Subepicardial hematoma after percutaneous coronary intervention.

BACKGROUND: Coronary artery perforation associated to cardiac tamponade is an uncommon life-threatening complication of percutaneous coronary intervention, and the occurrence of subepicardial or intramyocardial hematoma without hemopericardium is even rarer. CLINICAL CASE: We describe the case of a 72 year-old woman with a subepicardial hematoma after percutaneous coronary intervention, who required urgent left internal mammary artery graft to anterior descending artery surgery. CONCLUSIONS: Subepicardial or intramyocardial hematoma must be considered when a coronary perforation is suspected in absence of hemopericardium. Transthoracic echocardiogram or computed tomography may be used to decide a conservative or invasive approach.

Revascularización coronaria quirúrgica en pacientes con angina inestable aguda / Surgical coronary revascularization in patients with acute unstable angina

Se realizó un estudio descriptivo y transversal de 122 pacientes con angina inestable aguda, expuestos a cirugía de revascularización coronaria en el Servicio de Cirugía Cardiovascular del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2007 hasta igual período de 2014. En la serie predominaron los mayores de 50 años (68,9 por ciento), la angina de reposo en las últimas 48 horas, de tipo III (66,4 por ciento) y los que presentaron afectación de 3 vasos coronarios (47,5 por ciento); asimismo, como factores de riesgo coronario primaron el sexo masculino, con una relación de 5,6:1 en relación con el femenino, los antecedentes de hipertensión arterial (64,8 por ciento) y el hábito de fumar (63,1 por ciento). La mayoría de las intervenciones quirúrgicas se realizaron con la técnica a corazón latiendo (69,7 por ciento) y como principales complicaciones peroperatorias figuraron las arritmias cardíacas y el bajo gasto cardíaco; esta última causante del mayor número de fallecidos(AU)

A descriptive and cross-sectional study of 122 patients with acute unstable angina, exposed to coronary revascularization surgery at the Cardiovascular Surgery Service in Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital, Santiago de Cuba, was carried out from January, 2007 to the same period of 2014. In the series those patients older than 50 years (68.9 percent), those who presented angina in the last 48 hours, type III (66.4 percent) and those who presented damage in 3 coronary vessels (47.5 percent) prevailed; also, as coronary risk factors, the male sex with a relation of 5,6:1, the history of hypertension (64.8 percent) and the smoking habit (63.1 percent) prevailed. Most of the surgical interventions were carried out with the heart beating technique (69.7 percent) and as main peroperative complications there were the heart arrhythmias and the low cardiac output; this last one causing the highest number of deaths(AU)

Effects of skeletonized versus pedicled radial artery on postoperative graft patency and flow.

BACKGROUND: Radial artery (RA) was the second arterial graft introduced in clinical practice for myocardial revascularization. The skeletonization technique of the left internal thoracic artery (LITA) may actually change the graft's flow capacity with potential advantages. This leads to the assumption that the behavior of the RA, as a coronary graft, is similar to that of the LITA, when skeletonized. OBJECTIVE: This study evaluated 'free' aortic-coronary radial artery (RA) grafts, whether skeletonized or with adjacent tissues. METHODS: A prospective randomized study comparing 40 patients distributed into two groups was conducted. In group I, we used skeletonized radial arteries (20 patients), and in group II, we used radial arteries with adjacent tissues (20 patients). After the surgical procedure, patients underwent flow velocity measurements. RESULTS: The main surgical variables were: RA internal diameter, RA length, and free blood flow in the radial artery. The mean RA graft diameters as calculated using quantitative angiography in the immediate postoperative period were similar, as well as the flow velocity measurement variables. On the other hand, coronary cineangiography showed the presence of occlusion in one RA graft and stenosis in five RA grafts in GII, while GI presented stenosis in only one RA graft (p = 0.045). CONCLUSION: These results show that the morphological and pathological features, as well as the hemodynamic performance of the free radial artery grafts, whether prepared in a skeletonized manner or with adjacent tissues, are similar. However, a larger number of non-obstructive lesions may be observed when RA is prepared with adjacent tissues.

