Assuntos
Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica , Fibrinolíticos/química , Fibrinolíticos/farmacocinética , Fibrinolíticos/farmacologia , Fibrinolíticos/uso terapêutico , Ventrículos do Coração/fisiopatologia , Heparina/química , Heparina/farmacocinética , Heparina/farmacologia , Heparina/uso terapêutico , Humanos , Infarto do Miocárdio/etiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Estreptoquinase/química , Estreptoquinase/farmacocinética , Estreptoquinase/farmacologia , Estreptoquinase/uso terapêuticoRESUMO
From October 1991 to October 1993, a total of 205 patients with rheumatic mitral stenosis (178 female, 27 male, mean age 38 years, range 17-72) underwent percutaneous transvenous mitral commissurotomy (PTMC), 138 with the Inoue balloon and 67 with double balloon-catheter techniques. Mitral regurgitation (MR) was detected in 10% of the cases prior to the procedure, and 37% after PTMC (p < 0.05), grade I in 45 patients (22%), grade II in 24 (12%), grade III in 4 (2%), and grade IV in 3 (1.5%) cases (p = 0.003, 0.002, N.S. and N.S., respectively. In 40% of the total group (83/205) there was no new or worsening MR; in 26.8% of the cases (55/205) new MR appeared (p = 0.004); in 23% (47/205) MR increased one grade (p = 0.002) and in 9.7% (20/205) two or more grades. The comparative incidence of MR was 40.5% (56/138) with the Inoue balloon, and 16.4% (11/67) with the double balloon technique (p = 0.03); the severity of MR was grade I in 27% vs 9% (p = 0.001), grade II in 9.4% vs 6% (p = 0.05), grade III in 2.1% vs 1.5% (N.S.), and grade IV in 2.1% vs 0% (N.S.). Only the presence of commissural calcification and echo-score > 8 points were found as independent predictors of severe MR. In conclusion, mild and moderate MR occur frequently after PTMC, with significantly greater incidence using the Inoue technique. Severe MR following PTMC is much less frequent, and the comparative incidence is somewhat greater with the Inoue balloon, though the difference is not significant.
Assuntos
Cateterismo , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/terapia , Valva Mitral , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/terapia , Adolescente , Adulto , Idoso , Cateterismo Cardíaco , Cateterismo/efeitos adversos , Cateterismo/métodos , Cateterismo/estatística & dados numéricos , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Análise Multivariada , Prognóstico , Cardiopatia Reumática/complicações , Cardiopatia Reumática/diagnósticoRESUMO
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.
Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/terapia , Adulto , Idoso , Angina Pectoris/complicações , Angina Pectoris/epidemiologia , Angina Pectoris/terapia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/estatística & dados numéricos , Doença das Coronárias/complicações , Doença das Coronárias/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Recidiva , Estudos Retrospectivos , Fatores de RiscoRESUMO
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.
Assuntos
Cateterismo Cardíaco/instrumentação , Valva Mitral/cirurgia , Adolescente , Adulto , Cateterismo Cardíaco/métodos , Feminino , Seguimentos , Hemodinâmica , Humanos , Masculino , México , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Indução de Remissão , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/cirurgiaRESUMO
Rupture of the myocardium is often a catastrophic complication of myocardial infarction with a poor prognosis in the short term. The occurrence of more than one myocardial rupture is a rare condition, and has been published in most cases as a necropsy finding. The purpose of this communication is to report one case of double rupture of the myocardium, diagnosed in life; and the clinical and surgical implication of such cases.
Assuntos
Ruptura Cardíaca Pós-Infarto/diagnóstico , Idoso , Vasos Coronários/patologia , Emergências , Feminino , Ruptura Cardíaca Pós-Infarto/patologia , Septos Cardíacos , Humanos , Miocárdio/patologiaRESUMO
We tried to establish the incidence of silent myocardial ischemia (SMI) in the general population and also in patients with recognised ischemic heart disease. For this, purpose 2, 375 stress tests (ST) with Bruce protocol were reviewed, 364 were positive and those patients were divided in two groups: group I with SMI during the ST and group II with myocardial ischemia and angina during the ST. Coronary risk factors ergometric behaviour and angiographic factors were analysed. Group I had 263 patients with SMI (71%). Group II had 111 patients with ischemia and angina (29%) P less than 0.05; 90 patients had diabetes mellitus in group I and 19 in group II P less than 0.05. A previous myocardial infarction was registered in 157 patients from group I and 55 from group II P less than 0.05. The remaining coronary risks factors, ergometrics variables and significance and number of diseased coronary vessels were similar in both groups. We conclude that SMI is a frequent event in patients with ischemic heart disease. It represents probably the most frequent event in this disease. Previous myocardial infarction and diabetes mellitus may play an important role in the pathogenesis of SMI. The ST and Holter monitoring are dependable procedures for the identification of SMI and should be always performed specially in patients with high coronary risk factors. Once detecting SMI a therapeutic plan should be considered for medical, angioplastic or surgical procedures even in asymptomatic patients.
Assuntos
Doença das Coronárias/diagnóstico , Angina Pectoris/etiologia , Estudos de Coortes , Doença das Coronárias/complicações , Doença das Coronárias/epidemiologia , Doença das Coronárias/terapia , Complicações do Diabetes , Eletrocardiografia Ambulatorial , Teste de Esforço , Humanos , México/epidemiologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnósticoRESUMO
The classic electrocardiographic abnormalities observed in massive or submassive thromboembolism in the absence of preexistent cardiac or pulmonary disease are: S1Q3T3 pattern, right axis deviation, "pulmonary" P wave, ST segment depression or elevation, subepicardic ischemia and transient right bundle branch block. Left axis deviation due to pulmonary embolism was first described in 1949; this same finding and the presence of low voltage of the frontal plane owed to pulmonary embolism has been reported occasionally in the last decades, but it has had little diffusion. We report on a patient with no prior cardiac or pulmonary disease who suffered massive pulmonary thromboembolism. Electrocardiographically left axis deviation and low voltage of the horizontal plane attributed to pulmonary thromboembolism was observed. The mechanisms that originate this electrocardiographic changes in pulmonary embolism are unknown. Since the electrocardiogram is aspecific method for the diagnosis of this disorder, and the presence of the mentioned changes originate a greater difficulty in the diagnosis; we consider is important to publish it.