RESUMEN
Introducción. La enfermedad de Kawasaki (EK) es una vasculitis sistémica inespecífica que suele presentarse en los niños; la lesión de las arterias coronarias (LAC) es la complicación más grave.Objetivos. Nuestro objetivo fue investigar los factores de riesgo de LAC en niños con EK.Materiales y métodos. Se incluyó a niños con EK según los criterios diagnósticos, hospitalizados entre enero de 2014 y diciembre de 2017. Se realizaron análisis univariado y multivariado de regresión logística para investigar las relaciones entre LAC y género, edad, diagnóstico clínico, velocidad de sedimentación globular (VSG), recuento de trombocitos, concentración de hemoglobina, concentración de proteína C-reactiva, recuento de leucocitos, momento de inicio de la administración de inmunoglobulina intravenosa (IgIV) y duración de la fiebre.Resultados. Se dividió a los 982 niños con EK en un grupo con LAC (n = 104) y otro sin LAC (n = 878), según una ecocardiografía Doppler color. La tasa de incidencia de LAC fue del 10,6 % (104/982). En el análisis univariado, se observó una diferencia significativa entre ambos grupos en cuanto al género, la VSG, el recuento de trombocitos, el momento de inicio de la administración de IgIV y la duración de la fiebre (p < 0,05). Según el análisis multivariado de regresión logística, el sexo masculino, una VSG elevada y la administración tardía de IgIV fueron factores de riesgo independientes de EK complicada con LAC.Conclusiones. El sexo masculino, una VSG elevada y la administración tardía de IgIV fueron factores de riesgo independientes de EK complicada con LAC.
Introduction. Kawasaki disease (KD) is a non-specific systemic vasculitic disease that frequently occurs among children, and coronary artery lesion (CAL) is the most serious complication.Objectives. We aimed to study the risk factors for CAL in children with KD.Materials and methods. KD children in accordance with diagnostic criteria, who were hospitalized from January 2014 to December 2017, were selected as subjects. Univariate and multivariate logistic regression analyses were conducted to explore the relationships between CAL and gender, age, clinical diagnosis, erythrocyte sedimentation rate (ESR), platelet count, hemoglobin level, C reactive protein level, white blood cell count, initiation time of IVIG administration and duration of fever.Results. The enrolled 982 KD children were divided into a CAL group (n = 104) and an NCAL group (n = 878) according to cardiac color Doppler ultrasonography. The incidence rate of CAL was 10.6 % (104/982). Univariate analysis showed that the two groups had significantly different gender, ESR, platelet count, initiation time of IVIG administration and duration of fever (P < 0.05). Multivariate logistic regression analysis revealed that male gender, elevated ESR and delayed use of IVIG were independent risk factors for KD complicated with CAL.Conclusions:Male gender, increased ESR and delayed use of IVIG were independent risk factors for KD complicated with CA
Asunto(s)
Humanos , Masculino , Femenino , Niño , Enfermedad de la Arteria Coronaria/epidemiología , Síndrome Mucocutáneo Linfonodular/complicaciones , Modelos Logísticos , Factores de Riesgo , Vasos Coronarios/lesiones , Síndrome Mucocutáneo Linfonodular/diagnósticoRESUMEN
BACKGROUND: Coronary artery perforation associated to cardiac tamponade is an uncommon life-threatening complication of percutaneous coronary intervention, and the occurrence of subepicardial or intramyocardial hematoma without hemopericardium is even rarer. CLINICAL CASE: We describe the case of a 72 year-old woman with a subepicardial hematoma after percutaneous coronary intervention, who required urgent left internal mammary artery graft to anterior descending artery surgery. CONCLUSIONS: Subepicardial or intramyocardial hematoma must be considered when a coronary perforation is suspected in absence of hemopericardium. Transthoracic echocardiogram or computed tomography may be used to decide a conservative or invasive approach.
