RESUMEN
BACKGROUND: Patients with symptomatic myocardial ischemia from a chronic totally occluded coronary (TOC) artery are usually referred for coronary artery bypass surgery. Because guide wire technology has improved considerably in recent years, percutaneous coronary angioplasty has become a useful technique in opening chronic TOC arteries. We evaluated the early functional results of successful percutaneous recanalization by performing dobutamine stress echocardiography (DSE). METHODS: Fifteen patients with a chronic TOC artery who underwent a successful recanalization were prospectively studied. Each patient had a DSE within 24 hours before and 48 hours after the procedure. Wall motion was scored according to a 16-segment/5-point model. A clinical and angiographic follow-up of 6 months was obtained. RESULTS: The wall motion score index at rest improved from 1.26+/-0.23 before to 1.22+/-0.21 after the procedure (P < .05). Of those 10 segments that improved at rest, 7 were collateral recipients and 3 were collateral donors. The number of ischemic segments decreased from 46 before to 4 after the procedure (P < .0001). Wall motion score index at peak stress improved from 1.34+/-0.20 before to 1.15+/-0.12 after the procedure (P < .05). DSE was positive for ischemia in 15 patients before and 2 patients after the procedure (P < .0001). Angina was present in 12 patients before and in 2 patients after recanalization (P < .0001). Two patients (13%) had angiographic reocclusion and 5(33%) restenosis after 6 months of follow-up. CONCLUSIONS: Successful percutaneous recanalization of chronic TOC artery results in an early improvement of both clinical status and resting or stress-induced wall motion abnormalities, as detected by DSE.
Asunto(s)
Angioplastia Coronaria con Balón , Cardiotónicos , Enfermedad Coronaria/fisiopatología , Dobutamina , Ecocardiografía , Adulto , Anciano , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Ecocardiografía/métodos , Femenino , Pruebas de Función Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
The ultrasound contrast medium obtained by the original methods was administered into the left ventricular cavity and myocardium of 12 open-chest dogs by using a catheter. After its administration into the cavity there was its intensive contrast. When the ultrasound contrast was administered into the aortic root, the entire myocardium contrasted, on selective administrations of the contrast into the coronary arteries, the beds supplied by appropriate arteries contrasted. The ultrasound contrast study enabled the areas with impaired perfusion as echo-negative "filling defects" to be detected and mapped. The imaging of myocardial blood flow in tomographic sections and real time allows one to regard it promising for clinical use.