RESUMEN
INTRODUCTION: A reduction in the number of interventional cardiology procedures has emerged as a result of the COVID-19 pandemic. A survey was performed to quantify this decrease and the impact on the management of myocardial infarction in Latin America. METHODS: A telematic survey was conducted for all countries in Latin America. Diagnostic catheterisations, coronary and structural interventions, as well as the incidence and delay to reperfusion therapy of myocardial infarction (STEMI), were recorded. Two periods were compared: from 24 February to 8 March 2020 (pre-COVID-19) and another 2week period that varied according to country (COVID-19). RESULTS: Responses were obtained from 79 centres in 20 countries. There was a significant decrease in the number of diagnostic procedures (-65.2%), coronary interventions (-59.4%), structural therapeutics (-86.1%) and STEMI care (-51.2%). A decrease was noted in the incidence of STEMI, but also a delay in the time to STEMI reperfusion. While there was a variation in activity in interventional cardiology between countries, patient behaviour was rather homogeneous. CONCLUSIONS: A significant reduction in healthcare activity has been noted during the COVID-19 pandemic, including STEMI care, with the risk of increased mortality and/or morbidity following STEMI. Healthcare providers should encourage patients with suspected symptoms of STEMI to call for emergency care to ensure rapid diagnosis and timely reperfusion treatment.
RESUMEN
BACKGROUND: Previous studies have suggested a benefit of cilostazol in addition to standard dual-antiplatelet therapy (DAPT), reducing in-stent late luminal loss and restenosis after percutaneous coronary intervention (PCI) with bare-metal and drug-eluting stent (DES) implantation. However, there is a paucity of intravascular ultrasound (IVUS) assessment of neointimal tissue hyperplasia (NIH) after triple-antiplatelet therapy (TAPT), especially in diabetic patients treated with DES. METHODS: This prospective, placebo-controlled trial was conducted in diabetic patients randomized (1:1) to receive either standard DAPT (aspirin and clopidogrel) vs TAPT with cilostazol for a minimum of 12 months after PCI with Endeavor zotarolimus-eluting stent (E-ZES). The primary endpoint was the 9-month comparison of percentage of NIH in both groups. Additionally, we compared in-stent late lumen loss, binary restenosis, major adverse cardiac event (MACE; cardiac death, non-fatal myocardial infarction, and restenosis) rates, and the incidence of vascular/bleeding complications. RESULTS: In total, 133 diabetic patients were enrolled (cilostazol cohort = 65 patients) with 56.4% male and mean age of 60.8 years. Overall, the two cohorts were comparable in terms of baseline clinical and angiographic characteristics, except for the reference vessel diameter, which was smaller among patients randomized to cilostazol (2.48 ± 0.46 mm vs 2.69 ± 0.48 mm; P=.01). At 9 months, there was a non-significant trend toward less percentage of NIH obstruction in the TAPT cohort (33.2 ± 8.29% vs 35.1 ± 8.45%; P=.07). However, this finding did not impact angiographic late-lumen loss (0.60 ± 0.46 mm cilostazol group vs 0.64 ± 0.48 mm control group; P=.30) and binary restenosis (9.8% vs 6.8%; P=.99). MACE rate also did not significantly differ between the cohorts (13.8% cilostazol group vs 8.8% control group; P=.81). Of note, the addition of a third antiplatelet agent did not increase vascular and bleeding complications. CONCLUSION: In diabetic patients treated with E-ZES, TAPT with cilostazol did not add any significant benefit in terms of NIH suppression or MACE reduction.