Efeitos da Esqueletização em Comparação com a Manutenção do Pedículo da Artéria Radial sobre a Patência e Fluxo Pós-Operatórios do Enxerto / Effects of Skeletonized versus Pedicled Radial Artery on Postoperative Graft Patency and Flow

Fundamento: O enxerto de artéria radial (AR) foi o segundo enxerto arterial a ser introduzido na prática clínica para revascularização miocárdica. A técnica de esqueletização da artéria torácica interna esquerda (ATIE) pode, de fato, alterar a capacidade de fluxo do enxerto com potenciais vantagens, o que leva à suposição de que o comportamento da AR, como enxerto coronariano, seja semelhante ao da ATIE esqueletizada. Objetivo: Este estudo avaliou enxertos aortocoronários "livres" de AR, quer esqueletizados, quer com tecidos adjacentes. Métodos: Foi realizado um estudo prospectivo randomizado comparando 40 pacientes distribuídos em dois grupos. No grupo I, foram utilizadas artérias radiais esqueletizadas (20 pacientes), e no grupo II, artérias radiais com tecidos adjacentes (20 pacientes). Após o procedimento cirúrgico, os pacientes foram submetidos a medidas da velocidade de fluxo. Resultados: As principais variáveis cirúrgicas foram: diâmetro interno, comprimento e fluxo sanguíneo livre da AR. Os diâmetros médios dos enxertos de AR calculados através de angiografia quantitativa no pós-operatório imediato foram semelhantes, assim como as variáveis de medidas de velocidade de fluxo. Por outro lado, a cinecoronariografia mostrou a presença de oclusão em um enxerto de AR e estenose em cinco enxertos de AR no GII, enquanto que apenas um caso de estenose em um enxerto de AR no GI (p = 0,045). Conclusão: Os resultados mostram que tanto as características morfológicas e anatomopatológicas quanto o desempenho hemodinâmico dos enxertos livres de artéria radial, quer preparados de forma esqueletizada ou com tecidos adjacentes, são semelhantes. Entretanto, pode-se observar um maior número de lesões não obstrutivas quando a AR ...

Background: Radial artery (RA) was the second arterial graft introduced in clinical practice for myocardial revascularization. The skeletonization technique of the left internal thoracic artery (LITA) may actually change the graft's flow capacity with potential advantages. This leads to the assumption that the behavior of the RA, as a coronary graft, is similar to that of the LITA, when skeletonized. Objective: This study evaluated 'free' aortic-coronary radial artery (RA) grafts, whether skeletonized or with adjacent tissues. Methods: A prospective randomized study comparing 40 patients distributed into two groups was conducted. In group I, we used skeletonized radial arteries (20 patients), and in group II, we used radial arteries with adjacent tissues (20 patients). After the surgical procedure, patients underwent flow velocity measurements. Results: The main surgical variables were: RA internal diameter, RA length, and free blood flow in the radial artery. The mean RA graft diameters as calculated using quantitative angiography in the immediate postoperative period were similar, as well as the flow velocity measurement variables. On the other hand, coronary cineangiography showed the presence of occlusion in one RA graft and stenosis in five RA grafts in GII, while GI presented stenosis in only one RA graft (p = 0.045). Conclusion: These results show that the morphological and pathological features, as well as the hemodynamic performance of the free radial artery grafts, whether prepared in a skeletonized manner or with adjacent tissues, are similar. However, a larger number of non-obstructive lesions may be observed when RA is prepared with adjacent tissues. .

Simultaneous myocardial and supra-aortic trunks revascularization.

We report the case of a 58-year-old patient, with a three vessel disease with unstable angina. Due to refractory angina, she was referred to urgent coronary artery bypass graft (CABG). In the preoperative evaluation were found severe obstructive lesions in the brachiocephalic trunk origin, left common carotid origin and left internal carotid artery. The patient underwent CABG, supra-aortic trunks revascularization (extra-anatomic bypass) and carotid endarterectomy in the same procedure. She presented an uneventful recovery and was discharged home on the seventh postoperative day. Currently, two years after the procedure, she continues under follow-up, symptomless.

Revascularização simultânea do miocárdio e dos troncos supra-aórticos / Simultaneous myocardial and supra-aortic trunks revascularization

Relatamos o caso de uma paciente de 58 anos com síndrome coronariana aguda, com acometimento triarterial. Em decorrência de angina refratária, foi indicada cirurgia de revascularização do miocárdio (RM) de urgência. Na avaliação pré-operatória, foram detectadas lesões obstrutivas na origem do tronco braquiocefálico, artérias carótida comum esquerda e carótida interna esquerda. A paciente foi submetida, concomitantemente, a RM e revascularização dos troncos supra-aórticos (bypass extra-anatômico), além de endarterectomia da artéria carótida interna esquerda. A paciente teve uma boa evolução, com alta hospitalar no sétimo dia pós-operatório. Atualmente, dois anos após o procedimento, encontra-se em acompanhamento ambulatorial, assintomática.

