Overview of Percutaneous Coronary Interventions for Chronic Total Occlusions Treated at Brazilian Centers Participating in the LATAM CTO Registry. / Panorama das Intervenções Coronárias Percutâneas em Oclusões Totais Crônicas em Centros Participantes do LATAM CTO Registry no Brasil.

BACKGROUND: Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. OBJECTIVES: To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. METHODS: Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. RESULTS: Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. CONCLUSIONS: CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.

FUNDAMENTO: Tem sido observado um grande avanço nas técnicas e nos dispositivos para a realização de intervenções coronárias percutâneas (ICP) em oclusões totais coronarianas crônicas (OTC), mas existem poucos dados da prática do mundo real em países em desenvolvimento. OBJETIVOS: Relatar as características clínicas e angiográficas, os aspectos dos procedimentos e os resultados clínicos da ICP de OTC em centros dedicados a esse procedimento no Brasil. MÉTODOS: Os pacientes incluídos foram submetidos à ICP de OTC em centros participantes do LATAM CTO Registry, um registro multicêntrico latino-americano dedicado à coleta prospectiva desses dados. Os critérios de inclusão foram procedimentos realizados no Brasil, idade acima de 18 anos e presença de OTC com tentativa de ICP. A definição de OTC foi lesão de 100% em uma artéria coronária epicárdica, conhecida ou estimada como tendo pelo menos 3 meses de evolução. RESULTADOS: Foram incluídos dados de 1.196 ICPs de OTC. Os procedimentos foram realizados principalmente para controle da angina (85%) e/ou tratamento de uma grande área isquêmica (24%). A taxa de sucesso técnico foi de 84% e foi alcançada com técnicas de fios anterógrados em 81%, dissecção/reentrada anterógrada em 9% e retrógrada em 10% dos procedimentos. Os eventos cardiovasculares adversos intra-hospitalares ocorreram em 2,3% dos casos, sendo a mortalidade de 0,75%. CONCLUSÕES: As OTC podem ser tratadas no Brasil por intervenção coronária percutânea de forma efetiva e com baixas taxas de complicações. O desenvolvimento científico e tecnológico observado nessa área na última década reflete-se na prática clínica de centros brasileiros dedicados a essa técnica.

Panorama das Intervenções Coronárias Percutâneas em Oclusões Totais Crônicas em Centros Participantes do LATAM CTO Registry no Brasil / Overview of Percutaneous Coronary Interventions for Chronic Total Occlusions Treated at Brazilian Centers Participating in the LATAM CTO Registry

Resumo Fundamento Tem sido observado um grande avanço nas técnicas e nos dispositivos para a realização de intervenções coronárias percutâneas (ICP) em oclusões totais coronarianas crônicas (OTC), mas existem poucos dados da prática do mundo real em países em desenvolvimento. Objetivos Relatar as características clínicas e angiográficas, os aspectos dos procedimentos e os resultados clínicos da ICP de OTC em centros dedicados a esse procedimento no Brasil. Métodos Os pacientes incluídos foram submetidos à ICP de OTC em centros participantes do LATAM CTO Registry, um registro multicêntrico latino-americano dedicado à coleta prospectiva desses dados. Os critérios de inclusão foram procedimentos realizados no Brasil, idade acima de 18 anos e presença de OTC com tentativa de ICP. A definição de OTC foi lesão de 100% em uma artéria coronária epicárdica, conhecida ou estimada como tendo pelo menos 3 meses de evolução. Resultados Foram incluídos dados de 1.196 ICPs de OTC. Os procedimentos foram realizados principalmente para controle da angina (85%) e/ou tratamento de uma grande área isquêmica (24%). A taxa de sucesso técnico foi de 84% e foi alcançada com técnicas de fios anterógrados em 81%, dissecção/reentrada anterógrada em 9% e retrógrada em 10% dos procedimentos. Os eventos cardiovasculares adversos intra-hospitalares ocorreram em 2,3% dos casos, sendo a mortalidade de 0,75%. Conclusões As OTC podem ser tratadas no Brasil por intervenção coronária percutânea de forma efetiva e com baixas taxas de complicações. O desenvolvimento científico e tecnológico observado nessa área na última década reflete-se na prática clínica de centros brasileiros dedicados a essa técnica.