Asunto(s)
Aspirina , Enfermedad de la Arteria Coronaria , Reestenosis Coronaria/prevención & control , Diabetes Mellitus/epidemiología , Quimioterapia Combinada/métodos , Neointima/prevención & control , Intervención Coronaria Percutánea , Tetrazoles , Ticlopidina/análogos & derivados , Aspirina/administración & dosificación , Aspirina/efectos adversos , Cilostazol , Clopidogrel , Comorbilidad , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/terapia , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/etiología , Stents Liberadores de Fármacos/efectos adversos , Femenino , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Sirolimus/análogos & derivados , Sirolimus/uso terapéutico , Tetrazoles/administración & dosificación , Tetrazoles/efectos adversos , Ticlopidina/administración & dosificación , Ticlopidina/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Previous studies have suggested a benefit of cilostazol in addition to standard dual-antiplatelet therapy (DAPT), reducing in-stent late luminal loss and restenosis after percutaneous coronary intervention (PCI) with bare-metal and drug-eluting stent (DES) implantation. However, there is a paucity of intravascular ultrasound (IVUS) assessment of neointimal tissue hyperplasia (NIH) after triple-antiplatelet therapy (TAPT), especially in diabetic patients treated with DES.METHODS: This prospective, placebo-controlled trial was conducted in diabetic patients randomized (1:1) to receive either standard DAPT (aspirin and clopidogrel) vs TAPT with cilostazol for a minimum of 12 months after PCI with Endeavor zotarolimus-eluting stent (E-ZES). The primary endpoint was the 9-month comparison of percentage of NIH in both groups. Additionally, we compared in-stent late lumen loss, binary restenosis, major adverse cardiac event (MACE; cardiac death, non-fatal myocardial infarction, and restenosis) rates, and the incidence of vascular/bleeding complications...
Asunto(s)
Diabetes Mellitus , Enfermedad CoronariaRESUMEN
Introdução: O escore SYNTAX estratifica a complexidade angiográfica e estabelece o prognóstico de portadores de doença triarterial e/ou com lesão de tronco, sendo uma importante ferramenta para decidir a melhor estratégia de revascularização. Avaliamos o impacto do escore SYNTAX no prognóstico de pacientes com doença arterial coronariana multiarterial da prática clínica tratados por intervenção coronária percutânea. Métodos: Identificamos no Registro SAFIRA pacientes com acometimento multiarterial tratados eletivamente com stents farmacológicos. Os pacientes foram agrupados em escore SYNTAX ≤ 8; escore SYNTAX > 8 e ≤ 16; e escore SYNTAX > 16, e comparados quanto aos eventos cardíacos adversos maiores. Resultados: No período de 2009 a 2014, identificamos 244 pacientes, que preencheram os critérios de inclusão para o estudo. Foram distribuídos em escore SYNTAX ≤ 8 (n = 61; 25%), > 8 e ≤ 16 (n = 116; 47,5%), e > 16 (n = 67; 27,5%). A média de idade foi de 64,6 ± 11,5 anos e 73% eram do sexo masculino. O escore SYNTAX variou de 1 a 39, com média de 13,4 ± 6,8. No período de 3,6 ± 2,1 anos, observaram-se maiores taxas de eventos cardíacos adversos maiores no grupo > 16 (4,9% vs. 6,9% vs. 11,9%; p < 0,01), às custas de maior revascularização do vaso-alvo (1,6% vs. 2,6% vs. 7,5%; p = 0,08). Quatro casos de trombose ...
Background: The SYNTAX score stratifies the angiographic complexity of coronary artery disease and establishes the prognosis of patients with triple vessel and/or left main coronary artery disease, being an important tool to decide the best revascularization strategy. We assessed the impact of the SYNTAX score in the prognosis of a daily practice population with multivessel coronary artery disease treated by percutaneous coronary intervention with drug-eluting stents. Methods: We identified in the SAFIRA Registry elective patients with multivessel coronary artery disease treated with drug-eluting stents. Patients were grouped in SYNTAX score ≤ 8; SYNTAX score > 8 and ≤ 16, and SYNTAX score > 16, and clinical outcomes in terms of major adverse cardiac events were stratified according to the SYNTAX score groups. Resultados: Between 2009 and 2014, we identified 244 patients that met the study inclusion criteria. Patients were distributed in those with SYNTAX score ≤ 8 (n = 61; 25%), > 8 and ≤ 16 (n = 116; 47.5%), and > 16 (n = 67; 27.5%). Mean age was 64.6 ± 11.5 years and 73% were male. The SYNTAX score ranged between 1 and 39, with an average of 13.4 ± 6.8. In the follow-up period of 3.6 ± 2.1 years, there were higher rates of major adverse cardiac events in group > 16 (4.9% vs. 6.9% vs. 11.9%; p < 0.01) due to a higher incidence of target vessel revascularization (1.6% vs. 2.6% vs. 7.5%; p = 0.08). Four cases of definitive or probable ...
