conclusions: Long-term results of coronary angioplasty in patients without an acute myocardial infarction shows low rates of cardiac death, target vessel revascularization and a high survival free of cardiac ischemic events.

Coronariografía no invasiva mediante tomografía axial computada multicorte / 16 detector computed tomagraphy for coronary angiography

Antecedentes: La tomografía axial computada de 16 detectores de las arterias coronarias (TAC Coronario) ha emergido recientemente como una alternativa diagnóstica a la coronariografía invasiva (CI). Objetivo: Estudiar la exactitud del TAC coronario de 16 detectores para pesquisar la presencia o ausencia de estenosis coronaria en distintos tipos de pacientes, mediante su comparación con la CI. Métodos: A un total de 55 pacientes (46 hombres, 9 mujeres, promedio 57 +/-12 años) en quienes se realizó una CI electiva, se les realizó un TAC coronario. Se analizó específicamente la presencia de lesiones 50 por ciento y se compararon estos resultados con los obtenidos mediante la CI cuantitativa. Resultados: Cincuenta pacientes requirieron beta bloqueo, obteniéndose una FC promedio de 57 lpm. En los segmentos principales se objetivaron 61 lesiones significativas por CI, de las cuales 52 (85,2 por ciento) fueron correctamente detectadas por el TAC coronario. La sensibilidad, especificidad, LH(+) y LH(-) del examen fueron 85 por ciento, 97 por ciento, 33 y 0.15, respectivamente. La presencia o ausencia de enfermedad coronaria significativa fue correctamente diagnosticada en 50 de los 55 pacientes (91 por ciento). Conclusión: El TAC coronario de 16 detectores es un examen sensible y específico para el diagnóstico de estenosis significativas de los segmentos principales del árbol coronario.

Background: Invasive coronary arteriography (ICA) is the gold standard to assess coronary artery stenosis. Sixteen detector computed tomography (Coronary CT) has recently been introduced as a less invasive diagnostic alternative. Aim: To assess the reliability of Coronary CT in detecting coronary stenosis among different types of patients by comparing the results with those obtained by ICA. Methods: 55 patients (age 57+/-12 years, 46 males) who underwent ICA had also a coronary CT. Beta blockade was used to obtain a heart rate < 65 beats per min. The presence of significant stenosis (•'3d50 percent of luminal diameter measured by quantitative angiography) was compared between methods.Results: Adequate coronary images were obtained in 53 of 55 patients with coronary CT; a total of 715 coronary segments were available for analysis. Fifty patients required beta blockade and the mean heart rate was 57 beats per min. Fifty-two out of 61 main segment stenosis were detected by coronary CT (85.2 percent). Sensitivity, specificity, LH+ and LH- of coronary CT were 85 percent, 97 percent, 33 and 0.15, respectively. The presence or absence of significant lesions was correctly diagnosed in 50 of the 55 patients (91 percent). Conclusion: 16 detector coronary CT is a sensitive and specific method to diagnose main segment significant coronary stenosis.

Enfermedad periodontal en pacientes con síndrome coronario agudo / Periodontal disease among patients with acute coronary syndrome

Background: Epidemiological studies suggest an association between periodontal disease and coronary heart disease. It is possible that periodontal disease may contribute to plaque destabilization in patients with acute coronary syndrome. Aim: To assess the association between severity of periodontal disease, the number of acute plaques and extension of coronary artery disease in patients with acute coronary syndrome. Patients and methods: The severity of periodontal disease was assessed by skilled independent observers in patients with acute coronary syndrome subjected to coronary angiography. The periodental disease was classified as mild or severe. Acute plaques were defined on angiography as those with thrombi, ulcers or flow alterations. The extension of coronary disease was analyzed using the Sullivan score. Results: Forty three patients (35 males) aged 41 to 83 years, were studied. Mild and severe periodontal disease was present in 18 (42percent) and 25 (58percent) patients respectively. Seventy six percent of those with severe disease had two or more acute plaques, compared with 17percent of those with mild disease (p<0.001). Median Sullivan score was 80.6 and 57.2 in patients with severe or mild periodontal disease respectively (p=0.001). Conclusions: Severe periodontal disease was associated with a higher number of acute coronary plasques and a higher extension of coronary artery disease, in patients with acute coronary syndromes.

