RESUMO
We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded.
Assuntos
Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Oclusão de Enxerto Vascular/complicações , Cardiopatias/etiologia , Veia Safena/transplante , Fístula Vascular/etiologia , Angiografia Coronária , Fístula/diagnóstico , Fístula/etiologia , Oclusão de Enxerto Vascular/diagnóstico , Átrios do Coração , Cardiopatias/diagnóstico , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Fístula Vascular/diagnósticoRESUMO
About half of the patients with acute myocardial infarction who undergo successful fibrinolytic treatment or primary percutaneous coronary artery rechanneling continue to have abnormal microcirculatory blood flow. Various medications have been designed to protect the myocardial cell and have been investigated in human beings as coadjuvants to rechanneling procedures. Overall, they can be divided into: a) medications that act on the inflammatory response triggered by ischemia/reperfusion, such as anti-CD11/CD18 antibodies and anti-complement, and b) medications that enhance metabolic tolerance, such as glucose-insulin-potassium solution and inhibitors of the Na+/H+ ion exchange system. Despite the importance of the problem, the results so far obtained have been inconclusive and it was concluded that new studies are needed. Some of these studies have already been undertaken in attempt to find a satisfactory response to the question.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Humanos , Infarto do Miocárdio/fisiopatologia , Miocárdio/citologiaRESUMO
Los stent coronarios fueron grandes optimizadores de la angioplastia coronaria con balón. Los estudios stress, benestent 1 y 2 evidenciaron reducciones importantes en las tasas de reestenosis coronaria. El proceso de reestenosis fue afectado por los stents en el sentido de reducir el retroceso elástico precoz y el remodelamiento negativo, pero el proceso de hiperplasia neoíntimal sólo no fue modificado sino que exagerado. En el sentido de minimizar la hiperplasia debemos establecer formas de reducir la injuria durante el implante del stent, reducir el proceso inflamatorio, inhibir la migración y proliferación celular y favorecer el proceso de endotelización del stent. Varias opciones farmacológicas han sido discutidas y presentaremos los resultados con dichas drogas tales como: actinomocina, tacrolimus, taxol y sirolimus