RESUMEN
INTRODUÇÃO: O tratamento percutâneo da doença arterial coronária foi revolucionado pelo uso dos stents farmacológicos (SF). No entanto, sua utilização na prática diária envolve pacientes com características clínicas e angiográficas mais complexas dos que aquelas encontradas em estudos randomizados. Este registro se propôs a caracterizar, em nosso meio, diabéticos e seus desfechos clínicos após implante de SF. MÉTODOS: Registro unicêntrico, prospectivo, que arrolou pacientes consecutivos submetidos a implante de SF. Foram registrados dados clínicos, angiográficos e do procedimento, assim como os desfechos hospitalares e tardios. A avaliação do desfecho primário, composto por óbito cardíaco, infarto agudo do miocárdio ou revascularização da lesão-alvo, foi realizada comparando-se pacientes diabéticos e não diabéticos. RESULTADOS: Avaliamos 1.670 pacientes tratados com SF no período de 2002 a 2012, com seguimento de 3,2 ± 2,5 anos. Um terço dos pacientes era diabético e apresentou sobrevivência livre de eventos menor que os não diabéticos (79,4% vs. 82,6%; P = 0,02). A razão de risco ajustada, no entanto, foi de 1,22 (IC 95%, 0,89-1,69) - não significativa. Ao analisar o subgrupo dos pacientes em uso de insulina, encontramos sobrevivência livre de eventos significativamente menor que a dos demais, enquanto que os diabéticos que não estavam em uso de insulina mostraram comportamento semelhante ao dos não diabéticos (68,7% vs. 83,9% vs. 82,8%, respectivamente; P < 0,01). A razão de risco ajustada foi 1,72 (IC 95%, 1,13-2,63) vez maior para os diabéticos em uso de insulina em comparação aos demais pacientes. CONCLUSÕES: O uso de SF traz benefícios para todos os diabéticos, especialmente para os que não utilizam insulina.
BACKGROUND: The percutaneous treatment of coronary artery disease has been revolutionized by the use of drug-eluting stents (DES). However, its use in the daily practice involves patients with more complex clinical and angiographic characteristics than those found in randomized trials. This registry was designed to characterize diabetic patients and their outcomes following DES implantation in our country. METHODS: Prospective single-center registry enrolling consecutive patients after DES implantation. Clinical, angiographic and procedure-related data, as well as early and long-term outcomes were recorded. The primary endpoint, including cardiac death, myocardial infarction or target lesion revascularization, was compared between diabetics and non-diabetics. RESULTS: We evaluated 1,670 patients treated with DES from 2002 to 2012 with a follow-up of 3.2 ± 2.5 years. One third of the patients were diabetic and had lower event-free survival when compared to non-diabetic patients (79.4% vs. 82.6%; P = 0.015). The adjusted odds ratio, however, was 1.22 (95% CI, 0.89-1.69) and was not significant. A significantly lower event-free survival was observed in the subgroup of patients receiving insulin, whereas it was similar for diabetic and non-diabetic patients in the subgroup not receiving insulin (68.7% vs. 83.9% vs. 82.8%, respectively; P < 0.01). The adjusted odds ratio was 1.72 (95% CI, 1.13-2.63) higher for diabetic patients receiving insulin when compared to the remaining patients. CONCLUSIONS: The use of DES is beneficial for all diabetic patients, especially those who do not receive insulin.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Stents Liberadores de Fármacos , Diabetes Mellitus/fisiopatología , Diabetes Mellitus/terapia , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Intervención Coronaria Percutánea/métodos , Estudios Prospectivos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Insulina/administración & dosificación , Modelos Logísticos , Interpretación Estadística de Datos , Resultado del TratamientoRESUMEN
We report 2 cases of transposition of the great arteries associated with anomalous pulmonary venous connection emphasizing the clinical findings, the diagnosis, and the evolution of the association. One of the patients had the anomalous pulmonary venous connection in its total infradiaphragmatic form, in the portal system, and the other patient had a partial form, in which an anomalous connection of the left superior lobar vein with the innominate vein existed. At the time of hospital admission, the patients had cyanosis and respiratory distress with clinical findings suggesting transposition of the great arteries. The diagnosis in 1 of the cases, in which the anomalous connection was partial, was established only with echocardiography, without invasive procedures that would represent risk for the patient; in the other case, in which the anomalous connection was total, the malformation was only evidenced with catheterization. The patients underwent surgery for anatomical correction of the heart disease. Only 1 patient had a good outcome.