Asunto(s)
Cardiomiopatías/etiología , Vasos Coronarios/lesiones , Hematoma/etiología , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/etiología , Anciano , Angina Inestable/etiología , Angina Inestable/cirugía , Implantación de Prótesis Vascular , Cardiomiopatías/diagnóstico por imagen , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Urgencias Médicas , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Femenino , Hematoma/diagnóstico por imagen , Humanos , Anastomosis Interna Mamario-Coronaria , Pericardio , Complicaciones Posoperatorias/diagnóstico por imagen , Reoperación , Vena Safena/trasplante , Tomografía Computarizada por Rayos XRESUMEN
Coronary perforation is a rare complication in patients undergoing percutaneous coronary angioplasty. The mortality of this complication varies depending on factors related to the patient and the procedure performed, reaching 44% in patients with Ellis type III perforation. We report the case of an 81 year old male with multiple cardiovascular risk factors, who underwent percutaneous angioplasty for unstable angina management. The patient developed grade III coronary perforation in the anterior descending artery, which was successfully managed with balloon inflation to 6 atmospheres for 10 minutes twice in the affected area, with an interval of 5 minutes between each dilatation. The patient improved and was discharged.
La perforación coronaria es una complicación rara en los pacientes sometidos a angioplastia percutánea coronaria. La mortalidad de esta complicación es variable, dependiendo de factores relacionados al paciente y al procedimiento realizado. Alcanza el 44% en pacientes con perforación tipo III, según la escala de Ellis. Presentamos el caso de un varón de 81 años con múltiples factores de riesgo cardiovascular, a quien se le realizó una angioplastia percutánea para manejo de un síndrome isquémico coronario agudo sin elevación del segmento ST (SICA STNE) de alto riesgo. El procedimiento se complicó con una perforación coronaria grado III en la arteria descendente anterior, la cual fue manejada exitosamente con dilatación de balón a 6 atmósferas por 10 minutos en dos oportunidades en la zona afectada, con intervalo de 5 minutos entre insuflaciones. El paciente evolucionó favorablemente y fue dado de alta.
Asunto(s)
Angina Inestable/terapia , Angioplastia Coronaria con Balón/métodos , Vasos Coronarios/lesiones , Anciano de 80 o más Años , Angioplastia Coronaria con Balón/efectos adversos , Lesiones Cardíacas/etiología , Lesiones Cardíacas/terapia , Humanos , Masculino , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Seek, therefore, to analyze in adults and young pigs, under light microscopy, the morphological characteristics of the coronary arterial branches under of the myocardial bridges, as well as the prepontine and postpontine segments, attempting to establish morphofunctional correlations between these. Was used for the study 40 pig hearts, all mongrel females, being 20 young and 20 adults, all with myocardial bridges, of which were removed prepontine, pontine and postpontine segments of the coronary arteries, together with the surrounding tissue. The segments were submitted with usual techniques of the light microscopy and stained with hematoxylin and eosin. Changes were observed in tunica intima, such as thickening, cells with clear cytoplasm, disruption and duplication of the limiting internal elastic lamina. The statistical test was significant for the position in adult pigs, confirming that there is a highter frequency of lesions in prepontine segment of the tunica intima of the coronary arteries when compared with the pontine and postpontine segments. The statistical test confirmed variation in the lesions frequency between sample studied, being highter in young animals when compared with adult animals. For the young animals, the test was not significant for the variable positions between of the segments compared with each other. There is statistically a highter occurrence of atherosclerotic lesions which precedes the myocardial bridge in relation to the others segments studied.
Buscou-se analisar em suínos jovens e adultos, sob microscopia de luz, as características morfológicas dos ramos arteriais coronarianos sob as pontes de miocárdio, bem como dos segmentos pré-pontino e pós-pontino, na tentativa de estabelecer correlações morfofuncionais entre eles. Foram utilizados 40 corações de suínos para a pesquisa, todos fêmeas sem raça definida, sendo 20 jovens e 20 adultos, todos portadores de pontes de miocárdio, dos quais foram retirados fragmentos pré-pontino, pontino e pós-pontino de ramos da artéria coronária direita e esquerda, junto com o tecido circunjacente. Os segmentos foram submetidos às técnicas habituais da microscopia de luz e corados pela hematoxilina-eosina. Observou-se alterações da íntima, tais como espessamentos, células com citoplasma claro, ruptura e/ou duplicação da lâmina limitante elástica interna. O teste estatístico se mostrou significativo para posição em suínos adultos, confirmando que existe uma maior frequência de lesões no segmento pré-pontino da túnica íntima das artérias coronárias quando comparado com o segmento pontino e com o pós-pontino. O mesmo teste confirmou uma variação na frequência de lesões entre as amostras estudadas, sendo maior em animais jovens quando defrontado com animais adultos. Paraos animais jovens, o teste não se apresentou significativo para a variável posição entre nenhum dos segmentos comparados entre si. Concluiu-se, estatisticamente, uma maior ocorrência de lesões ateroscleróticas nos segmentos arteriais que antecedem a ponte de miocárdio em relação aos demais segmentos estudados.
