RESUMEN

BACKGROUND: Alcohol septal ablation (ASA) is an alternative treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients refractory to pharmacological therapy. We sought to evaluate the immediate and long-term incidence of death and changes in life quality in a consecutive cohort submitted to ASA. METHODS AND RESULTS: Between October 1998 and December 2013, a total of 56 patients (mean age 53.2 ± 15.5) with symptomatic refractory HOCM were treated with ASA and followed during 15 years (mean 8 ± 4 years). There were 7 (12.5%) deaths, 2 (3.6%) being of cardiac cause. The Kaplan-Meier survival probability estimate was 96.4% at 1 year, 87.7 at 5 years and 81.0% at 12 years post-ASA. Significant improvement was observed in life quality assessed by DASI index and NYHA functional class as well as in the left ventricle outflow tract (LVOT) gradient reduction (from 92.8 ± 3.3 mm Hg to 9.37 ± 6.7 mm Hg, P < 0.001) and septum thickness (from 23.9 ± 0.6 mm to 12.9 ± 1.0 mm, P < 0.001). Only one patient (1.7%) required permanent pacemaker immediately after ASA. During follow-up, one patient had a repeated ASA, three patients underwent myectomy and other four required ICD/pacemaker. In the multivariate model only post-ASA LVOT residual gradient and left ventricle mass were associated with worse prognosis. CONCLUSIONS: In this long-term clinical follow-up without losses, ASA was effective in improving quality of life and NYHA functional class, with relatively low mortality and very low need for immediate permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.

Asunto(s)

Técnicas de Ablación/métodos , Cateterismo Cardíaco/métodos , Cardiomiopatía Hipertrófica/cirugía , Etanol/administración & dosificación , Tabiques Cardíacos , Brasil/epidemiología , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/mortalidad , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de Supervivencia/tendencias , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

BACKGROUND: Alcohol septal ablation (ASA) is an alternative treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients refractory to pharmacological therapy. We sought to evaluate the immediate and long-term incidence of death and changes in life quality in a consecutive cohort submitted to ASA. METHODS AND RESULTS: Between October 1998 and December 2013, a total of 56 patients (mean age 53.2 ± 15.5) with symptomatic refractory HOCM were treated with ASA and followed during 15 years (mean 8 ± 4 years). There were 7 (12.5%) deaths, 2 (3.6%) being of cardiac cause. The Kaplan-Meier survival probability estimate was 96.4% at 1 year, 87.7 at 5 years and 81.0% at 12 years post-ASA. Significant improvement was observed in life quality assessed by DASI index and NYHA functional class as well as in the left ventricle outflow tract (LVOT) gradient reduction (from 92.8 ± 3.3 mm Hg to 9.37 ± 6.7 mm Hg, P < 0.001) and septum thickness (from 23.9 ± 0.6 mm to 12.9 ± 1.0 mm, P < 0.001). Only one patient (1.7%) required permanent pacemaker immediately after ASA. During follow-up, one patient had a repeated ASA...

Asunto(s)

Cardiomiopatía Hipertrófica , Intervención Coronaria Percutánea

RESUMEN

O tratamento alternativo de Redução septal percutânea (RSP) em pacientes com cardiomiopatia hipertrófica obstrutiva é relativamente novo e há poucos trabalhos publicados sobre a evolução tardia...

Asunto(s)

Cardiomiopatía Hipertrófica , Intervención Coronaria Percutánea , Técnicas de Ablación