Abstract Background Major advances have been seen in techniques and devices for performing percutaneous coronary interventions (PCIs) for chronic total occlusions (CTOs), but there are limited real-world practice data from developing countries. Objectives To report clinical and angiographic characteristics, procedural aspects, and clinical outcomes of CTO PCI performed at dedicated centers in Brazil. Methods Included patients underwent CTO PCI at centers participating in the LATAM CTO Registry, a Latin American multicenter registry dedicated to prospective collection of these data. Inclusion criteria were procedures performed in Brazil, age 18 years or over, and presence of CTO with PCI attempt. CTO was defined as a 100% lesion in an epicardial coronary artery, known or estimated to have lasted at least 3 months. Results Data on 1196 CTO PCIs were included. Procedures were performed primarily for angina control (85%) and/or treatment of moderate/severe ischemia (24%). Technical success rate was 84%, being achieved with antegrade wire approaches in 81% of procedures, antegrade dissection and re-entry in 9%, and retrograde approaches in 10%. In-hospital adverse cardiovascular events occurred in 2.3% of cases, with a mortality rate of 0.75%. Conclusions CTOs can be treated effectively in Brazil by using PCI, with low complication rates. The scientific and technological development observed in this area in the past decade is reflected in the clinical practice of dedicated Brazilian centers.

Hepatic artery aneurysm: incidental diagnosis with abdominal ultrasonography and treatment by coil embolization / Aneurisma de artéria hepática: diagnóstico incidental com ultrassonografia do abdome e tratamento por embolização com molas

Hepatic artery aneurysm (HAA) was first reported at autopsy in 1809, represents one fifth of visceral aneurysms and the mortality from spontaneous rupture is high in most of cases. We are reporting a case of an asymptomatic 48-year-old woman with an extrahepatic HAA, diagnosed initially and incidentally with abdominal ultrasonography, confirmed by a three-dimensional contrast-enhanced magnetic resonance imaging and angiography. Endovascular treatment was considered feasible and was successfully treated with coil embolization.

Aneurisma da artéria hepática (AAH) foi relatado pela primeira vez através de autópsia em 1809, representa um quinto dos aneurismas viscerais, e a mortalidade por ruptura espontânea é alta na maioria dos casos. Relatamos o caso de uma mulher de 48 anos de idade com um AAH extra-hepático assintomático, diagnosticado inicialmente, e incidentalmente, com ultrassonografia abdominal e confirmado através de angiorressonância tridimensional e angiografia contrastada. O tratamento endovascular foi considerado viável, sendo tratada com sucesso através de embolização com molas.

Azygos vein lead implantation: a therapeutic option for elevated defibrillation threshold.

The evaluation of the defibrillation threshold (DFT) during the implantation of a cardioverter-defibrillator (ICD) is an important stage of the procedure, as a high DFT can be found in up to 16% of patients. We report a patient with idiopathic dilated cardiomyopathy (DCM) submitted to a biventricular ICD implantation. During the procedure, the patient showed a high DFT and showed to be resistant to usual therapeutic modalities. We opted for the azygos vein defibrillation lead implantation, with good resolution.

Implante de eletrodo em veia ázigos: uma opção terapêutica para limiar de desfibrilação elevado / Azygos vein lead implantation: a therapeutic option for elevated defibrillation threshold

A avaliação do limiar de desfibrilação (DFT) durante o implante do cardioversor-desfibrilador (CDI) é uma etapa relevante do procedimento, uma vez que, em até 16% dos pacientes, podemos encontrar elevados DFT. Relatamos o caso de um paciente portador de cardiomiopatia dilatada (CMPD) idiopática submetido a implante de CDI biventricular. Durante o procedimento, apresentou elevado DFT e se mostrou resistente às modalidades terapêuticas usuais. Optamos pelo implante de eletrodo de desfibrilação em veia ázigos, com resolução do quadro.