Asunto(s)
Animales , Placa Aterosclerótica/fisiopatología , Puente Miocárdico/fisiopatología , Porcinos/fisiología , Vasos Coronarios/lesiones , Aterosclerosis/veterinaria , Experimentación Animal , Hematoxilina , Microscopía/instrumentación , Microscopía/veterinariaRESUMEN
Seek, therefore, to analyze in adults and young pigs, under light microscopy, the morphological characteristics of the coronary arterial branches under of the myocardial bridges, as well as the prepontine and postpontine segments, attempting to establish morphofunctional correlations between these. Was used for the study 40 pig hearts, all mongrel females, being 20 young and 20 adults, all with myocardial bridges, of which were removed prepontine, pontine and postpontine segments of the coronary arteries, together with the surrounding tissue. The segments were submitted with usual techniques of the light microscopy and stained with hematoxylin and eosin. Changes were observed in tunica intima, such as thickening, cells with clear cytoplasm, disruption and duplication of the limiting internal elastic lamina. The statistical test was significant for the position in adult pigs, confirming that there is a highter frequency of lesions in prepontine segment of the tunica intima of the coronary arteries when compared with the pontine and postpontine segments. The statistical test confirmed variation in the lesions frequency between sample studied, being highter in young animals when compared with adult animals. For the young animals, the test was not significant for the variable positions between of the segments compared with each other. There is statistically a highter occurrence of atherosclerotic lesions which precedes the myocardial bridge in relation to the others segments studied. (AU)
Buscou-se analisar em suínos jovens e adultos, sob microscopia de luz, as características morfológicas dos ramos arteriais coronarianos sob as pontes de miocárdio, bem como dos segmentos pré-pontino e pós-pontino, na tentativa de estabelecer correlações morfofuncionais entre eles. Foram utilizados 40 corações de suínos para a pesquisa, todos fêmeas sem raça definida, sendo 20 jovens e 20 adultos, todos portadores de pontes de miocárdio, dos quais foram retirados fragmentos pré-pontino, pontino e pós-pontino de ramos da artéria coronária direita e esquerda, junto com o tecido circunjacente. Os segmentos foram submetidos às técnicas habituais da microscopia de luz e corados pela hematoxilina-eosina. Observou-se alterações da íntima, tais como espessamentos, células com citoplasma claro, ruptura e/ou duplicação da lâmina limitante elástica interna. O teste estatístico se mostrou significativo para posição em suínos adultos, confirmando que existe uma maior frequência de lesões no segmento pré-pontino da túnica íntima das artérias coronárias quando comparado com o segmento pontino e com o pós-pontino. O mesmo teste confirmou uma variação na frequência de lesões entre as amostras estudadas, sendo maior em animais jovens quando defrontado com animais adultos. Paraos animais jovens, o teste não se apresentou significativo para a variável posição entre nenhum dos segmentos comparados entre si. Concluiu-se, estatisticamente, uma maior ocorrência de lesões ateroscleróticas nos segmentos arteriais que antecedem a ponte de miocárdio em relação aos demais segmentos estudados.(AU)
Asunto(s)
Animales , Porcinos/fisiología , Puente Miocárdico/fisiopatología , Placa Aterosclerótica/fisiopatología , Vasos Coronarios/lesiones , Microscopía/instrumentación , Microscopía/veterinaria , Hematoxilina , Aterosclerosis/veterinaria , /fisiopatología , Experimentación AnimalRESUMEN
La angiografía coronaria ha sido y continúa siendo el pilar sobre el cual se deciden las intervenciones terapéuticas en la enfermedad coronaria constituyendo el grado de estenosis de las placas ateromatosas uno de los principales marcadores de isquemia miocárdica y por lo tanto del pronóstico de la enfermedad. Sin embargo, es un hecho repetidamente documentado que los fenómenos coronarios agudos se producen con mayor frecuencia en placas con estenosis angiográficamente no significativas; por lo tanto, la vulnerabilidad de las placas no parece tener relación con su grado de estenosis y en consecuencia tampoco con la producción de isquemia miocárdica. Esta conclusión no concuerda con los hallazgos histopatológicos ni con los grados de severidad de las estenosis que comprometen el flujo coronario. El objetivo de la presente comunicación es tratar de aclarar esta controversia analizando la información entregada por la histopatología de las lesiones agudas culpables de los infartos. Precisar si las lesiones coronarias crónicas que producen isquemia (probables causantes de futuros infartos) se correlacionan con el grado de estenosis anatómica; proponer el posible mecanismo que vincula el grado de estenosis a la vulnerabilidad de las placas y esbozar una explicación para conciliar los hallazgos angiográficos con los his-topatológicos y funcionales.