Tratamiento crónico combinado con iloprost y sildenafil en un paciente con hipertensión pulmonar primaria / Aerosolized iloprost combined with a phosphodiesterase inhibitor in the treatment of primary pulmonary hypertension

Iloprost, a prostacyclin analogue administered by inhalation, improves hemodynamic and functional class variables in patients with primary pulmonary hypertension. However, repetitive inhalations are required due to its short term effects. One potential approach to prolong and increase the effects of aerosolized iloprost might be to combine its use with phosphodiesterase inhibitors. We report a 36 years old female patient with primary pulmonary hypertension treated with this combination. After 18 months of therapy the patient had an improvement in functional class and in the 6 min walk distance despite persistence of high pulmonary pressures. Our case is in agreement with the reported beneficial effect of the association of sildenafil and iloprost. We postulate that functional improvement in primary pulmonary hypertension is not always related to a decrease in pulmonary artery pressure (Rev MÚd Chile 2004; 132: 353-6).

Utilidad del cierre del foramen oval permeable en pacientes con AVE criptogénico / Closure of patent foramen ovale in patients with cryptogenic stroke

Antecedentes: El foramen oval permeable (FOP) es un hallazgo frecuente en pacientes con accidente vascular encefálico criptogénico (AVEC), y se discute la utilidad de su cierre percutáneo (CP). Objetivo: Evaluar el riesgo de recurrencia de eventos neurológicos en pacientes con AVEC y FOP, y compararlos entre aquellos tratados médicamente y los sometidos a CP. Métodos: Entre los 106 pacientes admitidos por AVEC y FOP, en el período 2003 a 2006, determinamos la aparición de nuevos eventos neurológicos isquémicos (NEN), y estudiamos sus factores determinantes y comparamos los que se sometieron a CP versus lo que continuaron con tratamiento médico, según criterio del tratante. Se consignaron las características clínicas y de la antomía del FOP en el ecocardiograma Los NEN se confirmaron por examen neurológico y/o neuro-imágenes. Para el análisis de los datos se utilizó chi-cuadrado y regresión logística.Resultados: Entre los 106 pacientes evaluados, 87 siguieron tratamiento médico y 19 CP. Los pacientes sometidos a CP presentaban mayor asociación de FOP con aneurisma del septum interauricular (ASI) (57,9% versus 35,6%, p=0,05). El seguimiento fue de 27 +/-13 meses. En este período se demostró un 12,6% de nuevo evento neurológico entre los tratados médicamente, mientras que ninguno lo presentó entre los sometidos al CP (NS). El único predictor independiente para NEN fue el ASI asociado con FOP; OR: 8,45 (1,56-60,46). Conclusiones: De acuerdo a nuestros resultados, los pacientes con AVEC y FOP tienen alto riesgo de recurrencia cuando el FOP se asocia a ASI y aparentemente se benefician con CP.

Background: Patent Foramen Ovale (PFO) is a frequent finding in patients with cryptogenic stroke (CS). Theeffect of closing the PFO in this setting is debated. Aim: to evaluate de risk of stroke recurrence in patients with CS and PFO; to compare this risk in patients followed under medical treatment with those undergoing percutaneous closure of PFO. Methods: From 2003 to 2006, 106 patients were admitted with a CS and the presence of PFO was documented by echocardiography. New ischemic strokes and risk factors were compared between those who weresubmitted to percutaneous closure of PFO and those treated in a conventional way. The decision to close thePFO was taken by the physician in charge. Clinical findings and echocardiographic characteristics of thePFO were recorded. New ischemic events were diagnosed by neurologic assessment and/or imaging techniques. Data was analyzed by chi square testing and logistic regression. Results: 87 patients were followed under medical treatment and 19 had closure of the PFO. The latter group had a greater incidence of atrial septal aneurysm (57.9% vs. 35.6%, p=0.05). The mean follow up was 27 +/- 13 months.New ischemic stroke occurred in 12.6% in the medically treated group while none was observed in the PFO closure group (NS). The sole independent predictor of new stroke was the presence of atrial septal aneurysm (OR: 8.45, 95% C.I. 1.56 - 60.46) Conclusion: Patients with CS and PFO are at considerable risk of developing new strokes, especially those with concomitant atrial septal aneurysm. Closure of PFO was apparently useful to prevent this risk.

