RESUMEN
We analyzed the results and the follow-up in our first 80 patients after percutaneous balloon aortic valvuloplasty (BAV) since November 1986. Mean age was 74 +/- 10 years, 78 patients were in the NYHA functional classes III or IV. Initially we used relatively small balloons (15-18 mm), later balloons of 20 mm and, with increasing frequency, of 23 mm diameter were utilized, providing very strong inflations at the end of the procedure. The average valve area after BAV increased from initially 0.75 +/- 0.18 to 0.87 +/- 0.28 cm2 after July 1987. Using the 23-mm balloon a mean valve area of 1.05 +/- 0.19 cm2 was obtained. The procedure-related mortality was 2.5%, the total early mortality (30 days) was 6.25%. Other non-fatal complications included two cases of severe valve incompetence requiring valve replacement, one dissection in the aortic root, one cerebrovascular accident, and eight cases of arterial damage (surgical repair). Twenty-six patients with initially successful dilation were restudied hemodynamically, 12 of whom had a restenosis (46%) after 5 months; 13 patients had a second dilatation. The clinical improvement was remarkable (at least 1 NYHA functional class) in 79% of the patients. 33% were improved 1 year and 20% 18 months after the first or eventually the second BAV. Eighteen of the discharged patients died in the follow-up period (two after valve replacement); 20 patients had aortic valve replacement due to restenosis. Our results show a correlation of the maximal balloon size to the valve area after BAV. However, even a perfect technique cannot prevent the restenosis that occurs mostly during the first year. Therefore, BAV may be useful and appropriate for selected patients with inoperable aortic stenosis, but it is no alternative to valve replacement.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Calcinosis/terapia , Cateterismo/instrumentación , Ecocardiografía Doppler/métodos , Hemodinámica/fisiología , Anciano , Anciano de 80 o más Años , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/fisiopatología , Calcinosis/fisiopatología , Cateterismo/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , RecurrenciaRESUMEN
A persistent left superior vena cava was noted in a 63-year-old woman during pacemaker implantation because of sinus bradycardia and AV dissociation. During atrial test stimulation a 2 degree AV block occurred at a rate of only 110/min and dual-chamber provision was thus necessary. Both catheters were introduced into the right heart via the coronary sinus, but placement of the right-ventricular lead was made more difficult than usual because of looping. One year later pacemaker function (DDI mode) was unchanged and the patient symptom-free.
Asunto(s)
Marcapaso Artificial , Vena Cava Superior/anomalías , Cateterismo Cardíaco/métodos , Electrodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Radiografía , Síndrome del Seno Enfermo/diagnóstico por imagen , Síndrome del Seno Enfermo/terapia , Vena Cava Superior/diagnóstico por imagenRESUMEN
Of 2,600 coronary operations performed from August 1983, to December 1988, two ischemic reactions of the inferior wall immediately after operation were observed. In both patients the right coronary artery was either dissected or revascularized intraoperatively. Under the diagnosis of postoperative spasm both patients had reangiography three hours after surgery. Right coronary artery spasm was demonstrated in both patients. After intracoronary injection of calcium channelblockers the spasm resolved completely. Patient 1 demonstrated a small inferior infarction during control angiography, patient 2 remained free of a myocardial infarction. The possible causes of coronary spasm during or after surgery are discussed. The diagnosis and an approach to therapy are outlined.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Vasoespasmo Coronario/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Circulación Coronaria/efectos de los fármacos , Vasoespasmo Coronario/tratamiento farmacológico , Vasos Coronarios/fisiopatología , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nifedipino/administración & dosificación , Complicaciones Posoperatorias/tratamiento farmacológico , Verapamilo/administración & dosificaciónRESUMEN
Between November 1986 and March 1987, 14 patients (11 men and three women, aged 48-84 years, mean 71.3 years) had percutaneous transluminal balloon dilatation of calcific aortic valve stenosis. Peak transvalvar pressure gradients were reduced from a mean of 81.4 mm Hg (25-122 mm Hg) to a mean of 44.8 mm Hg (range 19-63 mm Hg). Calculated valve opening area was increased from a mean of 0.48 (0.3-0.86) cm2 to 0.75 (0.6-1.16) cm2. All but one patient were in stage III or IV (New York Heart Association) and most improved by about one stage. There were no complications that could be ascribed to the procedure. Blood transfusion was not required.