Coronary angiography has long been and is still the basic method for deciding coronary interventions, and the severity of stenosis remains the main prognostic marker of the disease. However, plaque vulnerability does not appear to be associated with a greater degree of angiographic stenosis, which is not consistent with histopathological findings or with physiological assessment of ischemia-producing lesions. The purpose of this article is to briefly review this controversy while suggesting that plaques vulnerability correlate with the degree of anatomical and functional stenosis, and to describe the potential mechanism that could determine this vulnerability as well as to give likely explanations that reconcile angiographic findings with histopathological and functional observations.
Asunto(s)
Humanos , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Infarto del Miocardio/etiología , Índice de Severidad de la Enfermedad , Vasos Coronarios/lesiones , Estenosis Coronaria/complicaciones , Estenosis Coronaria/fisiopatología , Estenosis Coronaria/patología , Placa AteroscleróticaRESUMEN
Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9±7.3 years (means±SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4±362.2 vs 122.0±370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9±387.7 kcal/day while abstainers consumed 1836.0±305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9±10.9 vs 39.5±9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6±18.2 vs 118.4±29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.
Asunto(s)
Anciano , Humanos , Masculino , Persona de Mediana Edad , Abstinencia de Alcohol , Calcio/metabolismo , Vasos Coronarios/lesiones , Placa Aterosclerótica/patología , Vino , Consumo de Bebidas Alcohólicas , Brasil , Glucemia/análisis , Arteria Braquial , Grosor Intima-Media Carotídeo , Estudios Transversales , Arterias Carótidas , HDL-Colesterol/sangre , Colesterol/sangre , Vasos Coronarios/química , Vasos Coronarios , Dieta , Diabetes Mellitus/sangre , Estilo de Vida , Análisis Multivariante , Factores Socioeconómicos , gamma-Glutamiltransferasa/sangreRESUMEN
Our aim was to assess the timing and mechanisms of the sympathoexcitation that occurs immediately after coronary ligation. We recorded thoracic sympathetic (tSNA) and phrenic activities, heart rate (HR) and perfusion pressure in Wistar rats subjected to either ligation of the left anterior descending coronary artery (LAD) or Sham operated in the working heart-brainstem preparation. Thirty minutes after LAD ligation, tSNA had increased (basal: 2.5±0.2 µV, 30 min: 3.5±0.3 µV), being even higher at 60 min (5.2±0.5 µV, P<0.01); while no change was observed in Sham animals. HR increased significantly 45 min after LAD (P<0.01). Sixty minutes after LAD ligation, there was: (i) an augmented peripheral chemoreflex - greater sympathoexcitatory response (50, 45 and 27% of increase to 25, 50 and 75 µL injections of NaCN 0.03%, respectively, when compared to Sham, P<0.01); (ii) an elevated pressor response (32±1 versus 23±1 mmHg in Sham, P<0.01) and a reduced baroreflex sympathetic gain (1.3±0.1 versus Sham 2.0±0.1%.mmHg-1, P<0.01) to phenylephrine injection; (iii) an elevated cardiac sympathetic tone (ΔHR after atenolol: -108±8 versus -82±7 bpm in Sham, P<0.05). In contrast, no changes were observed in cardiac vagal tone and bradycardic response to both baroreflex and chemoreflex between LAD and Sham groups. The immediate sympathoexcitatory response in LAD rats was dependent on an excitatory spinal sympathetic cardiocardiac reflex, whereas at 3 h an angiotensin II type 1 receptor mechanism was essential since Losartan curbed the response by 34% relative to LAD rats administered saline (P<0.05). A spinal reflex appears key to the immediate sympathoexcitatory response after coronary ligation. Therefore, the sympathoexcitatory response seems to be maintained by an angiotensinergic mechanism and concomitant augmentation of sympathoexcitatory reflexes.