The evaluation of the defibrillation threshold (DFT) during the implantation of a cardioverter-defibrillator (ICD) is an important stage of the procedure, as a high DFT can be found in up to 16% of patients. We report a patient with idiopathic dilated cardiomyopathy (DCM) submitted to a biventricular ICD implantation. During the procedure, the patient showed a high DFT and showed to be resistant to usual therapeutic modalities. We opted for the azygos vein defibrillation lead implantation, with good resolution.

Síndrome de Budd-Chiari tratada por angioplastia transjugular da veia supra-hepática / Budd-Chiari Sindromy treated by transjugular angioplasty of the supra-hepatic vein

A Síndrome de Budd-chiari é caracterizada pela oclusão das veias supra-hepáticas e apresenta inúmeras causas, mas nenhuma delas é identificável em cerca de 60-70% dos pacientes. O diagnóstico é realizado pela suspeita clínica e confirmado por exames complementares, sendo a ultrassonografia com Doppler a mais sensível (85%). A terapia varia desde medicamentos, cirurgias como anastomoses portossistêmicos e transplante hepático até métodos menos invasivos como derivação intra-hepática portossistêmica transjugular (TIPS) e angioplastia. O objetivo desse trabalho é apresentar um paciente portador da SBC submetido à angioplastia transjugular da veia supra-hepática, utilizando via anterógrada (punção através da veia cava inferior trans-hepática, atingindo a veia supra-hepática e recanalizando anterogradamente a veia supra-hepática).

The Budd-chiari syndrome is characterized by occlusion of the supra-hepatic veins and has any causes, but none of them are identifiable by about 60-70% of patients. The diagnosis is made by clinical suspicion and confirmed by additional tests, and the Doppler ultrasound with the most sensitive (85%). The therapy varies from medications, surgeries such as liver transplantation and anastomosis portossistêmicos even less invasive methods like bypass intra-hepatic portosystemic transjugular (TIPS) and angioplasty. The aim of this article is to present a patient of SBC submitted to angioplasty transjugular the above hepatic vein using antegrade route (puncture through the inferior vena cava reaching the above-hepatic vein and the vein recanalizando anterograde above-liver).

Myocardial revascularization surgery with regional anesthesia without an endotracheal tube in conscious patients.

OBJECTIVE: To report initial experience with myocardial revascularization surgery (MRS) performed on patients who were totally awake and without an endotracheal tube. METHODS: Between January 1994 and May 2001, 272 patients underwent MRS without extracorporeal circulation. In 24, the operations were performed without the use of an endotracheal tube and with the patients totally awake and breathing normally. The age ranged from 51-75 years with the predominant male sex. Epidural thoracic administrations of the anesthesia was performed. Surgery was performed through a habitual anterolateral thoracotomy. During the entire procedure, the left lung remained partially collapsed. RESULTS: The 24 patients progressed well through the surgery. Pneumothorax time ranged from 70-190 minutes. No electrocardiographic, echocardiographic, or enzymatic alterations occurred that characterized pre- and postoperative infarcts. Twenty-three patients were stable enough to be released after 24 hours. CONCLUSION: This technique could be performed on an large number of selected patients. However, more experience is necessary.

Cirurgia de revascularização do miocárdio com anestesia regional, sem tubo orotraqueal em pacientes acordados / Myocardial revascularization surgery with regional anesthesia without an endotracheal tube in conscious patients

OBJECTIVE: To report initial experience with myocardial revascularization surgery (MRS) performed on patients who were totally awake and without an endotracheal tube.METHODS: Between January 1994 and May 2001, 272 patients underwent MRS without extracorporeal circulation. In 24, the operations were performed without the use of an endotracheal tube and with the patients totally awake and breathing normally. The age ranged from 51-75 years with the predominant male sex. Epidural thoracic administratios of the anesthesia was performed. Surgery was performed through a habitual anterolateral thoracotomy. During the entire procedure, the left lung remained partially collapsed.RESULTS: The 24 patients progressed well through the surgery. Pneumothorax time ranged from 70-190 minutes. No electrocardiographic, echocardiographic, or enzymatic alterations occurred that characterized pre- and postoperative infarcts. Twenty-three patients were stable enough to be released after 24 hours.CONCLUSION: This technique could be performed on an large number of selected patients. However, more experience is necessary