RESUMEN

OBJECTIVES: This study sought to randomly compare cerebral protection with ANGIOGUARD (Cordis Corporation, Bridgewater, New Jersey) with Mo.Ma (Invatec/Medtronic Vascular Inc, Santa Rosa, California) during carotid artery stenting (CAS), using diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic cerebral lesions. The number, size, and location of lesions were analyzed. BACKGROUND: The choice of the type of cerebral protection during CAS is controversial. METHODS: From July 2008 to July 2011, 60 patients undergoing CAS were randomized to ANGIOGUARD or Mo.Ma, distributed by chance, 30 patients for each group. All patients underwent DW-MRI before and after CAS. An independent neuroradiologist blinded to the cerebral protection used analyzed the images. Univariate and multivariate logistic models were fitted to analyze new ischemic lesions. Alternatively, a propensity score approach was used to reduce the bias due to differences between the groups. For the number of lesions, we used Poisson regression models. RESULTS: New ischemic lesions seen on DW-MRI were present in 63.3% of the ANGIOGUARD group versus 66.7% of the Mo.Ma cohort (p = 0.787). The number of ischemic cerebral lesions per patient, when present, was significantly lower in the Mo.Ma group (a median of 6 lesions per patient vs. a median of 10 in the ANGIOGUARD, p < 0.001). Most lesions were small (<0.5 mm) and localized in the ipsilateral territory. One patient in the ANGIOGUARD group had a minor stroke during CAS (1.66%). CONCLUSIONS: New ischemic lesions seen on DW-MRI were present in both groups in >60%, but the number of lesions per patient was greater in the ANGIOGUARD group. No death or disabling stroke occurred during at least 1 year of follow-up in both cohorts.

Asunto(s)

Angioplastia/instrumentación , Isquemia Encefálica/prevención & control , Estenosis Carotídea/terapia , Circulación Cerebrovascular , Dispositivos de Protección Embólica , Stents , Anciano , Angioplastia/efectos adversos , Enfermedades Asintomáticas , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Isquemia Encefálica/fisiopatología , Brasil , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/fisiopatología , Distribución de Chi-Cuadrado , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Puntaje de Propensión , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/prevención & control , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

The electrocardiogram is an important tool for the initial diagnostic suspicion of hypertrophic cardiomyopathy in any of its forms, both in symptomatic and in asymptomatic patients because it is altered in more than 90 percent of the cases. Electrocardiographic anomalies are more common in patients carriers of manifest hypertrophic cardiomyopathy and the electrocardiogram alterations are earlier and more sensitive than the increase in left ventricular wall thickness detected by the echocardiogram. Nevertheless, despite being the leading cause of sudden death among young competitive athletes there is no consensus over the need to include the method in the pre-participation screening. In apical hypertrophic cardiomyopathy the electrocardiographic hallmarks are the giant negative T waves in anterior precordial leads. In the vectorcardiogram, the QRS loop is located predominantly in the left anterior quadrant and T loop in the opposite right posterior quadrant, which justifies the deeply negative T waves recorded. The method allows estimating the left ventricular mass because it relates to the maximal spatial vector voltage of the left ventricle in the QRS loop. The recording on electrocardiogram or Holter monitoring of nonsustained monomorphic ventricular tachycardia in patients with syncope, recurrent syncope in young patient, hypotension induced by strain, bradyarrhythmia, or concealed conduction are markers of poor prognosis. The presence of rare sustained ventricular tachycardia is observed in mid-septal obstructive HCM with apical aneurysm. The presence of complete right bundle branch block pattern is frequent after the percutaneous treatment and complete left bundle branch block is the rule after myectomy.

Asunto(s)

Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/epidemiología , Vectorcardiografía/métodos , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Electrocardiografía/métodos , Femenino , Humanos , Lactante , Masculino , Prevalencia , Reproducibilidad de los Resultados , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Adulto Joven