Asunto(s)
Vasos Coronarios/lesiones , Nervio Frénico/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Animales , Barorreflejo , Circulación Cerebrovascular/efectos de los fármacos , Vasos Coronarios/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Losartán/farmacología , Masculino , Ratas , Ratas Wistar , Receptor de Angiotensina Tipo 1RESUMEN
Observational studies suggest there are clinical benefits to moderate red wine (RW) consumption. However, the effects on coronary vasculature and overall lifestyle are unclear. We investigated whether a lifestyle of regular long-term RW consumption is associated with changes in coronary plaque burden, calcium score, carotid intima/media thickness, endothelial function, and metabolic variables, compared with alcohol abstinence. Healthy volunteers were evaluated by coronary computed tomography angiography (CTA) as well as carotid and brachial artery ultrasound. Nutritional status, psychological status, and metabolic variables were assessed. The study included 101 drinkers [aged 58.9 ± 7.3 years (means ± SD)], from wine brotherhoods, and 104 abstainers, from Anglican, Evangelical and Catholic churches both in the city of São Paulo, Brazil. No significant differences in demographics were noted. Lesion prevalence per patient assessed by coronary CTA and classified as absent (0), 1-25, 26-49, and ≥ 50% stenosis was similar between groups. When analyzed by individual arteries, i.e., left anterior descending, circumflex, and right coronary, prevalence was also not different. On the other hand, calcium scores were higher among drinkers than abstainers (144.4 ± 362.2 vs 122.0 ± 370.3; P<0.01). However, drinkers reported less history of diabetes and exercised more. RW drinkers consumed 2127.9 ± 387.7 kcal/day while abstainers consumed 1836.0 ± 305.0 (P<0.0001). HDL cholesterol was significantly higher among drinkers compared to abstainers (46.9 ± 10.9 vs 39.5 ± 9.0 mg/dL; P<0.001), while fasting plasma glucose was lower (97.6 ± 18.2 vs 118.4 ± 29.6 mg/dL; P<0.02). Liver enzymes were normal in both groups. In conclusion, long-term wine drinkers displayed a similar plaque burden but greater calcium score than abstainers, despite a more atherogenic diet, and the mechanisms for the increased calcium scores in the former remain speculative.
Asunto(s)
Abstinencia de Alcohol , Calcio/metabolismo , Vasos Coronarios/lesiones , Placa Aterosclerótica/patología , Vino/estadística & datos numéricos , Anciano , Consumo de Bebidas Alcohólicas , Glucemia/análisis , Arteria Braquial/diagnóstico por imagen , Brasil , Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Colesterol/sangre , HDL-Colesterol/sangre , Vasos Coronarios/química , Vasos Coronarios/diagnóstico por imagen , Estudios Transversales , Diabetes Mellitus/sangre , Dieta , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Análisis Multivariante , Radiografía , Factores Socioeconómicos , gamma-Glutamiltransferasa/sangreRESUMEN
Objetivo: Determinar si el resultado positivo de la ergometría o del ecoestrés con dobutamina son suficientes para la identificación de lesiones coronarias significativas en pacientes con angina estable sometidos a cinecoronariografía, atendidos en el Instituto Nacional Cardiovascular durante el periodo Enero 2013 - Enero 2014. Metodología: Estudio de tipo observacional, analítico-comparativo, retrospectivo de corte transversal. Se estudió a pacientes mayores de 18 años de edad con diagnóstico de angina estable evaluados con ergometría, ecoestrés con dobutamina y cinecoronariografía (Gold estándar) durante el periodo Enero 2013 - Enero 2014. La muestra estuvo conformada por 200 pacientes que cumplieron con los criterios de inclusión y ninguno de exclusión. Para el análisis descriptivo se empleó medidas de tendencia central y de dispersión, así como, frecuencias absolutas y relativas. Para el análisis bivariado se empleó la prueba del Chi-cuadrado, con nivel de confianza del 95 por ciento, además para evaluar el valor diagnóstico de ambas pruebas se utilizó los indicadores de Sensibilidad (S), Especificidad (E), Valor Predictivo Positivo (VPP) y Valor Predictivo Negativo (VPN). Resultados: Entre las características clínico-epidemiológicas de pacientes con angina estable se observó que el 80 por ciento de los pacientes eran de sexo masculino y sus características clínicas más frecuentes fueron: hipertensión arterial (74,5 por ciento), consumo de tabaco (55 por ciento), dislipidemia (49 por ciento) y en menor frecuencia se observó diabetes (20,5 por ciento) y obesidad (13 por ciento). En la prueba de ergometría el 79,5 por ciento de los pacientes tuvieron resultado positivo para la identificación de lesión coronaria significativa, además se encontró clase funcional I en el 45.7 por ciento de los pacientes y el 34,3 por ciento tuvieron angina limitante. En los resultados del ecoestrés con dobutamina en el 77 por ciento de los pacientes se identificaron lesión...