Asunto(s)
Cardiopatías Congénitas/diagnóstico por imagen , Venas Pulmonares/anomalías , Ecocardiografía/métodos , Resultado Fatal , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Transposición de los Grandes Vasos/complicaciones , Transposición de los Grandes Vasos/diagnóstico por imagen , Transposición de los Grandes Vasos/cirugíaRESUMEN
OBJECTIVE: To assess whether coronary stenting in diabetic patients provides in-hospital results and clinical evolution similar to those in nondiabetic patients. METHODS: From July '97 to April '99 we performed coronary stent implantation in 386 patients with coronary heart disease, who were divided into two groups: diabetic patients and nondiabetic patients. The in-hospital results and the clinical evolution of each group were retrospectively analyzed. RESULTS: The nondiabetic group comprised 305 (79%) patients and the diabetic group 81 (21%) patients. Basic clinical and angiographic characteristics were similar. Angiographic success was in diabetics = 96.6% vs in nondiabetics = 97.9% (p=ns). Among the major complications in the in-hospital phase, the rate of myocardial infarction was higher in the diabetic group (7.4% vs 1.9%) (p=0.022). In the follow-up, a favorable and homogeneous evolution occurred in regard to asymptomatic patients, myocardial infarction, and death in the groups. A greater need for revascularization, however, existed in the diabetic patients (15% vs 2.4%, p<0.001). CONCLUSION: Coronary stenting in diabetic patients is an efficient procedure, with a high angiographic and clinical success rate similar to that in nondiabetic patients. Diabetic patients, however, had a higher incidence of in-hospital myocardial infarction and a greater need for additional myocardial revascularization.
Asunto(s)
Enfermedad Coronaria/terapia , Angiopatías Diabéticas/terapia , Stents , Estudios de Casos y Controles , Angiografía Coronaria , Diabetes Mellitus Tipo 1/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Revascularización Miocárdica , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The aim of this study was to evaluate long-term clinical follow-up and echocardiographic data on pregnant patients with mitral stenosis who underwent percutaneous mitral valvuloplasty (PMV) in our center and the development of their infants. PMV has proven to be an effective alternative to treat pregnant patients with mitral stenosis. However, long-term outcome of these patients, as well as the potential harmful effects caused by radiation on their infants, still awaits to be determined. From January 1988 to February 1999, 30 pregnant women (mean gestational duration, 24.95 +/- 5.59 weeks) underwent PMV. Twenty-three (77%) were subsequently followed by a medical interview during 5.33 +/- 3.12 years. Clinical variables such as NYHA functional class (FC), the need of a repeat PMV or surgical procedure, the presence of embolic events, and mortality rate were evaluated during follow-up. Mitral valve area, mean transmitral gradient, and the presence of mitral regurgitation were also assessed by Doppler echocardiography. Clinical data on the development of the infants were obtained from the assistant pediatricians. All patients were in NYHA FC III or IV before the procedure. During follow-up, 91% of them were in FC I and II. Two patients (9%) who had remained in FC III underwent a repeat successful PMV; no further surgery was required. There were no embolic events or death related to the procedure. Echocardiography showed an initial increase in mitral valve area from 1.14 +/- 0.22 cm(2) to 2.01 +/- 0.21 cm+/- (P < 0.0001). During long-term follow-up, it decreased to a mean of 1.75 +/- 0.24 cm(2) (P < 0. 0001). Initial transmitral valve gradient decreased from 17.73 +/- 4. 56 mm Hg to 5.91 +/- 1.80 mm Hg (P = 0.0001) and 8.95 +/- 3.58 (P = 0.002) during long-term follow-up. Twenty one children (96%), aged 4. 91 +/- 2.8 years, showed normal growth and development, and no clinical abnormalities were observed. These favorable long-term results suggests PVM to be the procedure of choice to treat pregnant women with mitral stenosis who remain in FC III or IV despite adequate medical therapy. No harmful effects due to the use of radiation were observed in the children.