RESUMEN

INTRODUÇÃO: O tipo de proteção cerebral utilizado durante o implante de stent carotídeo é controverso em idosos. Nosso objetivo foi avaliar os resultados dos dispositivos de proteção embólica cerebral (PEC), proximal e distal, em pacientes > 70 anos de idade, por meio da ressonância magnética ponderada de difusão (RM-PD). MÉTODOS: Entre 2008 e 2011, 60 pacientes com indicação de stent carotídeo foram randomizados para PEC com Mo.Ma® ou Angioguard®, dos quais 26 tinham > 70 anos de idade. Os resultados da RM-PD realizada antes e 48 horas após o procedimento foram avaliados por neuro­logista independente e cego para o tipo de PEC utilizado. Foram analisados o número de novos focos isquêmicos, sua localização e o tamanho. RESULTADOS: Novos focos isquêmicos cerebrais foram encontrados em 8/12 (66,7%) pacientes do grupo Mo.Ma® e em 12/14 (85,7%) pacientes do grupo Angioguard® (P = 0,37). A maioria das lesões (> 90%) era ipsilateral à artéria tratada em ambos os grupos, e o tamanho das lesões foi < 0,5 cm na maioria dos casos. O número de lesões por paciente foi menor com o dispositivo Mo.Ma® (mediana [variação]: 3 [1 a 8] lesões vs. 15 [2 a 76] lesões; P < 0,001). Todos os pacientes que tiveram mais de 40 lesões pertenciam ao grupo Angioguard®. CONCLUSÕES: Mesmo utilizando PEC (proximal ou distal), novas lesões isquêmicas foram observadas em ambos os grupos em pacientes idosos. Proporcionalmente maior número de pacientes com Angioguard® teve novos focos isquêmicos se comparados aos pacientes do grupo Mo.Ma®. O dispositivo de PEC Mo.Ma® parece diminuir o número de lesões por paciente.

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BACKGROUND: The type of cerebral protection used during carotid stenting in the elderly is controversial. Our objective was to evaluate the results of proximal and distal cerebral embolic protection devices (EPDs), in patients > 70 years through diffusion-weighted magnetic resonance imaging (DW-MRI). METHODS: Between 2008 and 2011, 60 patients with indication for carotid stenting were randomized to EPD with Mo.Ma® or Angioguard®, of which 26 patients were > 70 years of age. Results of DW-MRI performed before and 48 hours after the procedure were evaluated by an independent neurologist blinded to the type of EPD used. New ischemic lesions, their localization and size were analyzed. RESULTS: New cerebral ischemic lesions were found in 8/12 (66.7%) patients in the Mo.Ma® group and 12/14 (85.7%) patients in the Angioguard® group (P = 0.37). The vast majority of the lesions (> 90%) were ipsilateral to the treated artery in both groups and the size of the lesions was < 0.5 cm in most cases. The number of lesions per patient was lower with the Mo.Ma® device (median [variation]: 3 [1 to 8] lesions vs 15 [2 to 76] lesions; P < 0.001). All of the patients with more than 40 lesions were in the Angioguard® group. CONCLUSIONS: Despite the use of EPDs (proximal or distal), new ischemic lesions were observed in both groups in elderly patients. A proportionately larger number of patients with Angioguard® had new ischemic lesions when compared to those with Mo.Ma®. The Mo.Ma® device seems to decrease the number of lesions per patient.

Asunto(s)

Humanos , Masculino , Femenino , Anciano , Angiografía Cerebral/métodos , Angiografía Cerebral , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Anciano , Stents , Angioplastia/métodos , Factores de Riesgo

RESUMEN

Objectives This study sought to randomly compare cerebral protection with ANGIOGUARD (CordisCorporation, Bridgewater, New Jersey) with Mo.Ma (Invatec/Medtronic Vascular Inc, Santa Rosa,California) during carotid artery stenting (CAS), using diffusion-weighted magnetic resonance imaging(DW-MRI) to detect new ischemic cerebral lesions. The number, size, and location of lesions wereanalyzed.Background The choice of the type of cerebral protection during CAS is controversial.Methods From July 2008 to July 2011, 60 patients undergoing CAS were randomized toANGIOGUARD or Mo.Ma, distributed by chance, 30 patients for each group. All patients underwentDW-MRI before and after CAS. An independent neuroradiologist blinded to the cerebral protectionused analyzed the images. Univariate and multivariate logistic models were fitted to analyze newischemic lesions. Alternatively, a propensity score approach was used to reduce the bias due todifferences between the groups. For the number of lesions, we used Poisson regression models.Results New ischemic lesions seen on DW-MRI were present in 63.3% of the ANGIOGUARD groupversus 66.7% of the Mo.Ma cohort (p » 0.787). The number of ischemic cerebral lesions per patient,when present, was significantly lower in the Mo.Ma group (a median of 6 lesions per patient vs.a median of 10 in the ANGIOGUARD, p 60%, but thenumber of lesions per patient was greater in the ANGIOGUARD group. No death or disabling strokeoccurred during at least 1 year of follow-up in both cohorts.