Objective: To determine if the positive results of ergometry or ecoestrés with dobutamina are sufficient for identification of significant coronary lesions in patients with stable angina undergoing coronary angiography treated at the National Cardiovascular Institute during the period January 2013- January 2014. Methodology: Observational, analytical-comparative, retrospective, transversal study. The study included patients older than 18 years old with diagnosis of stable angina tested with ergometry, eco-stress with dobutamina and coronary angiography (Gold Standard) during the period January 20 13-January20 14.The sample consisted of 200 patients who met the inclusion criteria and none of the exclusion. For the descriptive analysis, measures of central tendency and dispersion were used, as well as absolute and relative frequencies. For bivariate analysis, the chi-square test was used with confidence level of 95 per cent, in addition to evaluate the diagnostic value of both tests were used indicators of sensitivity (S), specificity (E), positive predictive value (PPV) and Negative Predictive Value (NPV). Results: Among the clinical and epidemiological characteristics of patients with stable angina was observed that 80 per cent of patients were male and the most common c1inical features were hypertension (74.5 per cent), snuff consumption (55 per cent), dyslipidemia (49 per cent) and less frequently diabetes (20.5 per cent) and obesity (13 per cent). In the ergometry test, 79.5 per cent of patients tested positive for the identification of significant coronary lesion, also was found functional class I in 45.7 per cent of patients and 34.3 per cent had limiting angina. In the results of eco-stress with dobutamine, 77 per cent of patients with significant coronary lesion, where was found an average of 3.9 segments altered and the most frequent coronary lesions were observed in the left anterior descending coronary artery (68.6 per cent), followed by the right...
Asunto(s)
Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Angina Estable , Angiografía Coronaria , Ecocardiografía de Estrés , Ergometría , Vasos Coronarios/lesiones , Estudios Observacionales como Asunto , Estudios Retrospectivos , Estudios TransversalesRESUMEN
INTRODUÇÃO: A área luminal mínima (ALM), obtida pelo ultrassom intracoronário (USIC), é preditora de eventos em pacientes com lesões de moderada gravidade, identificadas à angiografia coronária. Por outro lado, a presença de cálcio é preditora de estabilidade das lesões. O objetivo deste estudo é avaliar qual a influência da quantidade total de cálcio coronário, obtido pela tomografia computadorizada cardíaca (TCC), na gravidade de lesões moderadas, avaliadas por meio de USIC. MÉTODOS: Realizamos USIC de 27 lesões moderadas, em uma série consecutiva de 22 pacientes com indicação para o procedimento, e que tinham TCC prévia. Foram obtidas medidas da ALM, carga de placa e porcentual de área de estenose. RESULTADOS: Os pacientes eram, em sua maioria, do sexo masculino (85%), com idade de 60 ± 9 anos e 41% eram diabéticos. Observamos correlação significativa entre ALM e escore de cálcio total (r = 0,67; P = 0,002), mas não houve correlação entre escore de cálcio total e carga de placa (r = 0,02; P = 0,93) ou porcentual de área de estenose (r = 0,3; P = 0,32). Os preditores independentes da ALM na análise multivariada foram idade (P = 0,02), índice de massa corporal (P = 0,01), diabetes (P = 0,02), dislipidemia (P = 0,02), proteína C-reativa ultrassensível (P = 0,02), glicemia (P = 0,02), HDL-colesterol (P = 0,02), triglicerídeos (P = 0,02), fração de ejeção do ventrículo esquerdo < 50% (P = 0,02) e escore de cálcio total (P = 0,03). CONCLUSÕES: O escore de cálcio total apresenta correlação positiva com a ALM em artérias coronárias, sugerindo que maior quantidade de cálcio na árvore coronária implica lesões ateroscleróticas moderadas com maiores áreas luminais ao USIC.