We report the case of a 58-year-old patient, with a three vessel disease with unstable angina. Due to refractory angina, she was referred to urgent coronary artery bypass graft (CABG). In the preoperative evaluation were found severe obstructive lesions in the brachiocephalic trunk origin, left common carotid origin and left internal carotid artery. The patient underwent CABG, supra-aortic trunks revascularization (extra-anatomic bypass) and carotid endarterectomy in the same procedure. She presented an uneventful recovery and was discharged home on the seventh postoperative day. Currently, two years after the procedure, she continues under follow-up, symptomless.

Estratificación pronóstica previa a la cirugía del síndrome coronario agudo sin supradesnivel del segmento ST / Prognostic stratification before surgery for acute coronary syndrome without ST segment elevation

Se realizó un estudio descriptivo de carácter prospectivo que incluyó a pacientes con edad menor o igual a 65 años con el diagnóstico de síndrome coronario agudo sin elevación del segmento ST, en el período comprendido entre diciembre de 2002 y enero de 2005. Existió un predominio del sexo masculino, con 49 pacientes, frente a 34 féminas, y una media de edad de 54,1 mas menos 8,0 en los hombres y 56,8 mas menos 6,9 años en las mujeres; fue más frecuente este diagnóstico en los pacientes de mayor edad. La diabetes mellitus y el antecedente de cardiopatía isquémica se relacionaron con enfermedad coronaria extensa. Todos los pacientes fueron seguidos en consulta, y existió una mayor incidencia de episodios clínicos adversos en los de alto riesgo (44,4 por ciento) en comparación con 26,3 por ciento en los de bajo riesgo(AU)

[Myocardial revascularization in the female population]. / Revascularización miocárdica en la población femenina.

OBJECTIVES: To analyze the factors that influence outcomes of surgical myocardial revascularization in the female population. PATIENTS AND METHOD: This is a retrospective study in which 128 woman, subjected to GABC[IBM1] from January to September 2004, were enrolled in an univariate and multivariate analysis of risk factors associated with morbidity and mortality. RESULTS: The mean age was 69.19 +/- 9.05 [IBM2] years, the most frequent pathologies, comorbilities, were dyslipemia, hypertension, and myocardial infarction. Unestable angina was found in 63.28% patients and stenosis in the left main coronary artery 42.96%; NYHA III-IV in 23.43%. The EuroSCORE mean preoperative risk was [IBM3] 5.57. Twelve surgeries were emergencies. Mean of grafts was 2.57. Mortality corresponded to 5.4% in programmed surgeries, 7% global. Univariate analysis identified this risk factors releated to mortality (p < 0.05): age older than 67 years, NYHA III-IV and emergency surgery, complicated in 25.2%. Follow-up was kept in 90.8% of patients, mean follow-up time was 17.11 (+/- 14.94) months; 115 patients did not present angina. The risk factor for angina during follow-up, in the univariate analysis (p < 0.05) was not having used the left internal thoracic artery as graft for the anastomosis of the anterior descending artery. CONCLUSIONS: Emergency surgery, age older than 67 years, and NYHA III-IV, were independent risk factors associated with mortality in this group. The use of artery grafts associated to reduced angina during follow-up.

Use of proven therapies in non-ST-elevation acute coronary syndromes according to evidence-based risk stratification.