Asunto(s)

Accidente Cerebrovascular , Espectroscopía de Resonancia Magnética , Stents

Asunto(s)

Angioplastia de Balón , Aorta Torácica , Stents

Asunto(s)

Cardiomiopatía Hipertrófica , Tabiques Cardíacos , Terapéutica

Asunto(s)

Cardiomiopatía Hipertrófica , Cardiomiopatía Hipertrófica/diagnóstico , Terapéutica

RESUMEN

We report an eight-year-old child presented with classical features of hypertrophic obstructive cardiomyopathy and with New York Heart Association (NYHA) class III symptoms, eight months after myectomy and refractory to medical treatment. Cardiac transplantation was indicated due to the severity of symptoms. But the lymphocyte reaction test showed almost 100% reaction of antibodies, and the surgeons rejected the heart transplantation for fear of hyperacute rejection. Then an alcohol septal ablation (ASA) was proposed, which was successfully performed on August 17, 2005. The post-extrasystolic gradient was reduced from 160 to 60 mm Hg immediately and no other complications were seen. The child is being followed since then and echocardiography changes include a further reduction of septum thickness and gradient (P = 0.001), and important symptoms relieved after 3.5 years of follow up. ASA may be an option to be considered in children with critical hypertrophic obstructive cardiomyopathy in NYHA functional class III/IV, when other methods of treatment failed. © 2010 Wiley-Liss, Inc.

Asunto(s)

Técnicas de Ablación , Procedimientos Quirúrgicos Cardíacos , Cardiomiopatía Hipertrófica/terapia , Etanol/administración & dosificación , Insuficiencia Cardíaca/terapia , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Cardiomiopatía Hipertrófica/fisiopatología , Cardiomiopatía Hipertrófica/cirugía , Niño , Contraindicaciones , Ecocardiografía Doppler en Color , Electrocardiografía , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Humanos , Masculino , Recuperación de la Función , Índice de Severidad de la Enfermedad , Insuficiencia del Tratamiento , Función Ventricular

RESUMEN

BACKGROUND: Stroke is a feared complication after coronary artery bypass grafting surgery (CABG), with an incidence between 1.3 and 4.3%. OBJECTIVE: To identify predictive factors for stroke after CABG in the modern era of cardiac surgery. METHODS: This is a case-control study of 65 pairs of patients, paired by sex, age (+ 3 years) and date of CABG (+ 3 months). The cases were patients submitted to elective CABG with extracorporeal circulation (ECC) that presented stroke (defined as clinical neurological deficit up to 24 hours post-operatively and confirmed by imaging assessment) and the controls were those individuals submitted to elective CABG with ECC, but without stroke. RESULTS: The univariate analysis demonstrated that the number of revascularized vessels was associated with the occurrence of stroke after the CABG (3 +/- 0.8 vs. 2.76 +/- 0.8, p = 0.01). The multivariate analysis by conditional logistic regression showed that systemic arterial hypertension (SAH) [OR: 6.1 (1.5 - 24), p = 0.009] and diabetes mellitus (DM) [OR: 3.1 (1.09 - 11), p= 0.03] were the determinants of the highest chance of stroke after CABG, whereas acute myocardial infarction (AMI) > 1 month, was the determinant of the lowest chance of stroke [OR: 0.1 (0.03 - 0.36), p = 0.003]. CONCLUSION: Hypertension and diabetes mellitus were identified as independent predictors of stroke within the first 24 postoperative hours after CABG. In patients with such risk factors, it is possible that the knowledge of the causal mechanisms of brain injury represents a strategy capable of decreasing the incidence of stroke after CABG.