Asunto(s)
Cateterismo , Estenosis de la Válvula Mitral/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Adolescente , Adulto , Ecocardiografía Doppler en Color , Femenino , Estudios de Seguimiento , Edad Gestacional , Hemodinámica , Humanos , Recién Nacido , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/fisiopatología , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Complicaciones Cardiovasculares del Embarazo/fisiopatología , Resultado del Embarazo , Estudios RetrospectivosRESUMEN
PURPOSE: A retrospective chart review of 20 consecutive patients with 23 anal fistulas treated with cutaneous advancement flap closure was undertaken to ascertain the efficacy of this previously unreported technique. METHODS: The so-called "diamond" and "house" flaps are commonly used to treat anal stenosis, and mucosal advancement flaps are successfully used to close fistulas. The authors began, in 1994, to close selected fistulas with skin advancement flaps after suture closure of the internal opening and adequate drainage of the external opening. Fourteen patients (4 females; average age, 42 years; a total of 14 fistulas) without inflammatory bowel disease and 6 patients (3 females; average age, 35 years) with inflammatory bowel disease (5 with Crohn's disease; 1 with chronic ulcerative colitis; a total of 8 fistulas) were treated. Indications were low internal opening with transsphincteric fistula in both groups. Mucosal advancement was relatively contraindicated, either because of fear of ectropion or, in the inflammatory bowel disease patients, diseased mucosa. No one in the noninflammatory bowel disease group was diverted or kept without anything by mouth, and all were treated as outpatients or with overnight observation. The inflammatory bowel disease group was either diverted (1 patient) or kept on home total parenteral nutrition (5 patients) for three to six weeks. Cyclosporine, antibiotics, 5-acetylsalicylic acid, and other medications were used judiciously in the inflammatory bowel disease group. RESULTS: In the noninflammatory bowel disease group, complete healing of all wounds occurred in 11 patients in an average of 6.5 weeks (average follow-up, 18 months). Complications included donor site separation in two patients and minor incontinence of flatus in one patient. In the inflammatory bowel disease group, five fistulas healed, two failed, and one patient developed a new fistula during an average follow-up of 16 months. Deep venous thrombosis and catheter sepsis occurred in one patient in this group. There were no fatalities in either group. CONCLUSIONS: Although the numbers, especially in the inflammatory bowel disease group, are very small, the results are encouraging. This technique appears to have a place in the armamentarium of the surgeon repairing anal fistulas.
Asunto(s)
Fístula Rectal/cirugía , Colgajos Quirúrgicos , Adulto , Colitis Ulcerosa/complicaciones , Enfermedad de Crohn/complicaciones , Femenino , Humanos , Masculino , Fístula Rectal/complicaciones , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We reported two cases of patients that underwent left internal mammary (LIMA)-coronary bypass graft and developed recurrent myocardial ischemia in the follow-up period caused by stenosis in the subclavian artery. The angiography showed retrograde flow from the left anterior descending artery to subclavian artery. After initial dilatation with a conventional angioplasty balloon catheter, we implanted Palmaz-Schatz Stents, achieving an excellent final result. Our finding suggest that Stent implantation is a safe and effective procedure, and provides an alternative to other forms of revascularization for the treatment of this disorder.
Asunto(s)
Arteriopatías Oclusivas/terapia , Anastomosis Interna Mamario-Coronaria/efectos adversos , Stents , Arteria Subclavia , Anciano , Angioplastia Coronaria con Balón , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/etiología , Constricción Patológica/terapia , Angiografía Coronaria , Femenino , Humanos , Masculino , Arteria Subclavia/diagnóstico por imagenRESUMEN
Descrevemos dois casos de pacientes que haviam sido submetidos a revascularizaçäo do miocárdio com a utilizaçäo da artéria mamária interna esquerda e que desenvolveram na evoluçäo, quadro de insuficiência coronária por estenose da artéria subclávia esquerda. A cinecoronariografia evidenciou fluxo retrógrado da artéria descendente anterior para artéria mamária com enchimento da artéria subclávia distal à estenose que se localizava na sua origem. Após dilataçäo inicial com catater baläo de angioplastia coronária, foram implantados stents de Palmaz-Schantz, obtendo-se excelente aspecto angiográfico, sem complicaçöes e regressäo dos sintomas. Nossos resultados demonstram que a implantaçäo de stents nestes pacientes pode ser realizada com eficácia e segurança, mostrando ser um tratamento alternativo a outras formas de revascularizaçäo cirúrgica ou percutânea para esta doença.