BACKGROUND: Current guidelines advise the use of risk stratification to determine which patients should receive more aggressive antithrombotic and invasive therapies. Our objective was to evaluate the relationship between risk stratification and therapeutic decision making in patients with non-ST-segment elevation acute coronary syndromes. METHODS: We analyzed data from 15,026 patients with acute coronary syndrome who were enrolled into the GRACE registry between 1999 and 2003. We assessed the evidence-based use of antithrombotic therapy and early invasive strategy according to risk profile defined by baseline troponin elevation, presenting ST-segment depression, and GRACE risk score. Patients with possible contraindications were removed to define the use of therapies specifically among clearly eligible patients. RESULTS: Patients with elevated troponin were more likely to receive enoxaparin (60% vs 50.4%, respectively), GP IIb/IIIa inhibitors (32.8% vs 17.6%), and to undergo catheterization (66% vs 54%) and percutaneous coronary intervention (37.4% vs 25.6%; all P < .0001). Patients with ST depression received modestly more enoxaparin and GP IIb/IIIa than those without ST depression, but not more catheterization (P = .8) or percutaneous coronary intervention (P = .09). Highest risk patients were somewhat less likely to receive enoxaparin (P < .0001) and cardiac catheterization (P = .0002) according to GRACE risk deciles. CONCLUSIONS: In spite of current guidelines recommending the use of selected therapies in high-risk patients, there is no clear correlation of use of effective therapies with overall risk profile even among eligible patients. Thus, there is substantial opportunity to improve use of effective therapies, especially in high-risk populations.

Avaliação da disposição cinética do atenolol em pacientes coronarianos submetidos à revascularização do miocárdio. Influência da circulação extracorpórea sobre as concentrações plasmáticas do atenolol no intra-operatório de cirurgia cardíaca / Evaluation of the kinetic disposition of atenolol in coronary patients submitted to coronary artery bypass grafting surgery. Influence of the cardiopulmonary bypass on the plasma concentrations of atenolol during the intra-operative period of cardiac

Pacientes submetidos à revascularização do miocárdio (RM), frequentemente utilizam betabloqueadores no pré-operatório para o controle da angina pectoris, e continuam o tratamento após a cirurgia, para a redução de mortalidade e complicações cardiovasculares perioperatórias. Entretanto, a circulação extracorpórea (CEC), empregada na maioria das cirurgias cardíacas, pode alterar as concentrações plasmáticas e a disposição cinética de muitos fármacos, e consequentemente seus efeitos terapêuticos. O atenolol é um beta-bloqueador altamente hidrossolúvel, de absorção incompleta e eliminação renal-dependente. O objetivo deste estudo foi o de investigar a influência da CEC sobre as concentrações plasmáticas do atenolol no intra-operatório de cirurgia cardíaca, além de comparar a sua farmacocinética no pré e pós-operatório de RM com CEC, em pacientes com angina instável grave. Investigou-se ainda, a variabilidade das concentrações plasmáticas do atenolol no período que antecede a cirurgia cardíaca. Na primeira etapa, avaliaram-se 19 pacientes coronarianos, em terapia crônica com atenolol PO, submetidos à cirurgia cardíaca com ou sem CEC. Na segunda parte, investigaram-se os períodos pré e pós-cirúrgico de 7 pacientes com angina instável, submetidos à RM com CEC e tratados com atenolol PO em regime de doses múltiplas. Todos os pacientes investigados apresentavam função renal dentro da normalidade ou leve disfunção renal, decorrente da idade e da insuficiência coronariana. O monitoramento do atenolol plasmático no intra-operatório de RM e o estudo farrnacocinético realizado antes e após a revascularização, exigiram coletas de amostras sangüíneas seriadas. A quantificação do atenolol em plasma foi realizada através da cromatografia líquida de alta eficiência com detector de fluorescência e consistiu num procedimento analítico rápido, simples e de baixo custo. Apenas 200 ‘mü’L de plasma foram utilizados em cada análise cromatográfica...

[Influence of Diabetes Mellitus on immediate results of coronary stent: National Center for Cardiovascular Interventions (CENIC) data analysis]. / Influência do diabete melito nos resultados imediatos do implante de stent coronário: uma análise dos dados da Central Nacional de Intervenções Cardiovasculares (CENIC).