Asunto(s)

Puente de Arteria Coronaria , Accidente Cerebrovascular/etiología , Anciano , Estudios de Casos y Controles , Complicaciones de la Diabetes , Femenino , Humanos , Hipertensión/complicaciones , Modelos Logísticos , Masculino , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo

RESUMEN

FUNDAMENTO: O acidente vascular encefálico (AVE) é uma temida complicação após cirurgia de revascularização do miocárdio (CRM), com incidência entre 1,3 por cento e 4,3 por cento. OBJETIVO: Identificar fatores preditores de AVE após CRM, na era moderna da cirurgia cardíaca. MÉTODOS: Este é um estudo caso-controle de 65 pares de pacientes, no qual o pareamento foi realizado por sexo, idade (+ 3 anos) e data da CRM (+ 3 meses). Os casos são pacientes submetidos à CRM eletiva com circulação extracorpórea (CEC), que apresentaram AVE (definido como déficit clínico neurológico até 24 horas de pós-operatório e confirmado por exame de imagem), e os controles aqueles submetidos à CRM eletiva com CEC sem AVE. RESULTADOS: A análise univariada revelou que o número de vasos revascularizados foi associado com a ocorrência de AVE após a CRM (3 ± 0,8 vs. 2,76 ± 0,8, p = 0,01). Na análise multivariada por regressão logística condicional, a hipertensão arterial sistêmica [OR: 6,1 (1,5 - 24), p = 0,009] e o diabete melito [OR: 3,1 (1,09 - 11), p= 0,03] foram determinantes de maior chance de AVE após CRM, e o infarto agudo do miocárdio > 1 mês determinante de menor chance [OR: 0,1 (0,03 - 0,36), p = 0,003]. CONCLUSÃO: Hipertensão e diabete melito foram identificados como preditores independentes de AVE nas primeiras 24 horas de pós-operatório de CRM. Em pacientes com tais fatores de risco, é possível que o conhecimento dos mecanismos causadores da injúria cerebral represente uma estratégia capaz de diminuir a incidência de AVE após CRM.

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BACKGROUND: Stroke is a feared complication after coronary artery bypass grafting surgery (CABG), with an incidence between 1.3 and 4.3 percent. OBJECTIVE: To identify predictive factors for stroke after CABG in the modern era of cardiac surgery. METHODS: This is a case-control study of 65 pairs of patients, paired by sex, age (+ 3 years) and date of CABG (+ 3 months). The cases were patients submitted to elective CABG with extracorporeal circulation (ECC) that presented stroke (defined as clinical neurological deficit up to 24 hours post-operatively and confirmed by imaging assessment) and the controls were those individuals submitted to elective CABG with ECC, but without stroke. RESULTS: The univariate analysis demonstrated that the number of revascularized vessels was associated with the occurrence of stroke after the CABG (3 ± 0.8 vs. 2.76 ± 0.8, p = 0.01). The multivariate analysis by conditional logistic regression showed that systemic arterial hypertension (SAH) [OR: 6.1 (1.5 - 24), p = 0.009] and diabete mellitus (DM) [OR: 3.1 (1.09 - 11), p= 0.03] were the determinants of the highest chance of stroke after CABG, whereas acute myocardial infarction (AMI) > 1 month, was the determinant of the lowest chance of stroke [OR: 0.1 (0.03 - 0.36), p = 0.003]. CONCLUSION: Hypertension and diabete mellitus were identified as independent predictors of stroke within the first 24 postoperative hours after CABG. In patients with such risk factors, it is possible that the knowledge of the causal mechanisms of brain injury represents a strategy capable of decreasing the incidence of stroke after CABG.