Resultados tardíos del tratamiento percutáneo de la reestenosis intrastent con el uso de stents con drogas: un estudio colaborativo / Percutaneous treatment of intra stent restenosis using drug eluting stents: late results in a multicenter study

Introducción. La proliferación neointimal es la causa de la reestenosis coronaria intra stent (RIS). Recientemente, el implante de stents liberadores de drogas (DES) ha emergido como una alternativa efectiva de tratamiento endovascular. Material y método. Seleccionamos pacientes con RIS de stents no recubiertos tratados con DES en forma consecutiva en 3 centros chilenos. Luego del alta los pacientes fueron seguidos por al menos 12 meses. Resultados. De 21 pacientes (19 por ciento mujeres) entre 47 y 91 años tratados por al menos una lesión coronaria con RIS, 33,3 por ciento eran diabéticos y 14,3 por ciento tenían cirugía coronaria previa. Se presentaron de preferencia con síndromes coronarios agudos y la mayoría tenía enfermedad de 1 vaso (71,4 por ciento). Se trató sólo 1 lesión con RIS, implantándose en 15 pacientes DES recubierto con Sirolimus y en 6 con Paclitaxel. El largo promedio de stent implantado fue de27,7 mm (13-51 mm). Se obtuvo éxito en todos los casos y no hubo complicaciones isquémicas intrahospitalarias. Durante el seguimiento, sólo 2 pacientes presentaron reestenosis intrastent y uno de ellos, un anciano, falleció en forma súbita en el seguimiento. El 90 por ciento se mantuvo libre de eventos isquémicos en el seguimiento. Conclusión. El implante de DES aparece como una alternativa efectiva en el tratamiento de la RIS.

Background. Neointimal proliferation causes coronary intrastent restenosis (ISR). Recently, drug eluting stents(DES) have emerged as an effective therapeutic approach to treat ISRMethods. Consecutive patients from 3 centers with in stent restenosis after bare metal stent implantation were treated with DES. Patients were followed for 12 months after discharge.Results. Of 21 patients (19 percent females), 47 to 91 years old, with one or more intrastent restenosis, diabetes was present in 33 percent and previous coronary artery surgery in 14 percent. Most patients presented with acute coronary syndromes and 71 percent had single vessel disease. Only one lesion in each patient was treated with DES implantation, 15 with paclitaxel and 6 with sirolimus stents. Mean stent length was 27.7 mm (13-51). The procedure was successful in all patients and no ischemic complications were observed prior to discharge. During follow up 2 patients developed new intra stent restenosis and one of them died suddenly. 90 percent of patients were free from ischemic events at the end of follow up. Conclusion. DES appears to be an effective therapy to treat intra stent restenosis.

Riesgo precoz y alejado de los pacientes con diabetes mellitus sometidos a angiosplastía primaria en las primeras horas de un IAM / Early and late risk of diabetic patients undergoing primary angioplasty in the initial hours of an acute myocardial infarction

Introducción: La angioplastía primaria (AP) disminuye la mortalidad del infarto agudo del miocardio (IAM), pero en los pacientes diabéticos esto está en investigación. Objetivo: Evaluar el rol de la diabetes mellitus como factor pronóstico en el IAM reperfundido por AP. Métodos: Se incluyeron 304 pacientes ingresados por IAM con SDST de menos de 12 horas de evolución tratados con AP en el período 2000-2003. Se consideraron factores de riesgo y parámetros clínicos y angiográficos. Los pacientes fueron controlados hasta 12 meses luego del alta. Se estudiaron mortalidad precoz (1 mes post evento) y 12 meses, y los eventos combinados de muerte, infarto y revascularización al año (MACE). Resultados: La edad promedio de los pacientes fue 62 ± 14 años; 234 eran hombres (77 por ciento), y 46 pacientes eran diabéticos (15 por ciento). No hubo diferencias significativas entre diabéticos y no diabéticos en edad, presencia de hipertensión, dislipidemia, tabaquismo, antecedentes de IAM o revascularización previa, FE, Killip, Flujo TIMI alcanzado o número de vasos comprometidos. Hubo menos mujeres en el grupo de diabéticos. La mortalidad precoz y al año fue de 9,3 por ciento y 16,3 por ciento en diabéticos y de 5,3 por ciento y 9,4 por ciento en no diabéticos (pNS). Los eventos combinados al año ocurrieron en un 37,2 por ciento en diabéticos vs. 23,4 por ciento en no diabéticos, p=0,06. La incidencia de MACE al año fue significativa en un modelo multivariado que incluyó DM, sexo femenino, HTA, dislipidemia, tabaquismo y fracción de eyección por ventriculografía. Conclusión: La presencia de DM se asocia a mayor incidencia MACE en el seguimiento al año en pacientes sometidos a AP por IAM.