OBJECTIVE: This study sought to investigate the influence of Diabetes Mellitus (DM) on immediate results after coronary stenting implantation (CSI) according to clinical presentation. METHODS: Between January, 1997 and December, 2003, 11,874 diabetic patients underwent CSI, as recorded by CENIC database: 7,386 (62.3%) had chronic coronary disease (CCD); 3,142 (26.4%) acute coronary syndrome with non-ST segment elevation (ACSNST); and 1,346 (11.3%), reported acute myocardial infarction (AMI), with ST Segment elevation. Those groups were compared with 48,103 non-diabetics: 30,980 (64.5%) with CCD; 10,938 (22.7%), with non-elevated ST segments and unstable angina; and 6,185 (12.8%), with AMI. RESULTS: Diabetic patients presented worse clinical and angiographic characteristics. Diabetics with CCD showed similar incidence of MACE as compared to non-diabetics (0.98% x 0.91%, p = 0.5971); however, diabetics with ACSNST and AMI reported higher incidence of events: 2.76% x 1.46% (p < 0.0001) and 7.87% x 4.1% (p < 0.0001), respectively. Multivariate analysis showed DM to act as independent risk predictor for larger adverse events under non-elevated ST segment and unstable angina (ACSNST) (OR: 1.92 CI: 1.46-2.52 p < 0.0001) and with AMI (OR: 2.0 CI: 1.57-2.54 p < or = 0.0001) and no influence for CCD (OR: 1.08 CI: 0.83-1.42 p = 0.5470. CONCLUSION: Diabetic patients with CCD reported similar outcome as compared to the non-diabetics; however, those with ACSNST and AMI presented higher incidence of major adverse cardiac events during hospital stay.

A micromethod for the quantification of atenolol in plasma using high-performance liquid chromatography with fluorescence detection: therapeutic drug monitoring of two patients with severe coronary insufficiency before cardiac surgery.

A simple, rapid, selective, and sensitive analytical method was developed for the quantification of atenolol in small volumes of plasma, by high-performance liquid chromatography with fluorescence detection. Only 200 microL of plasma was used for chromatographic analysis. Separation was performed on a C18 reverse-phase column (4 microm) using a binary mobile phase consisting of 0.05 M of phosphate buffer, pH 5.5, and methanol (80:20, vol/vol) at a flow rate of 0.7 mL/minute. The retention times of atenolol and of the internal standard (sotalol) were 12.7 and 10.4 minutes, respectively. Validation of this analytical method showed a good linear correlation (8-2000 ng/mL), high sensitivity (quantification limit: 8 ng/ml and detection limit: 4 ng/mL), accuracy of 99.3%, and intraday and interday precision of 5.3% and 6.9%, respectively. Absolute recovery was 93.7%. The method was found to be robust, with acceptable stability. The analytical method was validated by the quantification of atenolol in plasma obtained from 2 patients with unstable angina, scheduled for myocardium revascularization surgery, who were chronically treated with 50 mg of atenolol administered per os once a day. The method developed was found to be adequate for use in pharmacokinetic studies and in adjusted dose pharmacotherapy.

Influência do diabete melito nos resultados imediatos do implante de stent coronário: uma análise dos dados da Central Nacional de Intervenções Cardiovasculares (CENIC) / Influence of Diabetes Mellitus on immediate results of coronary stent: National Center for Cardiovascular Interventions (CENIC) data analysis

OBJETIVO: Avaliar a influência do diabete melito (DM) nos resultados imediatos do implante de stent coronário (SC), de acordo com o quadro clínico de apresentação. MÉTODOS: Entre janeiro/1997 e dezembro/2003, segundo a Central Nacional de Intervenções Cardiovasculares (CENIC), 11.874 pacientes diabéticos foram submetidos a implante de SC: 7.386 (62,3 por cento) com insuficiência coronária crônica (ICO), 3.142 (26,4 por cento), em síndrome isquêmica instável sem elevação ST (SIASEST) e 1.346 (11,3 por cento), com infarto agudo do miocárdio (IAM) com supradesnivelamento de ST. Estes grupos foram comparados com 48.103 não-diabéticos: 30.980 (64,5 por cento) com ICO, 10.938 (22,7 por cento) em SIASEST e 6.185 (12,8 por cento) com IAM. RESULTADOS: Os diabéticos apresentaram características clínicas e angiográficas de maior risco. Os diabéticos com ICO apresentaram taxa de eventos adversos semelhantes aos não-diabéticos (0,98 por cento x 0,91 por cento, p=0,5971), porém, os diabéticos em SIASEST e IAM apresentaram maior incidência de eventos: 2,76 por cento x 1,46 por cento (p<0,0001) e 7,87 por cento x 4,1 por cento (p<0,0001), respectivamente. A análise multivariada mostrou o DM como preditor independente de risco para eventos adversos maiores na SIASEST (OR: 1,92 IC: 1,46-2,52 p<0,0001) e no IAM (OR: 2,0 IC: 1,57-2,54 p<=0,0001) e não na ICO (OR: 1,08 IC: 0,83-1,42 p=0,5470). CONCLUSÃO: Os pacientes diabéticos portadores de ICO apresentaram evolução hospitalar semelhante aos não diabéticos, porém, os com SIASEST e IAM demonstraram maior taxa de eventos cardíacos adversos comparados com a população não-diabética.

