[Conventional percutaneous transluminal coronary angioplasty as the form of treatment of complex intra-stent restenosis]. / Angioplastia coronaria transluminal percutánea convencional como forma de tratamiento de reestenosis compleja intra-stent.

We report the case of a patient with unstable refractory angina due to a coronary narrowing because of in-stent restenosis affecting the first diagonal, first septal and left anterior descending coronary artery. The lesions were successfully dilated with a conventional balloon catheter and a triple guide-wire system was placed through the inter-filaments space of the stent, to protect and recanalize the branch vessels involved. The patient evolved well and was discharged asymptomatic.

[Encapsulated coronary rupture following stent implantation]. / Rotura coronaria encapsulada tras implantación de stent.

We report a case of coronary encapsulated rupture following stent implantation in the distal anastomosis of a saphenous by-pass graft to the left anterior descending coronary artery that evolved well with conservative treatment. The patient did not require pericardiocentesis and was treated with prolonged inflations with low pressure autoperfusion balloon at the rupture point. Pericardial adherences related to a previous coronary surgery probably limited the bleeding process avoiding hemodynamic collapse.

[Percutaneous revascularization with coronary angioplasty in patients with refractory angina]. / Revascularización percutánea mediante angioplastia coronaria en pacientes con angina refractaria.

INTRODUCTION AND OBJECTIVES: Refractory angina, specially when accompanied by electrocardiographic (ECGs) changes, has been associated with a high morbidity and mortality if urgent revascularization is not performed. Percutaneous Transluminal Coronary Angioplasty (PTCA) could be a useful therapeutic alternative in such cases. The aim of this study was to compare the immediate and midterm outcomes of a cohort of high risk patients with refractory angina with or without ECG changes revascularized by PTCA. METHODS: Of 801 consecutive patients who underwent PTCA, we selected 48 patients (49 procedures, 61 lesions), with unstable angina in spite of treatment with nitroglycerin, calcium channel blockers, beta blockers, heparin and aspirin (refractory angina). Twenty-six patients (27 procedures, 37 lesions) had ECG changes (group A), and 22 patients (22 PTCAs, 24 lesions) did not have changes (group B). RESULTS: Mean age of patients was 65 +/- 11 years. The most frequent ECG changes found in group A were T wave inversion (38%) and ST segment depression (34%). The left anterior descending coronary artery was the most frequent dilated vessel (41%). Some new devices (Stent, Rotablator, etc.) were used in 22% vs 25% of lesions in group A and B respectively. Successful dilatation was achieved in 59 (96%) of attempted lesion without statistical differences between group A and B. One patient in each group developed an acute myocardial infarction. Death occurred in 2 patients from group A (one of non-cardiovascular cause). Follow-up was obtained in 33 (94%) of the 35 patients (minimum follow-up > or = 6 months or less if a major event occurred). Mean follow-up time was 16.7 +/- 6 vs 13.4 +/- 6 months in group A and B. During this time, death occurred in 2 patients (6%) both from group B (one non-cardiac); in 9 (27%) patients a repeat PTCA was performed (26% of patients from group A and 28% from B); CABG was performed in 2 (6%) patients (both from group B), and an AMI occurred in 1 patient in each group. Angiographic follow-up was obtained in 73% of patients in group A vs 91% in group B. The restenosis rate was 47% in group A vs 54% in group B. At the end of the first year of follow-up, 93% of patients were alive and 9/10 patients successfully revascularized were asymptomatic or had less severe angina. CONCLUSIONS: At present, PTCA is a safe revascularization method in patients with refractory angina providing a high initial success (95% of cases) and a good mid-term outcome (one year): > 90% survival rate, with improvement in the quality of life in 9/10 patients successfully revascularized, regardless of the presence or absence of ECG changes at the time of PTCA.

[Diagnostic usefulness of 2-dimensional echocardiography in eosinophilic endomyocardial disease (Loeffler disease)]. / Utilidad diagnóstica de la ecocardiografía bidimensional en la enfermedad endomiocárdica eosinofílica (enfermedad de Löffler).

We present an uncommon case of idiopathic hypereosinophilic syndrome with cardiac involvement (fibroplastic parietal endocarditis --Löffler's disease--) in a 48-year-old female with congestive heart failure and hypereosinophilia. The 2-D echo findings (biventricular apical obliteration by echogenic endomyocardial proliferations with normal systolic inward motion) were the clue for the diagnosis that was hemodynamically and pathologically confirmed subsequently. We emphasize the diagnostic value of two-dimensional echocardiography in this condition and review the literature on it.