We reported two cases of patients that underwent leftinternal mammary (LIMA) - coronary bypass graft and developed recurrent myocardial ischemia in the follow-up period caused by stenosis in the subclavian artery. The angiography showed retrograde flow from the left anterior descending artery to subclavian artery. After initial dilatation with a conventional angioplasty balloon catheter, we implanted Palmaz-Schatz Stents, achieving an excellent final result. Our finding suggest that Stent implantation is a safe and effective procedure, and provides an alternative to other forms of revascularization for the treatment of this disorder
Asunto(s)
Humanos , Masculino , Anciano , Arteriopatías Oclusivas/cirugía , Arteria Subclavia/cirugía , Stents , Anastomosis Interna Mamario-Coronaria/efectos adversos , Arteriopatías Oclusivas/etiologíaRESUMEN
A 56-year-old female patient underwent myocardial revascularization with three saphenous bypass grafts. One month after surgery she had an acute myocardial infarction with cardiogenic shock and was treated with a Palmaz-Schatz stent implantation in the left main coronary artery (that was occluded) and a PTCA of the graft to the right coronary artery. The in hospital outcome was uneventful and angiographic study after six months showed no restenosis and important improvement in the left ventricular function.
Asunto(s)
Infarto del Miocardio/cirugía , Choque Cardiogénico/cirugía , Stents , Angioplastia Coronaria con Balón , Femenino , Humanos , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Choque Cardiogénico/complicacionesRESUMEN
PURPOSE: To find out new subjects that could be useful to select patients between 9 and 12 points, according to Block's Criteria, to mitral balloon valvotomy. METHODS: One hundred and forty patients underwent mitral balloon valvotomy. Among them, 29 (21%) had between 9 and 12 points. These patients were divided into two groups: group A-patients with mitral valve area > or = 1.5cm2, immediately after balloon valvotomy and in the follow-up period; group B-patients with mitral valve area < 1.5cm2 immediately after or during the follow-up period, patients with severe mitral regurgitation after the procedure and patients who died in the follow-up period. All patients were analyzed by echocardiographic relation criteria (ERC): calcification + subvalvar disease/thickness + mobility. Each one was quantified from 1 to 4 points according to the degree of valvular disease. RESULTS: Group A was composed of 17 (51%) and group B 12 (41%) patients. The variables age, sex, previous mitral commissurotomy and atrial fibrillation did not show difference between groups. In group A mitral valve area (cm2) increased from 1.15 +/- 0.25 to 1.97 +/- 0.26 (p < 0.00001) keeping stable during the follow-up period. In group B percutaneous mitral balloon valvotomy resulted in an increase from 1.26 +/- 0.19 to 1.77 +/- 0.16 (p < 0.00001), however, there was an important decrease in the follow-up period to 1.34 +/- 0.15 (p < 0.00001). The ERC showed that all group A patients had a relation < 1. However, in group B, 10 patients (83%), the relation was > or = 1, and in only 2 patients (17%) was < 1 (p < 0.00001). CONCLUSION: The group of patients between 9 and 12 points in the Block's criteria is heterogenic, therefore, each case might be evaluated individually and the echocardiographic relation criteria should be used in order to select these patients to the procedure.