BACKGROUND: The minimal luminal area (MLA) measured by intravascular ultrasound (IVUS) is a predictor of cardiovascular events in patients with angiographically moderate lesions. On the other hand, the presence of calcium is a predictor of lesion stability. The objective of this study is to evaluate the influence of the total amount of coronary calcium, obtained by multislice CT scanner (MDCT), on the severity of moderate lesions as assessed by IVUS. METHODS: IVUS was performed in 27 moderate lesions in a consecutive series of 22 patients with indication for the procedure who had a previous MDCT. Measurements of the minimal luminal area (MLA), plaque burden and percentage area stenosis were obtained. RESULTS: Most patients were male (85%), with mean age of 60 ± 9 years and 41% were diabetic. A significant correlation was observed between the MLA and total calcium score (r = 0.67; P = 0.002), but there was no correlation between the total calcium score and plaque burden (r = 0.02; P = 0.93) or percentage area stenosis (r = 0.3; P = 0.32). Independent predictors of MLA in the multivariate analysis were age (P = 0.02), body mass index (P = 0.01), diabetes (P = 0.02), dyslipidemia (P = 0.02), high-sensitive Creactive protein (P = 0.02), glucose (P = 0.02), HDL-cholesterol (P = 0.02), triglycerides (P = 0.02), left ventricular ejection fraction < 50% (P = 0.02) and total calcium score (P = 0.03). CONCLUSIONS: The total calcium score correlates positively with MLA in coronary arteries, suggesting that a large calcium burden in the coronary tree is related to angiographically moderate lesions with larger luminal areas at IVUS.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Calcinosis/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Ultrasonido/métodos , Vasos Coronarios/lesiones , Calcio/análisis , Factores de RiesgoRESUMEN
Relatamos o caso de um paciente de 61 anos de idade, hospitalizado por angina instável. Cineangiocoronariografia demonstrou lesão obstrutiva grave no terço médio da artéria descendente anterior. Intervenção coronária percutânea foi realizada com implante de stent. Logo depois da pós-dilatação com cateter-balão, observou-se ruptura coronária, com extravasamento de contraste para o ventrículo esquerdo (perfuração coronária tipo IV). Após reversão parcial da heparina com protamina e insuflação prolongada do cateter-balão com baixa pressão, a ruptura coronária foi controlada, com bom resultado angiográfico final. Ecocardiografia realizada em seguida evidenciou derrame pericárdico mínimo. A evolução clínica foi satisfatória após o procedimento.
We report the case of a 61-year-od male, hospitalized for unstable angina. Coronary angiography showed a severe lesion in the middle third of the left anterior descending coronary artery. Percutaneous coronary intervention was performed with stent implantation. Coronary rupture was observed with contrast spilling to the left ventricle (type IV coronary perforation) immediately after balloon post-dilatation. After partial heparin reversal with protamine and prolonged balloon inflation at low pressure, coronary rupture was controlled, with a good final angiographic result. Subsequent echocardiography showed minimal pericardial effusion. Post-procedure clinical follow-up was satisfactory.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/métodos , Vasos Coronarios/lesiones , Angioplastia , Rotura , StentsRESUMEN
Introdução: A intervenção coronária percutânea (ICP) em lesões ostiais é um dos maiores desafios para a cardiologiaintervencionista contemporânea. A despeito dos avanços tecnológicos,as lesões ostiais ainda apresentam maiores taxas de eventos adversos imediatos e tardios quando comparadas às lesões não-ostiais. O objetivo deste estudo foi avaliar a ICP em lesões ostiais, utilizando a técnica de Szabo. Métodos: Série de 10 pacientes, incluídos entre outubro e novembro de2011, tratados por meio de ICP utilizando a técnica de Szabo em lesões ostiais em ramos coronários principais. Não foram abordadas lesões aorto-ostiais. Resultados: Dos 10 pacientestratados, 7 eram do sexo masculino, com idade variando entre 42 anos e 75 anos, e 60% apresentavam síndrome coronária aguda sem supradesnivelamento do segmento ST. Artéria circunflexa foi tratada em 6 pacientes e cateter 7 F foi utilizadoem 8 pacientes. Em 3 pacientes não se observou progressão do stent em decorrência de torção das cordas-guia, que foi resolvida com o recuo parcial da corda-guia direcionada para a lesão-alvo e novo posicionamento. Houve sucesso do procedimento em 90% dos casos. Não ocorreram óbitos, (re)infartos ou revascularizações de urgência hospitalares. Conclusões: Neste estudo, a técnica de Szabo permitiu tratar lesões ostiais em ramos principais das artérias coronáriascom sucesso, posicionando o stent de maneira adequada na maioria dos casos.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Angioplastia/métodos , Angioplastia , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Stents , Vasos Coronarios/lesiones , Factores de Riesgo , MétodosRESUMEN