Asunto(s)

Anciano , Femenino , Humanos , Masculino , Puente de Arteria Coronaria , Accidente Cerebrovascular/etiología , Estudios de Casos y Controles , Complicaciones de la Diabetes , Hipertensión/complicaciones , Modelos Logísticos , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo

Asunto(s)

Humanos , Cardiomiopatía Hipertrófica Familiar/congénito , Cardiomiopatía Hipertrófica Familiar/etiología , Cardiomiopatía Hipertrófica Familiar/mortalidad , Cardiomiopatía Hipertrófica Familiar/terapia , Fibrosis

RESUMEN

OBJECTIVE: To assess the in-hospital evolution of patients undergoing percutaneous stent placement in the carotid arteries. METHODS: From August 1996 to April 2001, we studied 86 patients with carotid arterial obliterative lesions > 70% who were treated with percutaneous stent placement in the carotid arteries. We assessed the rate of success of the implantation and of the procedure, the types of stents used, mortality rate, and neurological complications. RESULTS: Successful implantation was obtained in 98.9% of the cases, and the procedure was successful in 91.8%. The Wallstent was the most frequently used stent (73 patients - 77%). Cerebral strokes occurred as follows: 3 (3.2%) transient ischemic attacks, 1 (1.1%) minor stroke, and 3 (3.1%) major strokes. One (1.1%) patient died during hospitalization. CONCLUSION: The high rate of success of stent implantation (98.9%) in addition to the low rate of cerebral stroke/death (4.2%) showed the efficiency and safety of percutaneous stent placement in carotid arteries.

Asunto(s)

Implantación de Prótesis Vascular/normas , Arteria Carótida Interna/cirugía , Estenosis Carotídea/terapia , Stents , Anciano , Implantación de Prótesis Vascular/efectos adversos , Brasil/epidemiología , Estenosis Carotídea/mortalidad , Angiografía Cerebral , Femenino , Estudios de Seguimiento , Humanos , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Stents/efectos adversos , Accidente Cerebrovascular/etiología

RESUMEN

OBJECTIVE: To assess the in-hospital evolution of patients undergoing percutaneous stent placement in the carotid arteries. METHODS: From August 1996 to April 2001, we studied 86 patients with carotid arterial obliterative lesions > 70 percent who were treated with percutaneous stent placement in the carotid arteries. We assessed the rate of success of the implantation and of the procedure, the types of stents used, mortality rate, and neurological complications. RESULTS: Successful implantation was obtained in 98.9 percent of the cases, and the procedure was successful in 91.8 percent. The Wallstent was the most frequently used stent (73 patients - 77 percent). Cerebral strokes occurred as follows: 3 (3.2 percent) transient ischemic attacks, 1 (1.1 percent) minor stroke, and 3 (3.1 percent) major strokes. One (1.1 percent) patient died during hospitalization. CONCLUSION: The high rate of success of stent implantation (98.9 percent) in addition to the low rate of cerebral stroke/death (4.2 percent) showed the efficiency and safety of percutaneous stent placement in carotid arteries

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Arteria Carótida Interna , Stents , Estenosis Carotídea , Implantación de Prótesis Vascular , Complicaciones Posoperatorias , Brasil , Angiografía Cerebral , Stents , Ataque Isquémico Transitorio , Estudios de Seguimiento , Resultado del Tratamiento , Estenosis Carotídea , Implantación de Prótesis Vascular , Accidente Cerebrovascular

RESUMEN

OBJECTIVE: Analyze the dromotropic disturbances (vector-electrocardiographic), and the possible anatomic causes, provoked by selective alcohol injection in the septal branch, for percutaneous treatment, of obstructive hypertrophic cardiomyopathy. METHODS: Ten patients with a mean age of 52.7 years underwent percutaneous septal ablation (PTSA) from october 1998; all in functional class III/IV). Twelve-lead electrocardiogram was performed prior to and during PTSA, and later electrocardiogram and vectorcardiogram according to Frank's method. The patients were followed up for 32 months. RESULTS: On electrocardiogram (ECG) prior to PTSA all patients had sinus rhythm and left atrial enlargement, 8 left ventricular hypertrophy of systolic pattern. On ECG immediately after PTSA, 8 had complete right bundle-branch block; 1 transient total atrioventricular block; 1 alternating transient bundle-branch block either right or hemiblock. On late ECG 8 had complete right bundle-branch block confirmed by vectorcardiogram, type 1 or Grishman. CONCLUSION: Septal fibrosis following alcohol injection caused a predominance of complete right bundle-branch block, different from surgery of myotomy/myectomy.

