Estudio ultrasónico de prevalencia de placa en la carina en lesiones que afectan a una bifurcación coronaria. Implicaciones en el tratamiento con stent provisional / Ultrasound study of the prevalence of plaque at the carina in lesions that affect the coronary bifurcation. Implications for treatment with provisional stent

Introducción y objetivos. Los patrones de distribución de placa en las lesiones en bifurcación coronaria son poco conocidos, y se ha especulado que la carina es inmune a la arteriosclerosis, debido al efecto ateroprotector derivado del high wall shear stress. El objetivo fue analizar con ecografía intracoronaria (EIC) la distribución de placa en lesiones en bifurcación coronaria y su prevalencia en la carina. Métodos. En 195 bifurcaciones coronarias, se hizo una EIC sobre el vaso principal (VP), y en 91 también sobre el ramo secundario (RS). Se consideró que había placa en la carina cuando el grosor era ≥ 0,3mm. Se midió la carga de placa en distintos puntos: referencia proximal, carina, punto de área luminal mínima (ALM) y referencia distal. Tras implantar el stent en el VP se realizó una EIC. Resultados. La prevalencia de placa en la carina fue del 32% y su grosor, 0,8±0,36mm, menor que el observado en la contracarina (1,22±0,54mm; p<0,01). La prevalencia de placa fue mayor (52%) cuando el punto de ALM estaba localizado distal a la carina. La presencia de placa en la carina se asoció a menor incidencia de daño del ostium del RS tras tratar el VP (el 32 frente al 54%; p=0,04). Conclusiones. La carina no es inmune a la arteriosclerosis y hay placa en un tercio de las bifurcaciones. La prevalencia de placa es mayor en bifurcaciones con ALM distal a la carina y parece asociarse a menor incidencia de daño del ostium del RS (AU)

Introduction and objectives: The plaque distribution patterns in coronary bifurcation lesions are not well understood. It has been speculated that carina is free of plaque partly because of high wall shear stress providing an atheroprotective effect. To study plaque distribution with intravascular ultrasound (IVUS) in the coronary bifurcation and the prevalence of carina involvement. Methods: IVUS study was performed on 195 coronary bifurcation lesions in the main vessel (MV) and on 91 in the side branch (SB). Plaque at the carina was considered when its thickness was > 0.3 mm. Plaque burden was measured at different levels: proximal reference, distal, carina and at the point of minimal lumen area (MLA). Results: The prevalence of plaque at the carina was 32%. Its thickness was 0.8 (0.36) mm, less than that observed at the counter-carina [1.22 (0.54) mm; P < .01]. The prevalence was higher (52%) when the MLA point was distal to the carina. The plaque at the carina was associated with a lower incidence of damage at the SB ostium after stenting the MV (32% vs 54%; P < .04). Conclusions: The carina is not immune to atherosclerosis, showing plaque at this level in one third of the bifurcations. The incidence of plaque is higher in those bifurcations with the MLA point distal to the carina and seems to be associated with a lower incidence of damage to the SB ostium (AU)

[Atrio-ventricular canal: possibilities of recovery]. / Canal atrio-ventricular comun. Posibilitati de recuperare.

UNLABELLED: The evolution and prognosis of the atrioventricular canal (AVC) depend very much on the clinical type of the disease and its recovery is sometimes an extremely difficult problem. METHODS: The evolution of the 24 cases with atrioventricular canal (10 boys and 14 girls), registered in the files of pediatric cardiology consulting room from the Outpatient Department of the "Sf. Spiridon" Hospital from Iasi, has been studied. According to the state of the patients and, especially, with the parents' permission, these children were sent to Cardiovascular Surgery, for corrective surgical treatment. Before that, they had received a medical treatment for the cardiac failure (digitals, diuretics) and for the pulmonary hypertension (beta-adrenergic blockers, renin angiotensin inhibitors) and they continued this treatment for 1-2 years after the surgical correction. RESULTS AND DISCUSSIONS: This sample included: 9 cases with AVC-complete type; 1 case with AVC-intermediate type; 14 cases with AVC-partial type (13 cases with atrial septal defect-ostium primum + mitral valve cleft and 1 case with left ventricle to right atrium type IIa communication). Only 7 of the 10 children with AVC partial type were surgically corrected, and in all cases the evolution was positive. Three of the nine cases with AVC complete type were investigated in Cardiovascular Surgery in our country, all of them considered without surgical solution. For one of the cases with AVC--complete type and pulmonary stenosis, considered also without surgical solution, a palliative systemic-to-pulmonary artery shunt was made, for the improvement of the pulmonary circulation. CONCLUSIONS: 1. AVC partial type could be recovered in the best conditions in the clinics of cardiovascular surgery in our country. 2. AVC--complete type didn't have, in our cases, surgical solution, either in our country or abroad. 3. For the special situation of the AVC complete type with pulmonary stenosis, the only treatment possible was palliative, performed to increase the pulmonary artery blood flow.

Efficacy and dosage of enalapril in congenital and acquired heart disease.

In a tertiary referral centre 63 patients underwent 67 treatment periods with enalapril. The median age was 5.4 months. All children had signs of heart failure: congestive cardiac failure with breathlessness at rest was present in 88%. Haemodynamic groups were left-to-right shunt (n = 15), impaired ventricular function (n = 14), after cardiac surgery (n = 23), valvar regurgitation (n = 12), and hypertension (n = 3). Serial clinical, radiological, and laboratory data were used to judge outcome. The mean (SD) maximal dose was 0.30 (0.21) mg/kg/day. Thirty nine (58%) patients improved, 20 (30%) showed no improvement, and eight (12%) had side effects requiring discontinuation of enalapril. Renal failure in eight patients was related to young age, low weight, and left-to-right shunt group. Three patients died in congestive heart failure with renal failure. Enalapril was clinically safe and effective for children with cardiac failure secondary to ventricular impairment, valvar regurgitation, or after cardiac surgery. Renal failure was a problem in young infants with left-to-right shunts.

Short-term hemodynamic effects of hydralazine in infants with complete atrioventricular canal defects.

We evaluated the acute hemodynamic responses to hydralazine during cardiac catheterization in eight infants (ages 1.0 to 5.5 months) with congestive heart failure due to complete atrioventricular canal defect. Hydralazine administered intravenously (0.5 to 1.0 mg/kg body weight) increased heart rate and systemic blood flow and decreased mean right atrial pressure, systemic and pulmonic arterial pressures, systemic arteriolar resistance, and the ratio of pulmonary to systemic blood flow (p less than .05). The percentage of pulmonary flow contributed by shunted blood (percent left-to-right shunt; measured by indicator dilution) was decreased by hydralazine in six (mean = 85% before to 64% after hydralazine; p less than .01), but remained unchanged (79%) in two infants. The two infants with no change in percent left-to-right shunt had higher pulmonary arteriolar resistances (Rp) before hydralazine (mean = 12.8 vs 3.2 U/m2) and had greater declines in Rp (mean change = -5.1 vs + 0.3 U/m2) in response to hydralazine. Thus, if Rp does not fall, hydralazine reduces the percentage of left-to-right shunt over the short term and therefore might be useful for managing congestive heart failure in these infants. However, because the response varies, an evaluation of the short-term hemodynamic effects of hydralazine may be warranted in an attempt to select those infants who might respond favorably to long-term hydralazine therapy.