[Coronary artery bypass graft surgery in patients with acute coronary syndrome. Analysis of results]. / Cirugía de revascularización miocárdica en pacientes con síndrome coronario agudo. Análisis de resultados.

BACKGROUND: The objective of this work was to determine the main risk factors that influence prognosis, results, morbidity and mortality rates and causes in patients with acute coronary syndrome requiring surgical myocardial revascularization. METHODS: This was a retrospective study including patients in our hospital with acute coronary syndrome requiring coronary artery bypass-graft surgery between January 2000 and December 2003. The following were identified and compared with international values: demographic factors, indications for surgery, intercurrent pathologies, results of the procedures, morbidity and mortality rates and causes. RESULTS: There were 73 males and 23 females with an age range of 46 to 88 years old. The main cause of surgery was unstable angina (42.7%). In two patients, surgery was indicated for percutaneous coronary angioplasty failure and in 28 patients due to mechanical complications of acute myocardial infarction. The procedure was urgent in 90.6%. The majority of patients were in Killip-Kimball or Forrester class I or II. Risk factors detected were left ventricular failure, mechanical complications, emergency surgery, diabetes and respiratory or renal failure. Perioperative mortality was 14.5% and morbidity was 41.6%, both compared with risk classification scales and were lower than expected according to Parsonet and Tuman evaluations. CONCLUSIONS: With a major number of risk factors and the high-risk associated with surgery, in our center surgical treatment for acute coronary syndromes showed favorable results.

[Myocardial revascularization of the anterior descending coronary artery with left internal mammary artery by means of extracorporeal circulation: 10 years follow-up]. / Revascularización miocárdica de la arteria descendente anterior con arteria mamaria interna izquierda con circulación extracorpórea: seguimiento a 10 años.

BACKGROUND: The use of left internal mammary artery (LIMA) as a graft to anterior descending artery (LAD) has been associated with better long term results in coronary surgery. AIM: To assess and report the long-term results of LIMA to LAD bypass grafting for isolated LDA lesions. PATIENTS AND METHODS: Retrospective analysis of the medical records and surgical protocols of 40 patients (aged 60+/-10 years, 28 male) subjected to coronary surgery between 1992 and 2002. RESULTS: Thirty-four patients presented with unstable angina. On angiography, the LAD had a proximal obstruction in 35 patients. Sixteen presented with a myocardial infarction of the LAD territory. Six were managed previously with angioplasty; four had a new critical obstruction, 1 was catalogued as a procedure failure, and one was totally occluded. There was no operative mortality, myocardial infarction, stroke or need for re operation. There were two late deaths, caused by an advanced cardiac failure at 120 months in one patient, and chronic renal failure at 61 months of follow-up in another. Actuarial survival probability was 100%, 93% and 75% at 1, 5 and 10 years. Probability of freedom from angina was 98%, and freedom of suffering a new myocardial infarction was 100% at more than 10 years. The probability of no need for a new coronary procedure (angioplasty or surgery) also was 100% at more than 10 years. CONCLUSIONS: The use of LIMA as a coronary bypass graft to LAD is a safe surgical technique, with an excellent duration and permeability and also provides a prolonged time free from cardiac events as mortality, angina, myocardial infarction, and the need of a new coronary procedure.

Revascularización miocárdica de la arteria descendente anterior con arteria mamaria interna izquierda con circulación extracorpórea: seguimiento a 10 años / Myocardial revascularization of the anterior descending coronary artery with left internal mammary artery by means of extracorporeal circulation: 10 years follow-up

