RESUMEN
Distal embolization of atheroma and thrombus is a major concern when performing balloon angioplasty in coronary saphenous vein grafts (SVGs). The transluminal extraction catheter (TEC) is designed to remove this material and may improve the safety of percutaneous treatment of SVG disease. We assessed the acute results and long-term outcome of 67 patients (mean age 65.6 +/- 8.1 years; range 47-83 years) who underwent 73 separate TEC atherectomy procedures. Eighty-eight SVG lesions were treated (mean age 8.7 +/- 3.8 years from bypass surgery). Procedural success (< 50% final diameter stenosis and absence of major complications) was obtained in 63 patients (86%). Adjunctive balloon angioplasty and/or directional coronary atherectomy was required in 69 of the procedures (95%). Major complications, occurring in 8 patients (11%), were acute closure in 4 (5%), resulting in Q-wave myocardial infarction in 3 and urgent bypass surgery in 1, and distal embolization in 4 (5%; 1 associated with Q-wave myocardial infarction). Angiographic follow-up was available for 50 patients and restenosis was present in 26 (52%). These data suggest TEC atherectomy can be performed in SVGs with an acceptable procedural risk, but restenosis remains a significant limitation which will require other strategies to overcome.
Asunto(s)
Aterectomía Coronaria/métodos , Oclusión de Injerto Vascular/cirugía , Vena Safena/trasplante , Anciano , Angioplastia Coronaria con Balón , Aterectomía Coronaria/instrumentación , Angiografía Coronaria , Puente de Arteria Coronaria , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/epidemiología , Oclusión de Injerto Vascular/terapia , Humanos , Masculino , Recurrencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Blunt chest trauma can result in significant cardiothoracic injury, which can include cardiac contusion, aortic injury, and myocardial valvular injury. Nineteen patients with no prior history of cardiac abnormalities who sustained severe blunt chest trauma and had widening of the mediastinum on chest radiographs were prospectively evaluated using transesophageal echocardiography (TEE). In each instance TEE was performed without difficulty, excellent images were obtained of the aorta and heart, and no complications were noted. Abnormalities were seen in 12 (63%) patients, with hypokinetic regional wall motion consistent with cardiac contusion demonstrated in five (26%) patients. Tricuspid regurgitation was found in three (16%) patients, and aortic and mitral regurgitation in one (5%) patient each. Aortic wall hematomas were seen in two patients, one of whom had an intimal tear on aortography, and a pericardial effusion was seen in one patient with an aortic intimal tear confirmed angiographically. Thus TEE can be performed safely in the acute setting of patients sustaining severe blunt chest trauma and yield useful information with respect to cardiovascular function and the aorta.
Asunto(s)
Aorta/lesiones , Ecocardiografía , Lesiones Cardíacas/diagnóstico , Traumatismos Torácicos/patología , Heridas no Penetrantes/patología , Adulto , Anciano , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/etiología , Válvulas Cardíacas/lesiones , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
It is often difficult to delineate the true course of anomalous coronary arteries by angiography because it only provides a 2-dimensional view of a complex 3-dimensional structure. The purpose of this study was to confirm morphologically the radiographic appearance of anomalous coronary arteries and to construct a protocol for rapid determination of their true course. Twenty-one adults who had anomalous origin of coronary arteries without other evidence of congenital heart disease were reviewed. Using an anatomically correct model of the heart, solder wire was placed in the pathologically described anomalous positions and radiographed. With this model the pathologically described courses could be easily recognized and separated radiographically. These courses were confirmed in the operating room in 2 patients and a rare anomaly of posterior origin of a coronary artery was also confirmed by autopsy.
Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico por imagen , Adulto , Aortografía , Medios de Contraste , Humanos , Métodos , Modelos Cardiovasculares , Ventriculografía con RadionúclidosRESUMEN
Findings are described in five patients who at necropsy were found to have origin of the left main coronary artery from the right sinus of Valsalva and coursing of the anomalously arising artery between aorta and pulmonary trunk to reach the left side of the heart. Three of the five patients were boys and died suddenly at ages 13, 14 and 19 years, respectively: two of them had had one or more episodes of syncope and the third had an abnormal electrocardiogram. The fourth patient, a 64 year old woman, died of chronic congestive heart failure 1 year after an acute myocardial infarction. She had insignificant coronary atherosclerosis. The fifth patient, an 81 year old man, died of chronic alcoholism, having been free of symptoms of cardiac dysfunction during life. Additionally, clinical and necropsy findings are summarized in 38 previously reported necropsy patients with the coronary anomaly. Of these 38 (34 male [89%]), 23 (61%) died suddenly in the first two decades of life; death in 6 others (16%) appears to have been related to coronary atherosclerosis and 9 patients (24%) died from noncoronary causes. Thus, this anomaly is life-threatening. Why it frequently causes fatal cardiac arrest in some young individuals and allows a normal life span in others remains unclear.