A perfuração da artéria coronária é complicação rara, porém muito temida nas intervenções percutâneas cardíacas. O advento das novas técnicas de angioplastia, como as ateroablativas, o aumento dos procedimentos em artérias antes consideradas desfavoráveis para intervenção e o aumento do arsenal antiplaquetário favorecem o aumento dessa complicação. Sua pronta identificação e o tratamento imediato trazem melhoras na sobrevida do paciente. Relata-se o caso de paciente com infarto agudo do miocárdio anterior com oclusão de grande ramo septal anômalo que apresentou perfuração da coronária durante angioplastia, com um tipo de perfuração denominada cavity spilling, com formação de shunt esquerdo-direito, tratado com sucesso.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Angioplastia/métodos , Angioplastia , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco , Taponamiento Cardíaco/complicaciones , Vasos Coronarios/lesiones , Electrocardiografía/métodos , Electrocardiografía , Factores de RiesgoRESUMEN
OBJECTIVE: The aim of this registry was to evaluate a new device designed to facilitate antegrade guidewire re-entry into the true lumen of a chronic total coronary occlusion (CTO) from the adjacent subintimal space. BACKGROUND: Successful recanalization of CTOs results in clinical improvement in appropriately selected patients. CTO intervention is time- and resource-consuming, and a simplified approach enabling antegrade guidewire re-entry into the distal true lumen might improve success. METHODS: Patients with CTO and ischemia were entered into a prospective registry regardless of lesion characteristics. If wire manipulation resulted in subintimal wire entrapment, a new re-entry tool (a 2.5-mm flat subintimal balloon with two exit ports offset by 180°) was used as a platform to attempt guidewire penetration into the distal true lumen. The primary endpoint assessed was successful device-guided re-entry. Standard techniques were then utilized to open the CTO. RESULTS: In 40 consecutive CTO lesions attempted, 19 resulted in subintimal wire entrapment (mean occlusion length 44 mm). Sixteen of these 19 were successfully crossed with an antegrade guidewire into the distal true lumen using the new device (84%). One patient with unsuccessful re-entry was subsequently recanalized with a retrograde technique. All crossed lesions were stented (17/17), resulting in TIMI 3 flow without major complications. Two cases were unsuccessful. One patient had a grade I coronary perforation requiring no treatment. CONCLUSIONS: A new device to recanalize CTOs complicated by subintimal wire entrapment can be used successfully by experienced operators. Further study of this coronary re-entry device is ongoing.
Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Catéteres Cardíacos , Oclusión Coronaria/terapia , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Chile , Enfermedad Crónica , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Vasos Coronarios/lesiones , Diseño de Equipo , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Resultado del Tratamiento , Lesiones del Sistema Vascular/etiologíaRESUMEN
Coronary pseudo-aneurysm is an extremely rare entity. Its natural history is scarcely known and its treatment is controversial. We report a case of pseudo-aneurysm of the left main coronary artery associated with an antero-apical infarct of the left ventricle diagnosed five years after a cardiac arrest following a non-penetrating thoracic trauma. The patient was treated conservatively because percutaneous or surgical correction were not considered suitable for this lesion. A multidetector computed tomography coronary angiogram performed 10 years after the initial event showed no evidence of progression.