Background: The use of left internal mammary artery (LIMA) as a graft to anterior descending artery (LAD) has been associated with better long term results in coronary surgery. Aim: To assess and report the long-term results of LIMA to LAD bypass grafting for isolated LDA lesions. Patients and methods: Retrospective analysis of the medical records and surgical protocols of 40 patients (aged 60±10 years, 28 male) subjected to coronary surgery between 1992 and 2002. Results: Thirty-four patients presented with unstable angina. On angiography, the LAD had a proximal obstruction in 35 patients. Sixteen presented with a myocardial infarction of the LAD territory. Six were managed previously with angioplasty; four had a new critical obstruction, 1 was catalogued as a procedure failure, and one was totally occluded. There was no operative mortality, myocardial infarction, stroke or need for re operation. There were two late deaths, caused by an advanced cardiac failure at 120 months in one patient, and chronic renal failure at 61 months of follow-up in another. Actuarial survival probability was 100%, 93% and 75% at 1, 5 and 10 years. Probability of freedom from angina was 98%, and freedom of suffering a new myocardial infarction was 100% at more than 10 years. The probability of no need for a new coronary procedure (angioplasty or surgery) also was 100% at more than 10 years. Conclusions: The use of LIMA as a coronary bypass graft to LAD is a safe surgical technique, with an excellent duration and permeability and also provides a prolonged time free from cardiac events as mortality, angina, myocardial infarction, and the need of a new coronary procedure.

Revascularização do miocárdio sem circulação extracorpórea em pacientes multiarteriais: experiência de 250 casos / Myocardial revascularization without extracorporeal circulation patients with multivessel disease

MÉTODO: No período de agosto de 1997 a maio de 2001, 250 pacientes multiarteriais, consecutivos, foram submetidos à cirurgia de revascularização do miocárdio sem circulação extracorpórea. A faixa etária dos pacientes variou de 38 a 83 anos (média de 59,9 anos), dos quais 62 por cento eram do sexo masculino. A principal indicação cirúrgica foi a insuficiência coronariana crônica (82 por cento). Todos os pacientes foram operados por esternotomia mediana. RESULTADOS: Três (1,2 por cento) pacientes necessitaram de instalação de circulação extracorpórea. Nos demais 247 pacientes, realizou-se 592 anastomoses, com uma média de 2,4 pontes/paciente. A artéria torácica interna esquerda foi utilizada em 198 (80,1 por cento) pacientes, a artéria torácica interna direita em 5 (2 por cento) pacientes e a veia safena em 247 (100 por cento) pacientes. As artérias coronárias mais revascularizadas foram o ramo interventricular anterior (89 por cento) e o ramo marginal esquerdo (53 por cento). A mortalidade hospitalar global foi de 4 por cento, sendo a principal causa o infarto pós-operatório (1,2 por cento). Morbidade pós-operatória foi constatada em 23 (9,3 por cento) pacientes. O tempo médio de permanência hospitalar foi de 7,7 dias. CONCLUSÃO: Conclui-se da presente investigação, que a revascularização do miocárdio sem circulação extracorpórea em pacientes multiarteriais é factível, reprodutível e com baixo índice de complicações pós-operatórias

[Mexican Cardiology Society Guidelines on the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. Cancún, Quintana Roo 15-16 November 2002. Cooperative Group of Consensus]. / Primer Consenso Mexicano Sobre los Síndromes Isquémicos Coronarios Agudos sin elevación del Segmento ST [angina inestable e infarto no Q] Cancún, Quintana Roo 15 y 16 de noviembre, 2001. Sociedad Mexicana de Cardiología. Por el Grupo Cooperativo del Consenso[+].

Mexican Cardiology Society guidelines for the Management of patients with unstable angina and non-ST--segment elevation myocardial infarction are presented. The Mexican Society of Cardiology has engaged in the elaboration of these guidelines in the area of acute coronary syndromes based on the recent report of RENASICA [National Registry of Acute Coronary Syndromes]: 70% of the ACS correspond to patients with unstable angina and non-ST--segment elevation myocardial infarction seen in the emergency departments during the years 1999-2001 in hospitals of 2nd and 3rd level of medical attention. Experts in the subject under consideration were selected to examine subject-specific data and to write guidelines. Special groups were specifically chosen to perform a formal literature review, to weight the strength of evidences for or against a particular treatment or procedure, and to include estimates of expected health outcomes where data exist. Current classifications were used in the recommendations that summarize both the evidence and expert opinion and provide final recommendation for both patient evaluation and therapy. These guidelines represent an attempt to define practices that meet the needs of most patients in most circumstances in Mexico. The ultimate judgment regarding the care of a particular patient must be made by the physician and patient in light of all of the available information and the circumstances presented by that patient. The present guidelines for the management of patients with unstable angina and non-ST--segment elevation myocardial infarction should be reviewed in the next coming future by Mexican cardiologists according to the forthcoming advances in ACS without ST-segment elevation.