RESUMEN
Between August 1988 and October 1993, 19 patients with native aortic coarctation were subjected to transluminal percutaneous balloon angioplasty, 12 of which were men (63.1%) and 7 were women (36.9%), with an average age of 22 +/- 7.7 years (r- 16 to 52), all of whom suffered from arterial hypertension at the time of the procedure, and a systolic pressure of 190 +/- 32.2 mmHg (r- 160 to 240). The gradient of the systolic pressure (GPS) was 77 +/- 0.9 mm, the average diameter of the balloon catheters that were used was 18.3 +/- 1.7 mm (r- 15 to 20). For all the patients, the procedure was carried out under local anesthesia and the usual Seldinger technique. After carrying out the procedure, the GPS as well as the blood pressure dropped to 5.0 +/- 4.1 mmHg and 130 +/- 20.6 mmHg, respectively. In similar manner, the enlargement of the ring displayed an increase of 4.2 +/- 0.9 to 14.1 +/- 1.6 mm. There were no complications in any of the procedures. During the follow-up, 11 patients were catheterized again in a period of 24.7 +/- 12.6 months (r- 10 to 48) with GPS of 5 +/- 2 mmHg. Besides, an increase of 15.4 +/- 1.2 mm in the ring's diameter was observed. In these patients, there was no evidence of the aneurysms at the dilatation site. Of the rest of the patients under control, 17 of whom have been able to maintain normal blood pressure without medical treatment, and only two required low dosages of antihypertensive treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Angioplastia de Balón , Coartación Aórtica/terapia , Adolescente , Adulto , Angioplastia de Balón/instrumentación , Angioplastia de Balón/métodos , Angioplastia de Balón/estadística & datos numéricos , Coartación Aórtica/diagnóstico , Coartación Aórtica/fisiopatología , Aortografía , Cateterismo Cardíaco , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Masculino , Recurrencia , Resultado del TratamientoRESUMEN
UNLABELLED: From Jan-21-91 to Jan-8-92 we performed percutaneous transvenous mitral commissurotomy (PTCM) with a Medi-tech balloon catheter (MBC) in 41 patients bearing mitral stenosis simple o predominant. We utilized an anterograde transseptal approach in order to access the mitral valve, the procedure failed in 5 patients, in 30 of them we used double MBC and single MBC were utilized in 6 patients. Both left ventriculogram and hemodynamic parameters were taken before and after PTCM. Posterior to PTCM an important decrease appeared in the mitral transvalvular gradient from 20.6 +/- 2.7 to 2.4 +/- 1.7 mmHg (p < 0.0001) and an average pressure of pulmonary artery of 46.2 +/- 9.8 to 23.9 +/- 6 mmHg (p < 0.0001), and also the pulmonary arterial resistance from 1178.1 to 557.1 dinas/cm-5/seg. There was an important concomitant increase in mitral valvular area from 0.84 +/- 0.11 to 2.38 +/- 0.08 cm2 (p < 0.0001) and in cardiac rate from 2.7 +/- 0.7 to 2.9 +/- 0.52 L/min (p < 0.001). COMPLICATIONS: Two female patients developed cardiac tamponade, one of them the procedure was successful, and for the other it was decided to submit her to valvular replacement. Mitral insufficiency was present in three patients; GI/IV in two of them and GII/IV angiographic in one. Another patient presented cerebral thromboembolism with complete recovery within 15 days. Short left to right shunt was detected only in 8 patients being 1.2/1 in 6 of them, 1.3/1 in one and 1.4/1 in other patient. Thirty three uncomplicated were dismissed within a maximum of 48 hours after procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Cateterismo Cardíaco/instrumentación , Válvula Mitral/cirugía , Adulto , Anciano , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estadística & datos numéricos , Cineangiografía , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/epidemiología , Estenosis de la Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/cirugía , Radiografía IntervencionalRESUMEN
In 121 patients (93 males, mean age 53.9 years), percutaneous transluminal coronary angioplasty (PTCA) of 140 lesions was performed as treatment of symptomatic, single or multiple vessel disease, with the following clinical syndromes: stable angina pectoris (Group I) in 59 cases (48.8%), unstable angina (Group II) in 40 (33%), and angina or residual ischemia after thrombolysis for myocardial infarction (MI) (Group III) in 22 patients (18.2%). PTCA was successfully accomplished in 123 of 140 segments (87.8%), with a reduction in mean luminal stenosis from 87.3 +/- 13% (range 70-100) to 15 +/- 10% (range 0-30, p less than 0.00001). Successful results were obtained in 85.9% of patients (104/121) and they were 84.7%, 82.5% and 95.5% in Groups I, II and III, respectively. The procedure failed in 17 cases (14.0%), and within this group, 14 complications occurred (11.6%): 2 deaths (1.6%), 3 cases of MI, acute closure in 4, and emergency coronary bypass surgery in 5 patients. Late evaluation (6-8 months) revealed clinical and functional improvement in 71/98 patients (72.4%), and recurrent ischemic symptoms (no improvement) in 27 cases. Coronary angiography performed in 20, showed restenosis in 10, and progressive disease in 7 patients. In conclusion, PTCA is an effective therapeutic option in selected cases of symptomatic ischemic heart disease with suboptimal results to medical management alone.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Adulto , Anciano , Angina de Pecho/complicaciones , Angina de Pecho/epidemiología , Angina de Pecho/terapia , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/estadística & datos numéricos , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Recurrencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter (IBC) was performed in 11 adult, symptomatic patients with moderately severe, pure of predominant mitral stenosis (MS). The transseptal approach and a valvuloplasty technique of progressive and controlled valvular dilatation were utilized. The procedure failed in one patient due to an inadequate transseptal puncture, and it was successful in the other 10. The mitral valve area increased from 1.00 +/- 0.27 to 2.19 +/- 0.31 cm2 (p less than 0.001); the diastolic mitral gradient decreased from 20.9 +/- 4.6 to 5.9 +/- 3.3 mmHg (p less than 0.001); similar reduction was obtained in the mean atrial pressure from 22.3 +/- 5.8 to 11.6 +/- 4.2 mmHg (p less than 0.001), and the mean pulmonary arterial pressure from 41.3 +/- 16.1 to 26.4 +/- 10.5 mmHg (p less than 0.05). There were no complications. Left to right shunting at the atrial level, due to the transseptal approach, was moderately significant in only 2 patients (QP/QS = 1.4 and 1.3 respectively). Grade I, and grade I-II mitral insufficiency occurred in 2 patients, one of them with previous mitral regurgitation, and it was not demonstrated or disappeared (if preexistent) in the rest. Patients were discharged in 48 hs at the most. They all referred improvement in their functional class, and at 4.3 months of average follow-up they are asymptomatic. In conclusion, PTMC with the IBC is a safe, simple and successful technique to separate the fused commissures, increase the mitral valve area and improve the functional class in selected cases of rheumatic MS. A long term follow-up is required for evaluation of late results.