In-hospital complications of percutaneous intraaortic balloon counterpulsation.

Complications related to intraaortic balloon counterpulsation pumping (IABP) remain a problem despite the development of small caliber balloon catheter shafts and introducer sheaths. The authors report their experience in counterpulsation-related complications of 201 consecutive patients who underwent 212 percutaneous counterpulsation balloon insertions from June 1989 to June 1996 by use of balloons with 8-9.5 French shafts. Of these, 82% were men and 36 (18%) were women, with a mean age of 61 +/-12 years. Indications for counterpulsation were acute myocardial infarction (AMI) (67%), severe left ventricular failure without AMI (20%), dilated cardiomyopathy (4%), unstable angina (3%), high-risk supported percutaneous coronary angioplasty (2%), and others (4%). IABP was instituted at the bedside in the intensive care unit in 82 patients (39%) and in the catheterization laboratory in 130 (61%). Median duration of counterpulsation was 48 hours (range 30 minutes to 25 days) with successful weaning from counterpulsation in 70% (148 of 212) of procedures. Overall in-hospital mortality rate was 45% (90 of 201). The overall complication rate was 22/212 (10.4%). Major complications were present in 10/212 procedures (4.7%): 6 patients with limb ischemia (1 death directly attributed to this complication, 1 with associated septicemia and limb amputation, 3 requiring surgical thromboembolectomy, and 1 with persistent limb ischemia treated medically until his death caused by intractable left ventricular failure), 2 with important bleeding (1 fatal despite vascular surgical repair and 1 requiring blood transfusion) and 2 with balloon rupture requiring vascular surgery. Minor complications were present in 12 procedures (5.7%), 6 with limb ischemia, 3 with local bleeding, and 3 with catheter dysfunction. All of these resolved after balloon removal and required no further intervention. When limb ischemia did develop it occurred after a median delay of 24 hours following balloon insertion (range 2 to 98 hours). The only predictor of limb ischemia among baseline clinical and procedure-related variables was an age greater than 60 years. Compared with previous recent studies, the rate of complications observed in this study performed with small balloon catheters was acceptably low. Limb ischemia was the most frequent complication, often occurred early, and required further intervention in half the cases.

Clinical evaluation of the efficacy and safety of calcium dobesilate in patients with chronic venous insufficiency of the lower limbs.

Several venotonic drugs have been used in the treatment of chronic venous insufficiency (CVI) of the lower limbs, most of them from natural sources. Calcium dobesilate, from synthetic origin, has been shown to improve clinical symptoms of these venous conditions. Three hundred fifty-two patients with CVI in grades I and II of Widmer's classification were included from an open population between January 1999 and June 2000; patients received calcium dobesilate 500 mg every 8 hours for 9 weeks. A basal recording and recordings every 3 weeks were made of heaviness, pain, cramps, and paresthesias of the lower limbs with a severity scale, and edema was assessed by measurement of the circumference of ankles and calves. Two hundred eighty-six patients (81.3%) were women and 66 (18.7%) were men with a mean age of 45.7 +/-14.1 years; 200 patients (56.8%) were grade I and 150 (42.6%) were grade II of Widmer's classification, and two patients had no classification, with a mean duration of symptoms of 6.5 +/-7.4 years. All of the symptoms had a significant reduction from the first to the final visit of treatment; 70% of the patients complained of moderate to severe heaviness of the lower limbs at the beginning of the study, whereas 10% of the patients presented this symptom at the end of treatment. Likewise, 75%, 37%, and 41% of the patients, respectively, complained of moderate to severe pain, cramps, and paresthesias of the lower limbs at the beginning of the study, with a reduction in this prevalence to 6%, 2%, and 4%, respectively, at the end of treatment (p<0.001, Wilcoxon test). In regard to edema of ankles and calves, a significant reduction in circumferences was registered in both sites at the end of treatment; for instance, the mean circumference of the right ankle was reduced from 23.78 +/-0.27 to 22.71 +/-0.31 cm while the right calf had a reduction from 35.08 +/-0.41 to 33.83 +/-0.5 cm (p<0.001, paired t test). Side effects were registered in 17.9% of the patients. This trial shows that calcium dobesilate had significant efficacy in the improvement of all the symptoms in patients with CVI, achieving this effect with an acceptable safety profile.

Efectos hemodinámicos del captropril oral en pacientes con estenosis aórtica crítica / Hemodynamic efects of oral captopril in patients with severe aortic stenosis

Objetivos: Se diseñó un protocolo prospectivo, abierto, no controlado, con el fin de analizar los efectos hemodinámicos del captopril oral en pacientes con estenósis aórtica crítia. Se les colocó un cateter de flotación, se midieron parámetros hemodinámicos completos en forma basal y a la 1, 2, 4, 6 y 8 horas de cada toma del captopril cuya dosis fue de 12.5 mg en la primera y si se toleró se incrementó a 25 mg cada 8 horas durante 48 horas (6 tomas en total). Análisis estadístico: se utilizó comparación multivariada con la prueba de neuman-Keuls con un error alfa (tipo-1) de 0.05. Resultados; se analizaron un total de 22 enfermos en los cuales las resistencia vasculares sistémicas de 1750 Din/seg/cm-5 disminuyeron a 1200 (P-0.001), el gasto cardiaco de 4.1 litros/minuto aumentó a 5.8 (P-0.001) el índice cardiaco de 2.4 litros/minuto aumentó a 2.9 (P-0.009), el volumen latido de 47 ml/latido aumentó a 64 (P-0-04) y el índice del volumen latido de 27 ml/latido/m²sc aumentó a 36 (P-0.002). Las otras variables no mostraron diferencias estadísticamente significativas. En el subgrupo de pacientes en insuficiencia cardiaca (n=7) las resistencias vasculares sistémicas de 2050 Din/seg/cm-5 disminuyeron a 1463 (P-0.02), el índice cardiaco de 2.07 litros/minuto/m²sc aumentó a 2.75 (P-0.04), el gasto cardiaco de 2.8 litros/minuto aumentó a 4.1 (P-0.04), el volumen latido de 46 ml/latido aumentó a 64 (P-0.03), la presión en cuña de la arteria pulmonar de 19 mmHg disminuyó a 16 (P-0.04) y la presión arterial pulmonar sistólica de 63 mmHg disminuyó a 42 (P-0.009). El resto de las variables no tuvieron diferencia estadísticamente significativa. Conclusiones. el captopril mejora los parámetros hemodinámicos y la función ventricular izquierda, en forma global así como en el subgrupo de pacientes en insuficiencia cardiaca

Infarto agudo del miocardio relacionado con el consumo de cocaína: informe de un caso / Acute myocardial infarction related to cocain use. Report of one case

El consumo de cocaína se asocia con síndromes isquémicos cardíacos, en especial angina de pecho, infarto agudo del miocardio, arritmias cardíacas y muerte súbita. Un número significativo de personas que sufren infarto agudo del micardio, asociado al abuso de cocaína, no tienen aterosclerosis coronaria significativa. El mecanismo del infarto, en estos pacientes, permanece obscuro. En este informe se describe el caso de un hombre joven con arterias coronarias sin lesiones angiográficas, en quien el consumo de cocaína produjo probablemente un espasmo coronario con formación de trombo intracoronario e infarto miocárdico. Después del tratamiento con heparina, aspirina y diltiazem, la angiografía de control demostró la desaparición del trombo intracoronario