Resultado de cardioversión eléctrica en pacientes con fibrilación auricular idiopática y secundaria a enfermedad reumática / Cardioversion in patients with atrial fibrillation

Cicuenta y siete pacientes portadores de fibrilación auricular fueron sometidos a cardioversión eléctrica electiva. En función de la cardiopatía basal, los pacientes se clasificaron en 3 grupos: fibriladores crónicos con valvulopatía no operada (11), fibriladores crónicos con valvulopatía operada (29) y fibriladores idiopáticos (12). El éxito inmediato de la cardioversión fluctuó entre 82 y 92% para los 3 grupos. El éxito alejado (11.9 +- 4.5 meses) disminuyó a un 27% para los valvulares no operados, a un 24% para los valvulares operados y a un 75% para los idiopáticos. Factores determinantes de éxito o fracaso, además de la patología de base, fueron la presencia de insuficiencia cardíaca y el tamaño de la aurícula izquierda. Concluimos que la cardioversión eléctrica tiene un éxito alejado pobre en pacientes valvulópatas y un éxito satisfactorio en pacientes sin otra evidencia de patología cardíaca

Indicadores de riesgo de aterosclerosis: evaluación mediante coronariografía en hombres no diabéticos con colesterol total igual o menor a 240 mg/dl / Index of atherosclerosis risk: evaluation by coronariography in non diabetic males with total cholesterol same or less than 240 mg/dl

We studied 90 male non diabetic patients aged between 40 and 65 years old with a total cholesterol of less than 240 mg/dl and not receiving cholesterol reducing drugs, that were subjected to elective coronary arteriography. Weight, height, blood pressure and smoking habits were recorded and a fsting blood sample was drawn to mesure total and HDL cholesterol, triglycerides, apoproteins A! and B, Lipoprotein(a) and plasma cholesteryl ester transfer activity. Arteriography disclosed coronary lesions in 54 patients. Compared to patients without lesions, the former had lower HDL cholesterol (34 ñ 9.8 vs 40.2 ñ 11.6 mg/dl) and higher total cholesterol/HDL, cholesterol and apoB/apoA1 ratios. No differences were found for lipoprotein(a) and plasma cholesteryl ester transfer activity. Unvariate analysis showed that low HDL cholesterol had the best predictive capacity for atherosclerosis

Aterectomía rotacional (rotablator) en la angioplastía coronaria percutánea transluminal / Rotational atherectomy (rotablator) for percutaneous transluminal coronary angioplasty

Background: The use of Rotablator in percutaneous transluminal coronary angioplasty attempts to reduce the atheromatous plaque abrading it and fragmenting the pariental calcium of the artery. Aim: To report our experience with the use of Rotablator: Patients and methods: Rotational atherectomy was performed in 189 patients aged 60.8 ñ 11 years (154 men). The clinical indication for the procedure was chronic angina in 22 percent, unstable angina in 44 por ciento, myocardial infarction in 21 percent, silent angina in 7 percent and re-stenosis in 6 percent. One bundred seventy seven patiens were followed for a mean of 15.9 ñ 6.3 months. Results: Two hundred thirty six stenoses in 215 coronary arteries were treated with a 98.7 percent angiographic success rate. One patient had a Q infarction and no patient died or required emergency surgery. Fourteen patients had rises in CK MB enzymes (non Q infarction). Thee patients had a pseudoaneurism and three had bleedings that required transfusion. Of the followed patients, 33 had a clinically suspected re-stenosis, that was angiographically confirmed in 23. Cardiac mortality was 2.3 percent. Seventy nine percent of patients had an evolution without angina or coronary events. Conclusions: Percutaneous transluminal coronary angioplasty with the use of Rotablator had a high immediate success rate and a low incidence of complications. The clinical evolution of patients has been favorable with a low incidence of mortality and ischemic events

Muerte súbita en el adulto joven sin cardiopatía demostrable: características clínicas y electrofisiológicas en 3 casos / Sudden cardiac death in 3 young patients without overt heart disease

We reported 3 young adult males who developed spontaneous ventricular fibrillation in the abscence of demonstrable heart disease. Extensive clincial and elelcrophysiilogic evaluation failed to disclose a cause for the arrhythmia. Antiarrhythmic drugs were empirically used in all patients but 2 of then eventually died. Thus, unexplained ventricular fibrillation without demonstrable heart disease carries a serious short term prognosis. An implantable cardiovertodefibrillator may be the therapy of choice in these cases