Asunto(s)
Cateterismo , Ecocardiografía/métodos , Estenosis de la Válvula Mitral/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/diagnóstico por imagen , Pronóstico , Estudios RetrospectivosRESUMEN
Percutaneous balloon mitral valvotomy (BMV) is an alternative therapeutic method for patients with mitral stenosis. We studied 62 patients (56 females, mean age 36.4 years) who underwent balloon mitral valvotomy. Five patients were pregnant and in New York Heart Association Functional Class IV. Doppler echocardiographic studies were performed prior to the procedure, and at 7 days, 6 months, 12 months, and 24 months after the procedure. We studied the following parameters: echo-score by the sum of valvular mobility, thickening, and calcification, and subvalvular disease, graded from 1 to 4; and mitral valve area (MVA) and mitral pressure gradient (MPG) by Doppler echocardiography. The patients were separated into two groups: group I with an echo-score less than or equal to 8 (40 patients), and group II with an echo-score greater than or equal to 9 (22 patients). Mitral valve area and MPG were compared with hemodynamics through the correlation coefficient and linear regression. Comparison between groups I and II was performed using the unpaired Student's t-test. Follow-up of MVA and MPG was analyzed by analysis of variance. The Student's t-test did not show any significant difference between MVA and MPG before balloon mitral valvotomy. There was significant decrease of MVA in group II (P less than 0.01) in the last three studies. There was significant increase in MPG in group II (P less than 0.01) in every postvalvotomy study. The analysis of variance of group I showed statistical increase of the MVA, and significant decrease of the MPG after BMV. The analysis of variance of group II showed significant increase in MVA and significant decrease in MPG between the pre- and the first postvalvotomy study. There was significant decrease (P less than 0.01) in MVA, and increase in MPG in the three postvalvotomy studies. Complications included mitral regurgitation, residual interatrial communication, pericardial effusion due to an atrial wall perforation, and peripheral embolization. Atrial fibrillation did not significantly alter the results of BMV. Results were considered positive when MVA was greater than 1.5 cm 2 and area increase was greater than 25%. Patients with an echo-score less than or equal to 8 (group I) benefit from BMV, with a positive predictive value greater than 78%. In pregnant patients the symptomatology was alleviated by BMV, without any signs of fetal compromise.
Asunto(s)
Cateterismo , Estenosis de la Válvula Mitral/diagnóstico por imagen , Complicaciones Cardiovasculares del Embarazo/diagnóstico por imagen , Cardiopatía Reumática/diagnóstico por imagen , Adolescente , Adulto , Anciano , Análisis de Varianza , Ecocardiografía Doppler/métodos , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Estenosis de la Válvula Mitral/terapia , Embarazo , Complicaciones Cardiovasculares del Embarazo/terapia , Cardiopatía Reumática/terapiaAsunto(s)
Cateterismo , Estenosis de la Válvula Mitral/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Adulto , Cateterismo Cardíaco/métodos , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Estenosis de la Válvula Mitral/diagnóstico , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Supinación , UltrasonografíaRESUMEN
The authors report on three pregnant patients with mitral stenosis with heart failure in functional class IV (NYHA) unresponsive to clinical treatment. They were submitted to mitral valvuloplasty, with significant clinical improvement, and were, hence, asymptomatic. Despite the small number of cases, it may be concluded that the procedure is simple and safe, which can be attested by the successful results.
Asunto(s)
Cateterismo , Estenosis de la Válvula Mitral/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Adulto , Ecocardiografía , Femenino , Hemodinámica , Humanos , EmbarazoRESUMEN
Abdominoperineal resection for the treatment of carcinoma of the rectum has been the benchmark for all other forms of therapy since Miles described the procedure in 1908. During the past 25 years, 81 patients have had carcinoma of the rectum treated curatively by electrocoagulation and have been observed for five years or more. Treatment was selectively applied to those patients whose tumors were less than 7.5 centimeters from the anal verge with less than 50 per cent of the rectum involved. All of the tumors were freely movable. The over-all five year survival rate was 47 per cent. Thirty-one of the 81 patients underwent conversion to abdominoperineal resection because of recurrence. The survival rate for those treated by electrocoagulation alone was 58 per cent and for those converted to abdominoperineal resection, 29 per cent. The survival rate was 65 per cent for those with lesions less than 4 centimeters in diameter versus 30 per cent for those with lesions more than 4 centimeters. The morbidity rate was 21.0 per cent and the mortality rate was 2.7 per cent. There were an additional 33 patients treated for palliation with only one five year survivor. Electrocoagulation for the treatment of carcinoma of the distal part of the rectum is a reasonable alterative to abdominoperineal resection when selectively applied.