Asunto(s)

Bloqueo de Rama/inducido químicamente , Cardiomiopatía Hipertrófica/cirugía , Ablación por Catéter/métodos , Etanol/uso terapéutico , Tabiques Cardíacos/efectos de los fármacos , Vectorcardiografía , Adulto , Anciano , Bloqueo de Rama/fisiopatología , Cardiomiopatía Hipertrófica/fisiopatología , Femenino , Fibrosis , Tabiques Cardíacos/patología , Tabiques Cardíacos/cirugía , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio

RESUMEN

OBJECTIVE - Analyze the dromotropic disturbances (vector-electrocardiographic), and the possible anatomic causes, provoked by selective alcohol injection in the septal branch, for percutaneous treatment, of obstructive hypertrophic cardiomyopathy. METHODS - Ten patients with a mean age of 52.7 years underwent percutaneous septal ablation (PTSA) from october 1998; all in functional class III/IV). Twelve-lead electrocardiogram was performed prior to and during PTSA, and later electrocardiogram and vectorcardiogram according to Frank's method. The patients were followed up for 32 months. RESULTS - On electrocardiogram (ECG) prior to PTSA all patients had sinus rhythm and left atrial enlargement, 8 left ventricular hypertrophy of systolic pattern. On ECG immediately after PTSA, 8 had complete right bundle-branch block; 1 transient total atrioventricular block; 1 alternating transient bundle-branch block either right or hemiblock. On late ECG 8 had complete right bundle-branch block confirmed by vectorcardiogram, type 1 or Grishman. CONCLUSION - Septal fibrosis following alcohol injection caused a predominance of complete right bundle-branch block, different from surgery of myotomy/myectomy

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Vectorcardiografía , Cardiomiopatía Hipertrófica , Bloqueo de Rama , Ablación por Catéter , Etanol , Tabiques Cardíacos , Periodo Posoperatorio , Cardiomiopatía Hipertrófica , Fibrosis , Bloqueo de Rama , Etanol , Tabiques Cardíacos

RESUMEN

Objetivos: Avaliar a evolução hospitalar de pacientes submetidos a implante percutâneo de stents nas artérias carótidas (ISC) com uso adjunto de filtros para a proteção cerebral. Métodos: No período de dezembro de 2001 a agosto de 2002 estudamos 14 pacientes que apresentaram lesão obstrutiva significativa na artéria carótida e foram tratados com ISC. Mensuramos o sucesso do implante , do procedimento, os tipos de stents utilizados, os tipos de filtros utilizados, a mortalidade e as complicações neurológicas relacionadas ao procedimento. Resultados: O sucesso do implante e do procedimento foi alcançado em 100% dos casos. O stent mais utilizado foi o WALLSTENT carotídeo em 12 pacientes (85,7%). Não houve acidente vascular cerebral (AVC) transitório, AVC maior e AVC menor...

Asunto(s)

Masculino , Anciano , Anciano de 80 o más Años , Humanos , Arterias Carótidas/fisiopatología , Prótesis e Implantes , Stents

RESUMEN

A cardiomiopatia hipertrófica obstrutiva (CMHO) é uma doença caracterizada por obstrução dinâmica da via de saída do ventrículo esquerdo (VSVE), devido a desarranjo de fibras musculares predominantemente no septo interventricular. A ablação da artéria septal (AAS) tem se constituído numa alternativa a cirurgia de miomectomia no tratamento da CMHO. Realizamos este procedimento (AAS) em dez pacientes no período de março/98 a julho/2001. Houve sucesso em todos os pacientes (100%). O gradiente médio teve importante redução (88mmHg para 5mmHg). No segmento clínico todos os pacientes encontram-se assintomáticos e não houve recidiva da obstução. Ao ecocardiograma observamos remodelamento da VSVE caracterizado por alargamento da mesma, não havendo mais hipertrofia significativa septal.

Asunto(s)

Ablación por Catéter/métodos , Cardiomiopatía Hipertrófica Familiar/genética